NC Immigrant Health Insurance: Updated Medicaid and Marketplace Rules

North Carolina has widened health coverage so more immigrants can get care through Medicaid and private Marketplace plans, with the biggest changes taking effect from December 2023 through 2025. Adults ages 19 to 64 with low incomes may now qualify for Medicaid if they hold an eligible status, while Most lawfully present immigrants can buy discounted private plans. State officials and community groups say these steps aim to cut medical debt and keep families healthy without risking anyone’s future immigration process.

Policy changes at a glance

At the core, the state’s Medicaid expansion opened the door to many adults who were previously shut out. Adults ages 19 to 64 with an eligible immigration status can qualify for full Medicaid when their income is under 138% of the federal poverty level (FPL). For a family of three, that threshold is about $34,000.

This expansion includes many parents, single adults, and caretakers who live and work in North Carolina but previously struggled to see a doctor. The state also clarified who can enroll without a waiting period and who must rely on private plans during the first years after getting status.

Key Medicaid rules now in effect for immigrants

• Adults ages 19–64 with an eligible immigration status can get Medicaid if income is under 138% FPL.
• Certain groups—asylum seekers, refugees, Cuban/Haitian entrants, trafficking survivors, and qualified non‑citizens tied to veterans—can get Medicaid with no 5‑year wait.
• Most Lawful Permanent Residents (Green Card holders) must wait 5 years after getting status before full Medicaid, with limited exceptions (including some parolees from Afghanistan, Ukraine, Cuba, or Haiti).
• Children under 19 and pregnant people with any lawful status (except DACA recipients) can get Medicaid without the 5‑year wait.
• Undocumented immigrants cannot get full Medicaid but may receive Emergency Medicaid for urgent medical needs.
• Medicaid categories remain limited to people with disabilities, caretakers of children under 18, adults 65+, pregnant people, and children under 19.

These rules affect daily life. For example:
– A refugee mother caring for two school‑age children could qualify for full Medicaid now, enabling routine checkups that were out of reach last year.
– A new Green Card holder may still need to wait five years for full Medicaid but can often secure private coverage with help paying monthly costs.
– An undocumented construction worker who suffers a job injury can rely on Emergency Medicaid for hospital care.

Coverage paths beyond Medicaid: the Marketplace

Marketplace insurance fills gaps for lawfully present immigrants who earn too much for Medicaid or are within a waiting period. Most lawfully present immigrants can buy private insurance on the Marketplace, and many will get financial help to cut monthly premiums and out‑of‑pocket costs.

How Marketplace rules apply in North Carolina

• Most lawfully present immigrants may buy plans on the Marketplace regardless of the 5‑year Medicaid wait.
• People with incomes between 100% and 400% FPL usually qualify for premium subsidies.
• Some immigrants who cannot get Medicaid because of status may still get subsidies even if their income is below the poverty line.
• Starting November 1, 2024, DACA recipients became eligible to buy Marketplace plans and get financial help.
• Families can enroll mixed statuses together; only the applying person’s status is reviewed for coverage.

Practical examples:
– A Raleigh couple can have a U.S. citizen spouse apply for Medicaid while a lawfully present spouse buys a silver‑tier Marketplace plan with a low monthly premium after subsidies.
– A recent Green Card holder in Charlotte still within the five‑year bar can use the Marketplace to manage chronic conditions like asthma or diabetes without skipping medication.

Income thresholds and special rules

• Medicaid’s broad adult limit: under 138% FPL for ages 19–64.
• Marketplace subsidies: 100%–400% FPL.
• Special rules may help some people below 100% FPL if barred from Medicaid based on immigration status.
• These thresholds vary by family size—review current charts before applying.

According to analysis by VisaVerge.com, mixed‑status households often benefit when they apply for each eligible member, since coverage for one person does not change another person’s status or future citizenship chances.

How to apply and where to get help

Applying is meant to be straightforward. Immigrants can apply through their county Department of Social Services or submit forms online. Applicants should be ready to show proof of income and their immigration document, such as a Green Card, arrival‑departure record, or other status notice.

• If a family member does not have status and is not applying, they generally do not need to provide their own status details.
• The state urges families to list only the information needed for the person who seeks coverage, easing fear and confusion for mixed‑status households.

Free, in‑person help is available:
– The NC Navigator Consortium offers appointments in multiple languages by phone at 1‑855‑733‑3711.
– Community health centers and local navigators can guide families through Medicaid and Marketplace steps.
– Many providers host weekend enrollment events, especially around the fall open enrollment period.
– A trained navigator can compare plan networks, check a person’s doctors, and explain likely costs before enrollment to help prevent surprise bills.

Emergency Medicaid: what it covers

Emergency Medicaid is a safety net for undocumented people and others who cannot get full coverage. It pays for urgent care needed right away—examples include life‑threatening injuries, heart attacks, or emergency childbirth.

• Emergency Medicaid does not cover routine checkups or ongoing prescriptions.
• Example: a farmworker injured by machinery in eastern North Carolina can receive hospital care, surgery, and immediate follow‑up under Emergency Medicaid to save a limb or a life.

The 5‑year wait rule explained

The 5‑year wait for many Green Card holders is often confusing. Key points:

• Lawful Permanent Residents generally must wait 5 years from the date they obtained that status to qualify for full Medicaid.
• Exceptions exist: certain parolees and humanitarian categories from Afghanistan, Ukraine, Cuba, or Haiti are eligible without the wait.
• Children under 19 and pregnant people with any lawful status (other than DACA) may qualify immediately.
• Example: a new Green Card holder in Greensboro may need to buy a Marketplace plan for a few years before full Medicaid becomes available, while their U.S.‑born child qualifies now.

DACA recipients saw a major change on November 1, 2024: they can buy Marketplace plans and receive financial help based on income. Before this, many DACA recipients faced a coverage gap—now they can compare plans, check providers’ networks, and qualify for premium subsidies that make monthly costs manageable.

Official resources and enrollment timing

State agencies encourage residents to check official guidance as federal and state thresholds update annually.

• The NC Department of Health and Human Services posts details on Medicaid eligibility categories, income updates, and how to find your county office.
• During Marketplace open enrollment, Healthcare.gov updates plan options, subsidy amounts, and enrollment deadlines.
• Medicaid applications can often be submitted year‑round; Marketplace enrollment follows a calendar with special enrollment windows for life events (losing coverage, moving, having a baby).

Important: applying for eligible coverage does not harm future immigration steps. Families with mixed statuses can list only the person applying, and benefits given to a citizen child or eligible spouse do not change another person’s immigration status.

Many immigrant parents in North Carolina have signed up their U.S. citizen children for Medicaid—covering vaccinations, dental care, and asthma treatment—while parents buy subsidized Marketplace plans. This helps keep care consistent across the household and lowers the chance that a health issue forces someone to miss work or school.

Special categories: older adults and people with disabilities

Medicaid still follows long‑standing categories for certain groups:

• Adults 65+ and people who meet disability standards may qualify under dedicated rules separate from the expansion group.
• Caretakers of children under 18 may qualify when household income is low enough.
• If a person already receives coverage and their household changes (new job, new baby, move across counties), they should report the change to keep coverage aligned with current needs.

Bottom line and next steps

The Medicaid expansion and new Marketplace rules have reshaped the healthcare landscape for immigrants in North Carolina:

• Lawfully present adults with low incomes can qualify for Medicaid in more situations.
• Immigrants within a waiting period—and DACA recipients—can often secure private Marketplace plans with financial help.
• Undocumented residents still depend on Emergency Medicaid for urgent care but can access preventive services through community clinics on sliding scales.

Families who want help today can:
1. Call the NC Navigator Consortium at 1‑855‑733‑3711.
2. Contact their county Department of Social Services.
3. Gather proof of income and immigration documents for the person applying.

If someone in the home is not applying and does not have status, they can be left off the application, reducing stress for mixed‑status households. With these steps, North Carolina aims to keep more residents healthy, reduce medical debt, and ensure access to care does not hinge solely on immigration status in the United States 🇺🇸.