Written by a parent, not a doctor. Nothing here is medical advice.

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North Carolina program

Medicaid for a child

North Carolina’s free Medicaid coverage for children under 19. It can sit behind work insurance.

What it is

North Carolina’s free Medicaid coverage for children under 19. It can sit behind work insurance.

NC Medicaid covers children under 19 across one income range. A work plan does not prevent eligibility. The county decides who counts in your child’s household and which income counts.

Eligibility rules
  • Your child must be under 19 and live in North Carolina. There is no savings test for these child groups.
  • The county uses current monthly income and tax-household rules. A yearly figure divided by 12 is only an estimate.
  • From April 1, 2026, published monthly base amounts are $3,806 for two, $4,804 for three, $5,803 for four, $6,802 for five and $7,800 for six. These are before the separate income allowance.
  • If your income is just over the line, the county adds an allowance before deciding (about $114 a month for three people, more for a bigger family), so a family slightly over can still qualify.
  • A parent need not give their own immigration status when applying only for their child. The child’s eligibility has separate immigration rules.
What you get
  • No enrollment fee or child copays for covered care.
  • Hospital stays, chemotherapy, prescriptions, dental and vision care.
  • Rides and approved nursing at home.
  • Earlier eligible bills can be covered.
What the help covers
  • Medicaid pays after other insurance. Nursing and other services still require the child’s medical need and any required approval.
  • When your child has Medicaid and work insurance, the work plan pays first. For covered, properly approved care, a provider accepting Medicaid generally cannot bill you for the work plan’s deductible, copay or coinsurance, even when Medicaid pays nothing. This does not erase a Medicaid spend-down amount or charges you knowingly agreed to pay privately under the state’s rules; the billing office should check the exact service and date.
If you decide to apply
  1. Ask the hospital financial counselor to help with ePASS or a county social-services application.
  2. Have this month's income, any insurance cards and earlier bills ready.
  3. Ask which Medicaid plans your child’s oncology team accepts.

The county Department of Social Services decides; NC Medicaid and the health plan you pick run the coverage: 888-245-0179 · Official page ↗

If you decide to apply
  • The usual decision standard is 45 days; a disability application can take 90 days.
  • A qualified hospital can assess temporary Medicaid eligibility. Without a full application filed on time, that coverage ends at the end of the next month; a timely full application keeps it in place until the county decides. The social worker can check the hospital’s process and the dates.
  • For applications through December 31, 2026, coverage can reach three months back for eligible months. From January 1, 2027, the child window is two months.
Good to know

For covered, properly approved care, a clinic accepting Medicaid generally cannot collect your work-plan deductible or copay. That protection can apply even when Medicaid pays nothing extra.

Other details
  • Once approved, a child under 6 keeps coverage until the month of their sixth birthday, and an older child keeps it for 24 months, even if your income rises. The county's notice gives the end date.
  • Keeping work insurance means keeping its premium and managing two plans. The oncology billing office can check the exact hospital, doctors and pharmacy under both.
  • North Carolina has one children's program with no premium tier. A child you were told is on CHIP is on this Medicaid program already; there is nothing further to apply for.

Federal background: Medicaid · CHIP · Medicaid as second insurance.

Official sources
Ask your social worker

“Could Medicaid reduce our child’s treatment bills, and what would managing it alongside work insurance involve? Would you recommend applying, and could you help us?”

Why I’m asking: I want our child’s treatment covered and need to understand what another insurance plan would change.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on ePASS today with this month’s income and any insurance cards. Name the months with old bills and choose a plan the oncology group takes.

Your social worker

The oncology social worker or financial counsellor helps you file, asks whether the hospital can open temporary Medicaid that day, and follows the 45-day decision.

The care team

Nothing for ordinary child Medicaid. Medical records matter for the Community Alternatives Program for Children.

Who decides
The county Department of Social Services checks income. NC Medicaid and the health plan you choose run the coverage.
Ask your social worker
“Can you help me file on ePASS today, ask whether this hospital can open temporary Medicaid now, and list bills from the three months before we applied?”

How to apply

First step: Apply at epass.nc.gov or call 888-245-0179 this week, and ask the hospital counsellor today about temporary Medicaid.

  1. Apply on ePASS this week and ask the hospital counsellor about same-day temporary Medicaid.
  2. List every month with bills so the look-back covers the admission.
  3. Pick a health plan the hospital and the oncology group take before you choose.

Official application / program page ↗

Where it starts: Apply on ePASS at epass.nc.gov, or at the county Department of Social Services. Ask the hospital’s financial counsellor whether it can open temporary Medicaid the same day.

What to gather

  • The child’s birth certificate or identity document and Social Security number
  • A North Carolina address
  • This month’s income for each parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: Up to 45 days from an ePASS application, or up to 90 on a disability application. Coverage reaches back up to three months for an application made by December 31, 2026.

What a yes looks like

A notice with coverage dates and a health plan to choose. Check the hospital and the oncology group are in that plan first. A child aged 0 to 4 is then certified through the sixth-birthday month; an older child for 24 months.

What a no looks like, and the next move

Read whether the county said no on income, on a document, or on the category. If income is the reason, ask for a Medicaid deductible by name and appeal by the date on the notice.

Watch out

  • There is no CHIP in North Carolina. Health Choice merged into Medicaid in 2023, so this one application covers the whole income range.
  • Your child can keep private insurance and have Medicaid too. Do not cancel the work plan to apply.
  • If the county says income is too high, ask in the same application for a Medicaid deductible, and ask about the Community Alternatives Program for Children.

Dates that change this

2026-04-01: The income limits are the state’s April 1, 2026 table. The date the 2027 table takes effect was not published.

2027-01-01: Coverage reaches back up to three months for an application made by December 31, 2026; two months for a child from January 1, 2027.

2018-07-01: A hospital can open temporary Medicaid for a child under 19 under a 2018 policy the state still links. No newer policy and no list of participating hospitals were found, so ask the hospital rather than assuming. (not yet confirmed against the final rule)

2026-10-01: The state’s October 2026 guidance keeps a category for a lawfully residing child under 19. A parent does not have to give their own immigration status to apply for a child. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full Medicaid with no fee and no child copays. The line is $5,803 a month for a family of four, and the same at every age under 19.

  • $5,803/month — Family of 4, published upper line for a child at any age under 19
  • $4,804/month — Family of 3, published upper line
  • $3,806/month — Family of 2, published upper line
  • $6,802/month — Family of 5, published upper line
  • $7,800/month — Family of 6, published upper line
  • $2,943/month — Family of 4, the lower base row for a child aged 6 to 18 (which category the notice names)
  • $137.5/month — Family of 4, the separate allowance set aside before the county compares

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21 · Private duty nursing and personal care at home when approved · Rides to appointments, and meals and lodging around an inpatient stay · Dental and vision

Legal protection: No enrollment fee and no copays for a child who moved across from Health Choice · No asset test on the child groups

What it costs the family: No enrollment fee. No copays for a child.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MAGI budget group. Base rows 194% (under 1), 141% (ages 1 to 5) and 107% (ages 6 to 18); the MIC-1 upper endpoint is 211% at every age, and a separate 5% disregard cell is set aside against the highest comprehensive category (MA-3306).
Insurance status condition
none: Medicaid coexists with a work plan and pays second (MA-3510)
Residency
North Carolina
Assets
no reserve limit on the MAGI child groups
Continuous eligibility
ages 0 to 4 through the sixth-birthday month; older children 24 months, ending at 19
Retroactive months
3 for an application by 2026-12-31; 2 from 2027-01-01
Processing standard
up to 45 days; up to 90 days on a disability application

Decisions this site cannot make: County Department of Social Services MAGI determination through ePASS · Hospital presumptive eligibility for a child under 19 (policy is stale but still linked)

Expect friction on: Choosing a health plan the oncology group takes · A Tailored Plan is assigned by the county that administers the case

The trap: Do not go looking for CHIP. North Carolina Health Choice stopped being a separate programme on April 1, 2023 and those children moved to Medicaid, so one application covers the whole range and the old Health Choice rules about waiting periods and uninsured children no longer apply. North Carolina counts the tax household and this month’s income, not last year’s return. Do not cancel a work plan to apply.

Where I read this

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