Coverage Keeper — My Benefits Checklist
From 5Q Health (5qhealth.ai) · Printed · Rules last verified September 26, 2026
Which benefit do you want to protect?
Your checklist
Your key dates
These come from federal and state law and current program rules. The dates on any letter you receive always come first.
The work and community engagement rule, in plain language
This applies to most adults ages 19–64 who have Medicaid through expansion. If an exemption fits you (see the list below), the rule does not apply, but you may need proof.
| The rule | What it means |
|---|---|
| Hours each month | 80 hours a month (about 20 a week) of work, volunteering or community service, a work program or job training, or school at least half time. You can combine them. Looking for a job counts for less than half of the hours. |
| Or: income | Earning at least $580 a month counts instead of hours (that is 80 hours at the federal minimum wage). |
| When you apply | You must show you met the rule for the 3 months in a row right before you apply. |
| When you renew | You must show you met the rule in 3 of the 6 months before your renewal. |
| How often you renew | Every 6 months for most expansion adults (instead of once a year). American Indian and Alaska Native members stay on yearly renewals. |
| If the state can’t confirm it | You get a letter and 30 days to show you met the rule or that you are exempt. |
| If you lose coverage | The letter tells you how to appeal. You usually have 60 days from the date on the letter. Ask for help right away. |
Good to know: North Carolina asks for 3 months of proof. Federal rules would allow as little as 1. If your hours go up and down — seasonal, farm, gig, or shift work — start keeping records now, so a slow month doesn’t cost you coverage. Use the hour log below.
Who is excused (exempt) and what proof to keep
You may be excused if any one of these fits. Don’t assume you are excused: tell your county DSS office and keep proof. Only DSS can decide.
- Younger than 19 or older than 64Proof: ID or birth certificate
- Parent or caretaker of a child 13 or younger, or of a person with a disabilityProof: household records; a letter about the person you care for
- Pregnant now, or pregnant in the last 12 monthsProof: a note from your prenatal or postpartum provider
- Has Medicare, or gets SSI or SSDIProof: your award letter or Medicare card
- Veteran with a 100% disability ratingProof: VA rating letter
- Already found disabled by NC MedicaidProof: your disability determination letter
- Meets SNAP or Work First (TANF) work rulesProof: your SNAP or Work First letters
- In foster care now, or aged out and under 26Proof: foster care records
- American Indian, Alaska Native, or eligible for Indian Health Service careProof: tribal enrollment or IHS eligibility
- In jail or prison, or released in the last 3 monthsProof: release papers
- In a drug or alcohol treatment programProof: a letter from the program
- Medically frail — see the box belowProof: a provider letter about how your condition limits daily activities
“Medically frail”: bring proof of how your condition affects daily life
You may be excused if you are blind or disabled; have a physical, intellectual, or developmental disability that makes one or more daily activities hard (like bathing, dressing, eating, getting around, or using the toilet); have a substance use disorder; have a disabling mental health condition; or have a serious or complex medical condition.
A diagnosis alone is not enough under the federal rule. The condition has to seriously limit your ability to work or do the activities that count. Starting October 1, 2026, North Carolina also cannot accept your word alone as the only proof for Medicaid eligibility. So:
- Ask your doctor, therapist, or other treating provider for a letter that says how your condition limits daily activities — dressing, bathing, getting around, managing medicine, keeping a schedule. A diagnosis alone is usually not enough.
- Keep copies of recent visit notes, therapy evaluations, equipment prescriptions, and any disability or benefits letters.
- Tell DSS you think you may qualify, and ask what proof they need. If they say no and you believe that’s wrong, you can appeal.
This box describes the rules in general. It can’t tell you whether you qualify — only DSS can. Free help is listed below.
Monthly hour log
Write down your hours as you go. Keep proof for each line (a pay stub, timesheet, school record, or a signed note from the place you volunteer). Print one page for each month.
| Date | Activity (work, school, volunteering, training) | Who can confirm it | Hours | Proof kept |
|---|
Total this month: 0 of 80 hours
Hours you type stay on this page only. Print the page to keep a copy — nothing is saved when you close it.
SNAP work rules for adults without dependents
Adults ages 18–64 who don’t have a child under 14 in the home must work or train 80 hours a month. If not, SNAP is limited to 3 months in a 36-month period (the current period runs January 1, 2025 – December 31, 2027). North Carolina has applied these rules since December 1, 2025.
- Adults 55–64 are now included. They used to be excused.
- Veterans are excused only if they get VA disability compensation (any rating).
- Being homeless is no longer an automatic exemption. Chronic homelessness, pregnancy, disability benefits, caring for a child under 6 or an adult who can’t care for themselves, and being physically or mentally unable to work 20 hours a week can still excuse you.
Ask your county DSS what applies to you, and get the answer in writing.
When a letter arrives, do these five things
- Open it the same day. Letters about benefits almost always have a deadline.
- Find the deadline and circle it. The deadline printed in your letter is the one that counts — and sooner is always safer.
- Take a photo of every page before you do anything else.
- Respond before the deadline, even if you can’t get every document. Send what you have and say the rest is coming. Keep proof you responded (a receipt, confirmation number, ePASS upload screen, or a photo of what you mailed).
- If your benefits are stopping or shrinking and you think that’s wrong, ask for an appeal right away. Appeal deadlines are short, and asking quickly can sometimes keep your benefits on while the appeal is decided.
Where to get help — free
- Your county DSS office — questions about your case, renewals, exemptions, and reporting changes.
- ePASS (epass.nc.gov) — set up an enhanced ePASS account to upload documents and check your case.
- NC Medicaid Ombudsman: 1-877-201-3750 — free help understanding notices and appeals.
- Legal Aid of North Carolina (legalaidnc.org) — free legal help with denials and appeals.
- Call 2-1-1 — a free statewide line for local help with benefits, food, and housing.
- NC Navigator Consortium and NCCare360 — free help finding coverage and local services.
- Your health plan’s member services — the number is on the back of your Medicaid card. Ask in writing when you can, before assuming a service isn’t covered.
What this tool is and is not
It is: a plain-language checklist builder using dates and requirements from federal and North Carolina law and published program guidance, verified September 26, 2026.
It is not: an eligibility decision, legal advice, or a substitute for the notices you receive. It cannot tell you whether you qualify for anything or are excused from any rule — only DSS, your health plan, or a legal advocate can help with that.
Your privacy: everything happens on your device. This page has no accounts, no tracking, and no server storing answers. Nothing you tap or type is saved or sent. The only copy is the one you print or email to yourself. See our privacy notice.
Sources for the rules on this page
- Federal law: P.L. 119-21 § 71119 (Social Security Act § 1902(xx), community engagement), § 71107 (6-month renewals), § 71112 (retroactive coverage).
- CMS interim final rule CMS-2454-IFC, “Medicaid Community Engagement Requirement for Certain Individuals” (June 1, 2026).
- N.C. Session Law 2026-1 (HB 696): G.S. 108A-55.6 (self-attestation limit, effective October 1, 2026) and G.S. 108A-55.7 (3 consecutive months at application; 3 of 6 months at renewal, effective January 1, 2027).
- N.C. Session Law 2026-41 (SB 257, Current Operations Appropriations Act of 2026, approved July 7, 2026): § 9E.20 (monthly and quarterly eligibility reviews, G.S. 108A-55.5) and § 9E.19 (no copays for Innovations and TBI waiver services from July 1, 2027, G.S. 108A-58.3).
- NC Medicaid, “The Work and Community Engagement Requirement” (page updated August 31, 2026). NCDHHS, “Work Requirements for Able-Bodied Adults Without Dependents” (SNAP).
What changed in version 2.0 (September 26, 2026): added the January 1, 2027 Medicaid work rule (80 hours or $580 a month; 3-month proof; 6-month renewals), the full exemption list, the medically frail box, the monthly hour log, the retroactive-coverage change, updated SNAP rules, and more free help. Version 1.0 was current as of July 2026.