North Carolina’s guidance gives Medicaid expansion enrollees two ways to meet the coming monthly requirement: earn $580 per household or complete 80 hours of work, school or volunteering. The rules are due to take effect by January 1, 2027. At a Raleigh roundtable Thursday, the Keep Your Care campaign brought recipients, caregivers and lawmakers together to discuss how people can maintain coverage under the changes, NC Newsline reported.
What North Carolina’s guidance says
The work and community-engagement rule applies to adults ages 19 through 64 covered through Medicaid expansion, according to NCDHHS. The agency lists the $580 monthly household income option or 80 hours of work, school or volunteering. NC Medicaid says people subject to the requirement need to meet it for only three of the six months before each recertification.
Exemptions are available, but NC Medicaid advises people who believe they qualify to give supporting documents to their local Department of Social Services so it can confirm whether the rule applies. The agency lists online recertification through an enhanced ePASS account and mailing forms to a local DSS as ways to return renewal paperwork. These are state instructions; they do not establish how many people will ultimately lose coverage.
Potential losses remain projections
Gov. Josh Stein’s office has estimated that more than 250,000 North Carolinians could lose coverage under the changes. A separate estimate reported by the Greensboro News & Record put potential losses at 255,000 enrollees, nearly 38%. These are projections, not counts of people who have already lost coverage; the available figures do not settle how implementation will affect enrollment.
A previous renewal episode offers context, but not a forecast. KFF’s archived data show North Carolina’s disenrollment rate during the separate post-pandemic Medicaid unwinding was 12% as of September 12, 2024. That episode involved the resumption of regular eligibility renewals, not the coming work and reporting rules, so its state-level rate cannot predict future losses.
An earlier rollout is a caution, not a forecast
In Arkansas in 2018, officials sent 900,000 letters and emails explaining a similar requirement. Enrollment later fell by about 80%; recipients were not required to document compliance, but had to indicate that they met the rule, Tradeoffs reported. The experience underscores that outreach by itself does not guarantee people remain enrolled, but it is a different state and period and does not show what will happen in North Carolina.
Keep Your Care says it is preparing outreach through digital advertising and local partnerships to explain requirements, exemptions and deadlines. The campaign’s North Carolina event puts that effort against a concrete implementation task: helping enrollees understand what applies to them and complete the state’s required reporting and renewal steps before the 2027 deadline.
