No. Having a disability does not automatically qualify you for Medicaid in NC, with one exception: if you already receive Supplemental Security Income (SSI), North Carolina enrolls you in Medicaid automatically with no separate application. For everyone else, disability is only half the picture. You still have to meet income and resource limits under one of several Medicaid pathways, and which pathway fits depends on your age, your earnings, and your assets.
The One Automatic Path: SSI Recipients
North Carolina is one of the states where the Social Security Administration notifies the state Medicaid office directly when someone is approved for SSI. Once your SSI disability payments start, Medicaid coverage follows automatically.1Social Security Administration. State Medicaid Eligibility and Enrollment Policies and Rates of Medicaid Participation You do not need to file anything with the state.
If you later start working and your earnings eventually push your SSI cash payments to zero, you can often keep Medicaid under a federal rule known as Section 1619(b). In North Carolina, the 2026 gross earnings threshold for continued Medicaid under 1619(b) is $51,178 per year.2Social Security Administration. Continued Medicaid Eligibility Section 1619B If you earn above that, SSA may still calculate a personalized limit for you when you have impairment-related work expenses or other qualifying costs.
Disabled, But Not on SSI: The ABD Pathway
If you have a disability but do not receive SSI, you apply through the Aged, Blind, and Disabled (ABD) Medicaid category. Your disability has to be confirmed either by the Social Security Administration or by North Carolina’s Disability Determination Services, which develops the medical evidence and issues a finding on whether you meet the federal disability definition.3Social Security Administration. Disability Determination Process
Meeting that definition is not enough on its own. As of April 2026, you also have to fall within these limits:
- Monthly income: $1,330 for an individual, $1,804 for a couple
- Countable resources: $2,000 for an individual, $3,000 for a couple
The income figures track 100% of the 2026 federal poverty level.4North Carolina Department of Health and Human Services. MAABD Eligibility Overview Chart Effective 04-01-2026 Your primary home and one vehicle are generally exempt from the resource count. Bank accounts, investment accounts, and other financial assets count toward the limit.
If You Are Under 65: Try Medicaid Expansion First
North Carolina expanded Medicaid on December 1, 2023, opening coverage to adults aged 19 through 64 who were previously shut out.5NC Medicaid. Questions and Answers about Medicaid Expansion Under expansion, disability is not part of the calculation at all. Eligibility is based purely on income: roughly $1,800 per month for a single adult, or $3,065 per month for a family of three.6NC Medicaid. NC Medicaid Eligibility
For many people with disabilities, this is the simpler route. The expansion income limit is higher than the ABD limit, so a disabled adult earning $1,500 a month would fail the ABD test at $1,330 but qualify under expansion. Expansion Medicaid also has no resource test, so savings and other assets do not disqualify you. If you are under 65 and your income fits, you may not need to go through the disability determination process at all.
If You Work and Earn More: Health Coverage for Workers with Disabilities
North Carolina runs a Medicaid buy-in program, created under N.C. Gen. Stat. ยง108A-66.1, that lets people with disabilities work and earn more without losing coverage.7North Carolina General Assembly. North Carolina General Statutes 108A-66.1 – Medicaid Buy-In for Workers With Disabilities The Health Coverage for Workers with Disabilities program uses higher income and resource limits than standard ABD Medicaid.
To qualify, you must meet all of these requirements:8NC Medicaid. Medicaid for Workers with Disabilities
- Be between 16 and 64 years old
- Meet the Social Security Administration’s disability definition, excluding the earnings test (so your work income cannot be used against you to say you are not disabled enough)
- Be working in a competitive job or self-employed, earning at least minimum wage
- Have unearned income at or below 150% of the federal poverty level
The resource limit is tied to the community spouse resource standard used in long-term care Medicaid, which is well above the $2,000 ABD limit.7North Carolina General Assembly. North Carolina General Statutes 108A-66.1 – Medicaid Buy-In for Workers With Disabilities If your medical condition later improves while you are enrolled, you may keep coverage under a “medically improved” category rather than being dropped.
If Your Income Is Too High: Medically Needy Spend-Down
When your income exceeds the ABD limit but you have significant medical bills, the medically needy program offers a way in. You qualify by spending down your excess income on medical expenses until you reach the medically needy income limit: $242 per month for an individual or $317 per month for a couple.4North Carolina Department of Health and Human Services. MAABD Eligibility Overview Chart Effective 04-01-2026
The state calculates a “deductible” by taking the difference between your monthly income and the medically needy limit, multiplied by the number of months in your certification period. Once your documented medical bills reach that deductible, Medicaid covers costs for the rest of the period.9North Carolina Department of Health and Human Services. MA-2360 Medicaid Deductible For someone admitted to a hospital without Medicare Part A coverage, the deductible is treated as automatically met regardless of the actual charges. This route works best for people with recurring, expensive medical needs, and it requires careful documentation of every bill applied toward the deductible.
How to Apply
Before submitting an application, gather:10NC Medicaid. How To Apply for NC Medicaid
- Proof of identity and citizenship, such as a photo ID, birth certificate, or passport
- Proof of immigration status if applicable
- Proof of North Carolina residency, such as a utility bill, lease, vehicle registration, or proof of employment
- Proof of income: pay stubs, employer verification, or your most recent tax return; self-employed applicants should provide tax returns or business records
- Your Social Security number
- Medical records supporting your disability claim, for disability-based applications
You can apply online through the NC ePASS portal at epass.nc.gov, in person at your local Department of Social Services office, by phone with your county DSS, or by mail, fax, or email to your local DSS.10NC Medicaid. How To Apply for NC Medicaid
What Happens After You Apply
Standard Medicaid applications take up to 45 days to process. Disability-based applications can take up to 90 days because they require a separate medical determination.10NC Medicaid. How To Apply for NC Medicaid The Department of Social Services may contact you for more documents or an interview during that time. Answer quickly to avoid delays.
You will get a written decision. If you are approved, the notice explains your coverage start date. If you are denied, you have 30 days from the date the denial is mailed to file a hearing request with the North Carolina Office of Administrative Hearings; the request form comes with the denial notice.11NC Office of Administrative Hearings. Filing a Contested Medicaid Recipient Appeal If your coverage runs through a managed care organization and you are appealing a benefit decision after their internal review, you have 120 days to request a state fair hearing instead.