{"data":{"id":"us-nc/n.c.-gen.-stat.-108a-54.3a","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 108A-54.3A","heading":"(Effective until October 1, 2026) Eligibility categories and income thresholds.","body":"(a)\tThe Department shall provide Medicaid coverage for individuals in accordance with federal statutes and regulations and specifically shall provide coverage for the following populations:\n(1)\tFamilies, children under the age of 21, pregnant women, and individuals who are aged, blind, or disabled, who are medically needy, subject to the following annual income levels after meeting the applicable deductible:\nFamily Size\tIncome Level\n1\t$2,904\n2\t3,804\n3\t4,404\n4\t4,800\n5\t5,196\n6\t5,604\n7\t6,000\n8\t6,300\n9\t6,504\n10\t6,900\n11\t7,200\n12\t7,596\n13\t8,004\n14\t8,400\neach additional family member\tadd $396\n(2)\tFamilies and children under the age of 21, subject to the following annual income levels:\nFamily Size\tIncome Level\n1\t$5,208\n2\t6,828\n3\t8,004\n4\t8,928\n5\t9,888\n6\t10,812\n7\t11,700\n8\t12,432\n9\t13,152\n10\t14,028\neach additional family member\tadd $936\n(2a)\tRepealed by Session Laws 2024-1, s. 3.3(c), effective July 1, 2022.\n(3)\tChildren through the age of 18 with family incomes equal to or less than two hundred eleven percent (211%) of the federal poverty guidelines.\n(4)\tRepealed by Session Laws 2023-11, s. 3.2(c), effective April 1, 2023.\n(5)\tChildren under the age of 21 who are receiving foster care or adoption assistance under Title IV-E of the Social Security Act, without regard to income.\n(6)\tChildren in the legal custody of State-sponsored foster care who are under the age of 21 and ineligible for Title IV-E assistance, without regard to income.\n(7)\tIndependent foster care adolescents ages 18, 19, and 20, as defined in 42 U.S.C. § 1396d(w)(1), without regard to income.\n(8)\tFormer foster care children under the age of 26 in accordance with 42 U.S.C. § 1396a(a)(10)(A)(i)(IX), without regard to income.\n(9)\tAdoptive children with special or rehabilitative needs, regardless of the adoptive family's income.\n(10)\tPregnant women with incomes equal to or less than one hundred ninety-six percent (196%) of the federal poverty guidelines. Pregnant women shall remain eligible for coverage for 12 months postpartum.\n(11)\tMen and women of childbearing age with family incomes equal to or less than one hundred ninety-five percent (195%) of the federal poverty guidelines. Coverage for the individuals described in this subdivision shall be limited to coverage for family planning services.\n(12)\tWomen who need treatment for breast or cervical cancer and who are defined in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XVIII).\n(13)\tAged, blind, or disabled individuals, as defined in Subpart F of Part 435 of Subchapter C of Chapter IV of Title 42 of the Code of Federal Regulations, with incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines.\n(14)\tBeneficiaries receiving supplemental security income under Title XVI of the Social Security Act.\n(15)\tWorkers with disabilities, as provided in G.S. 108A-66.1.\n(16)\tQualified working disabled individuals, as provided in G.S. 108A-67.\n(17)\tQualified Medicare beneficiaries with incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines. Coverage for the individuals described in this subdivision shall be limited to payment of Medicare premiums and deductibles and coinsurance for Medicare-covered services.\n(18)\tSpecified low-income Medicare beneficiaries with incomes equal to or less than one hundred twenty percent (120%) of the federal poverty guidelines. Coverage for the individuals described in this subdivision shall be limited to payment of Medicare Part B premiums.\n(19)\tQualifying individuals who are Medicare beneficiaries and who have incomes equal to or less than one hundred thirty-five percent (135%) of the federal poverty guidelines may be covered within funds available for the Limited Medicare-Aid Capped Enrollment program. Coverage for the individuals described in this subdivision shall be limited to payment of Medicare Part B premiums.\n(20)\tRecipients of an optional State supplementation program provided in accordance with 42 U.S.C. § 1382e.\n(21)\tIndividuals who meet eligibility criteria under a Medicaid waiver approved by the Centers for Medicare and Medicaid Services and authorized by an act of the General Assembly, within funds available for the waiver.\n(22)\tRefugees, in accordance with 8 U.S.C. § 1522.\n(23)\tQualified aliens subject to the five-year bar for means tested public assistance under 8 U.S.C. § 1613 and undocumented aliens, only for emergency services under 8 U.S.C. § 1611.\n(24)\tIndividuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act who are in compliance with, or are exempt from, any applicable community engagement requirements. Coverage for individuals under this subdivision is available through an Alternative Benefit Plan that is established by the Department consistent with federal requirements, unless that individual is exempt from mandatory enrollment in an Alternative Benefit Plan under 42 C.F.R. § 440.315.\n(b)\tThe applicable federal poverty guidelines for the eligibility categories in subsection (a) of this section shall be updated annually on April 1 immediately following publication of the federal poverty guidelines. (2020-78, s. 4D.1; 2021-62, s. 4.3; 2021-180, ss. 9D.13(a), 9D.14(b); 2022-74, ss. 9D.14(e), 9D.15(c); 2023-7, s. 1.1(b); 2023-11, s. 3.2(a), (c); 2023-134, s. 9E.23(c1), (e1); 2024-1, s. 3.3(c); 2025-64, s. 5.1(a); 2026-1, s. 3C.4(a).)","path":["Chapter 108A. Social Services.","Article 2. Programs of Public Assistance.","Part 6. Medical Assistance Program."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-54.3A.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:16:22Z","sha256":"f5b3b20dc2e25aa71dfa0cf5d2f32ca4f7a1b12727463e7ba48e1bffd7c0c477","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-108a-54.3","next":"us-nc/n.c.-gen.-stat.-108a-54.3a--2"},"notice":"GroundRules: Original legal text. Not legal advice."}