North Carolina is one of the 22 states that has elected not to accept federal funding under the ACA to extend Medicaid coverage to parents and other low-income adults. Consequently, parents in North Carolina are not eligible for Medicaid or premium tax credits if their incomes exceed 45 percent of the poverty line ($8,840 annually, or $737 per month, for a family of three in 2015) but remain below 100 percent of the poverty line ($20,090 annually, or $1,674 per month for a family of three). As a result, there are an estimated 357,000 North Carolinians (including childless adults) who fall into this coverage gap and a total of 587,000 adults excluded from Medicaid coverage due to North Carolina’s decision not to expand Medicaid.

Should North Carolina choose to extend Medicaid coverage to adults with incomes up to 138 percent of FPL, federal funding will be available to cover 100 percent of the costs for this new coverage through 2016. North Carolina has the option to join six other states in creating its own plan to extend coverage through a waiver of certain Medicaid provisions. All six states that have proposed Medicaid waivers so far have come to agreement with the federal government and extended coverage.