North Carolina Medicaid Program Overview
Enrollment, funding, and managed care facts for North Carolina Medicaid.
Get North Carolina's Medicaid Fee Schedule →Enrollment
North Carolina Medicaid covered approximately 2.82-2.87M people. Two independent sources give close but not identical figures: KFF's state indicator reports 2,820,258 (May 2026), while healthinsurance.org (citing Medicaid.gov's 'October 2025 Medicaid & CHIP Enrollment Data Highlights') reports 2,865,323 (October 2025). Different reporting months, not a contradiction, so reported as a range.
Funding & federal match
North Carolina has adopted ACA Medicaid expansion, effective 2023-12-01.
For FFY2026 (Oct 1, 2025 - Sep 30, 2026), North Carolina's Federal Medical Assistance Percentage (FMAP) is 64.62%.
Delivery system & managed care
A large share of North Carolina Medicaid is delivered through managed care organizations (MCOs) rather than fee-for-service — estimates range from 60.6-79.1% of Medicaid enrollees.
Waivers
North Carolina operates Medicaid managed care under the North Carolina Medicaid Transformation, a Section 1115 demonstration waiver. Authorizes North Carolina's transition of most Medicaid beneficiaries from fee-for-service to managed care (Standard Plans, Behavioral Health and I/DD Tailored Plans, Advanced Medical Homes, tailored/value-based care management). North Carolina's own Medicaid agency states the state submitted its waiver proposal to CMS in June 2016; healthinsurance.org reports CMS approved it in October 2018, effective 2019 through 2024. The state completed its transition to NC Medicaid Managed Care on July 1, 2021. Whether/how the demonstration has since been renewed past its original 2024 end date was not confirmed this session.
Frequently Asked Questions
Get North Carolina's Free Medicaid Fee Schedule
Request actual North Carolina Medicaid reimbursement rates by billing code — free, delivered as a CSV.
Sources
- KFF State Health Facts - Total Monthly Medicaid & CHIP Enrollment
- healthinsurance.org - Medicaid eligibility and enrollment in North Carolina (citing Medicaid.gov Enrollment Data Highlights, October 2025)
- Federal Register - FY2026 FMAP Notice (89 FR 94742)
- MACPAC - MACStats Data Book 17, Exhibit 6: FMAPs and E-FMAPs by State, FYs 2023-2026
- KFF - Status of State Medicaid Expansion Decisions
- CMS - Medicaid Managed Care Enrollment and Program Characteristics, 2024
- MACPAC - MACStats Data Book, Exhibit 29: Percentage of Medicaid Enrollees in Managed Care by State, July 1, 2022
- NC DHHS - NC Medicaid Transformation
Data last verified 2026-09-17. Also see our free Medicaid Fee Schedule tool.