New Medicaid rules near as state warns of coverage losses
Starting Jan. 1, 2027, many enrollees will have to show 80 hours a month of work, school or volunteering and renew their coverage every six months.
Gov. Josh Stein met with Medicaid beneficiaries, health providers and county commissioners in Fayetteville on Tuesday, Oct. 13, to prepare for federal Medicaid cuts in H.R. 1. The governor's office said more than 250,000 North Carolinians are at risk of losing health care coverage because of the cuts, which it said will raise costs for all North Carolina taxpayers.
Starting Jan. 1, 2027, many people with NC Medicaid coverage will be required to prove they are working, going to school or volunteering 80 hours a month, and to renew and verify their eligibility every six months instead of once a year. The N.C. Department of Health and Human Services says those changes apply to people ages 19 through 64 without a disability, and that because of federal changes, many non-citizens no longer have Medicaid coverage as of Oct. 1, 2026.
NC Medicaid covers more than 3 million people, 1 in 4 North Carolinians, along with half of all births in the state. In many rural counties, Medicaid covers more than half the population, according to NCDHHS. The state says H.R. 1 will cut nearly $50 billion in federal funds for North Carolina's Medicaid program over the next 10 years, and that as many as 90,000 North Carolinians who receive SNAP food assistance could lose that help.
"I continue to urge Congress to reverse these cuts and focus on delivering solutions that help people live healthier, safer, and more prosperous lives," Stein said. He also sent a letter to congressional leaders and the state's congressional delegation asking them to reverse the cuts and repeal the work requirements, and wrote an op-ed in The News & Observer warning that everyone will bear the costs. NC Newsline reports that Stein says counties will shoulder the costs of the new Medicaid rules.
"NCDHHS will continue to work with our state and local partners to ensure every North Carolinian has the tools they need to access care when and where they need it," said Health and Human Services Secretary Dev Sangvai. The department has a Know What's Next toolkit in English and Spanish at Medicaid.nc.gov/changes and Medicaid.nc.gov/cambios, and people can contact their local Department of Social Services to learn how the new rules may affect their coverage.
- N.C. Office of the Governor, “Governor Stein Hosts Roundtable Focused on Protecting North Carolinians from Federal Cuts to Medicaid”, Tuesday, October 13, 2026
- N.C. Department of Health and Human Services, “NCDHHS Livestream Fireside Chat and Tele-Town Hall: New Rules for NC Medicaid: Know What’s Next”, Monday, October 12, 2026
- N.C. Department of Health and Human Services, “Governor Stein Launches $20 Million Fund to Increase Access to Care in Rural North Carolina”, Wednesday, September 30, 2026
- N.C. Office of the Governor, “ICYMI: In New Op-Ed, Governor Stein Warns “Everyone Will Pay the Price” for Federal Medicaid Cuts”, Monday, October 12, 2026
- NC Newsline, “Stein says NC counties will shoulder costs of new Medicaid rules, urges Congress to reverse cuts”, Friday, October 16, 2026












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