Medicaid Restrictions Cut Coverage for 10,500 in NC
North Carolina's new noncitizen eligibility rules have removed Medicaid coverage from about 10,500 people since October 1.
Updated on Nov. 2, 2026 in Healthcare
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Medicaid coverage restrictions for noncitizens took effect in North Carolina on October 1, and approximately 10,500 people have lost coverage. State Health Director Lawrence Greenblatt projects roughly $50 billion in Medicaid cuts over the next 10 years.
Why it matters
The restrictions were enacted through HR 1, the One Big Beautiful Bill Act, signed in July 2025, and they affect how the state's Medicaid expansion program serves its more than 730,000 enrollees. Additional work and renewal requirements beginning January 1, 2027 will further shape eligibility for the state's residents.
About 10,500 people have lost Medicaid coverage since noncitizen eligibility restrictions took effect October 1, out of more than 730,000 people enrolled in North Carolina's expansion program. The state projects roughly $50 billion in Medicaid cuts over about 10 years, and the extraction does not detail how that total is split across years or programs.
The players
Lawrence Greenblatt
Greenblatt is the State Health Director for North Carolina who projected approximately $50 billion in Medicaid cuts over the next 10 years.
President Donald Trump
Trump is the current President of the United States, who signed the HR 1 budget legislation in July 2025 that enacted the Medicaid changes.
The details
Restrictions on Medicaid eligibility for noncitizens took effect October 1, with categories that may remain eligible including qualifying lawful permanent residents, certain lawfully residing children and pregnant women, people with Cuban or Haitian entrant status, and citizens of Micronesia, the Marshall Islands, or Palau living in the US. Affected expansion recipients will undergo eligibility reviews twice yearly rather than annually, with redeterminations taking place at county DSS offices.
Timeline
July 2025: President Trump signed HR 1, the One Big Beautiful Bill Act.
December 2023: North Carolina expanded Medicaid eligibility.
October 1, 2026: Noncitizen Medicaid coverage restrictions took effect.
January 1, 2027: New Medicaid work and renewal requirements take effect.
Roadmap
The North Carolina coverage losses are a direct implementation of HR 1, the One Big Beautiful Bill Act signed in July 2025, which set the federal framework for these eligibility changes. The state's December 2023 Medicaid expansion now faces contraction under those federal rules, marking a reversal in the direction North Carolina took just two years earlier.
Noncitizens in categories outside the eligible groups have lost Medicaid coverage, and remaining enrollees will face eligibility reviews twice yearly rather than annually. Adults subject to the new requirements must document 80 hours of monthly work, school, or volunteering, or meet an alternative household earnings threshold starting January 1, 2027.
The takeaway
Residents who rely on Medicaid should check whether they fall into an eligible category and prepare documentation for the twice-yearly reviews and the work requirements starting in 2027. Keeping records of work, school, or volunteer hours now can make future renewals easier.
What happens next
New Medicaid work and renewal requirements take effect January 1, 2027, requiring affected adults to complete 80 hours a month of work, school, or volunteering or meet an alternative household earnings threshold.
Further reading
For broader coverage of how federal changes are reshaping Healthcare policy and access, explore related reporting in that section.
Source note: This article includes information reported by Carolina Journal.
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