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GROUP BENEFITS BASIC MEDICAID ELIGIBILITY REQUIREMENTS ** Notes BASIC ELIGIBILITY REQUIREMENT WHOSE INCOME and RESOURCES COUNT MONTHLY INCOME LIMIT Updated 04/2026 RESOURCE LIMIT Updated 04/2026 DEDUCTIBLE/SPEND DOWN Non-IV-E/ Special Needs Adoption Full Medicaid Coverage Children with medical or rehabilitative needs, which are barriers to adoption are considered special needs adoption children. These children are ineligible through Title IV-E because at the time of placement in foster care they did not meet IV-E requirements. MAGI Methodology 1. MAGI 2. MAF-M 3. Authorize ongoing Medicaid (See Notes)

NO YES

If ineligible under MAGI, the child must have been enrolled in or eligible for Medicaid immediately before the adoption agreement, is under a Non-IV-E state adoption agreement or determined to be special needs by the State adoption assistance agreement.

MFC- Medicaid for Former Foster Care

Full Medicaid Coverage Be age 18-26 and have been in foster care at age 18 and enrolled in NC Medicaid. There is no income.

NO NO

Effective January 1, 2023: Individuals who turn age 18 that were in foster care and receiving Medicaid in any state. Breast & Cervical Cancer Medicaid MAF-W Full Medicaid Coverage Be under the age 65 and not enrolled in any creditable medical insurance. Breast and Cervical Cancer Control Program (BCCCP) provider determines eligibility for Breast and Cervical Cancer Medicaid (BCCM). There is no income (BCCM).

NO NO

Family Planning MAF-D

Family Planning Program NO AGE LIMIT MAGI Methodology 195% of Poverty Level 1 - $2,594 2 - $3,517 3 - $4,440 4 - $5,636 5 - $6,286 NO NO

If a beneficiary’s income increases to more than 195%, he/she will be ineligible for family planning coverage. Transitional Medicaid (TMA) Full Medicaid Coverage A beneficiary may receive up to twelve months of Transitional Medicaid (TMA) when ineligible for MAF-C because of new or increased income. MAGI Methodology 185% of Poverty Level 1 - $2,461 2 - $3,337 3 - $4,212 4 - $5,088 5 - $5,964 NO NO

Must have been eligible for MAF-C in North Carolina in at least three of the six months immediately preceding the first month of ineligibility. There must be an eligible child receiving Medicaid Medicaid Expansion (MXP) Full Medicaid Coverage Age 19 or over and under age 65. MAGI Methodology 133% of Poverty Level 1 - $1,769 2 - $2,399 3 - $3,028 4 - $3,658 5 - $4,288 NO NO

***This chart addresses benefits and basic eligibility requirements. Other requirements (such as citizenship/alien status, incarceration, & state residence) which can also affect eligibility, or the level of benefits are not reflected on this chart. Revised 4/1/2026