North Carolina expanded Medicaid on December 1, 2023, after a decade-long policy debate, becoming the 40th state to do so. Expansion has since added well over half a million newly eligible adults to coverage — enrollment has grown past 600,000, and figures continue to change, so check the latest with the state. Even so, the state’s safety net remains essential. Many newly eligible enrollees still rely on community health centers and free clinics for actual care delivery, and rural counties along the coast and in the western mountains face deep provider shortages. Free clinics in North Carolina serve as a workhorse of the system, blending federally funded community health centers, a robust free-clinic network (North Carolina has one of the strongest free and charitable clinic associations in the country), hospital charity care, and the newly expanded NC Medicaid program.
This guide explains the four main pathways, what each generally costs, and how to qualify. Because hours, services, and eligibility rules change and vary by location, treat the specifics below as general guidance and call the clinic directly to confirm current hours, services, and eligibility before you go. For broader cost context, see our healthcare costs guide.
Types of free and low-cost clinics in North Carolina
Four networks operate in parallel. Federally Qualified Health Centers (FQHCs), funded under Section 330 of the Public Health Service Act, are required to serve everyone regardless of insurance or ability to pay. Free and charitable clinics — many of them members of the National Association of Free & Charitable Clinics (NAFC) — deliver volunteer-staffed care at little or no cost. Sliding-scale practices and faith-based clinics extend reduced fees based on household income. Hospital charity care under ACA §501(r) can cover larger bills at nonprofit North Carolina systems, which include Atrium Health, Novant Health, Duke Health, UNC Health, and Cone Health, among others.
North Carolina has historically had one of the strongest free and charitable clinic ecosystems in the country, partly because the state delayed Medicaid expansion for a decade and the network grew to fill the gap. Because individual clinics open, close, merge, and change their offerings, use the directories below and confirm details with each site rather than assuming a particular clinic still operates as described.
FQHCs in North Carolina and sliding-scale fees
North Carolina has a large network of FQHC organizations operating roughly 250 sites statewide, per the Health Resources and Services Administration (HRSA). Concentrations exist in Charlotte, Raleigh-Durham, Greensboro, Winston-Salem, Asheville, and across both coastal and mountain rural counties. Services commonly include primary care, pediatrics, dental, behavioral health, women’s health, and pharmacy — though the exact mix varies by site, so confirm what each location offers.
Sliding-scale fees follow the HHS Poverty Guidelines, which are updated every year. For 2026, the guideline is about $15,960 for a single person and roughly $33,000 for a family of four in the 48 contiguous states (verify the current figures, as they change annually). At or below 100% of the federal poverty level (FPL), most FQHCs charge a nominal fee — often in the range of about $20 to $35 per visit — with discounts typically running up to 200% FPL. FQHCs accept NC Medicaid, Medicare, private insurance, and self-pay. Because each center sets its own nominal-fee schedule, ask about it when you schedule.
The North Carolina Community Health Center Association (NCCHCA) is the state’s HRSA cooperator and maintains a public directory of member health centers — a good starting point when you want to confirm a specific center’s current status.
Free, volunteer-staffed clinics in North Carolina
North Carolina’s free and charitable clinic network is one of the largest in the nation, with strong concentrations in Charlotte, the Triangle, the Triad, Asheville, Wilmington, and across smaller towns. The North Carolina Association of Free and Charitable Clinics is the state-level affiliate connected to the national NAFC.
Free clinics typically charge nothing, generally restrict eligibility to uninsured adults at or below 200% FPL, and run on volunteer physicians, nurses, dentists, and pharmacists. Hours are often evenings and Saturdays, and many operate limited schedules or by appointment. Services can include primary care, basic labs, chronic disease management for diabetes and hypertension, behavioral health, and dental. The NAFC clinic locator lets you search by ZIP code. Because volunteer clinics’ hours and services shift with staffing, call the specific clinic to confirm current hours, services, and eligibility before you visit.
Hospital charity care under ACA Section 501(r)
Every nonprofit hospital in North Carolina must comply with IRS Section 501(r), which requires a written Financial Assistance Policy (FAP), public posting of that policy, and limits on what FAP-eligible patients can be charged. Many North Carolina systems extend assistance to patients up to somewhere in the 200% to 400% FPL range, though the specific thresholds and covered services vary by system, so ask each hospital about its policy.
You generally have at least 240 days from your first post-discharge bill to apply for financial assistance. Apply early, ask for the “Financial Assistance Policy” by name, and request a written copy and a plain-language summary. If a bill is already in collections, applying for financial assistance may still be possible — ask the hospital’s billing or financial-counseling office.
NC Medicaid (expansion)
North Carolina’s Medicaid expansion took effect on December 1, 2023. NC Medicaid now covers adults up to 138% FPL — roughly $22,000 a year for a single person based on the 2026 guidelines (this figure updates annually, so confirm the current threshold). Children, pregnant people, parents, and people with disabilities may qualify under separate, often more generous income rules. The former NC Health Choice program (the state’s CHIP coverage for children) was folded into NC Medicaid for most enrollees as part of these changes.
You can apply year-round through NC Medicaid or, in some situations, the federal Healthcare.gov marketplace. FQHCs typically have certified application counselors who can help you apply on-site at no charge. KFF tracks North Carolina enrollment data and uninsured-rate trends since expansion launched. Because Medicaid eligibility depends on your specific household and income, confirm your situation with a counselor or the state rather than relying on general figures.
How to find free clinics in North Carolina near you
The HRSA Find a Health Center tool maps FQHC sites by ZIP code. NC 211 connects callers with local navigators around the clock and can point you to nearby resources. The NAFC locator covers volunteer free clinics specifically. When you find a promising option, call ahead to confirm it is still operating, that it serves your area, what it offers, and whether you qualify — this one step saves the most wasted trips.
For rural patients in coastal counties like Hyde, Tyrrell, or Camden, or mountain counties like Yancey or Mitchell, ask the closest FQHC about telehealth visits. Many North Carolina community health centers expanded telehealth during the pandemic and have kept it, though availability varies by center.
What to bring to a clinic visit
Bring a photo ID (a North Carolina driver’s license, state ID, passport, or consular ID), proof of North Carolina address (a utility bill, lease, or piece of mail), and proof of household income (recent pay stubs, your last tax return, a Social Security or unemployment letter, or a self-attestation form for cash income). Bring your insurance card if you have coverage, a current medication list, and any past medical records you can gather.
If you plan to apply for NC Medicaid during the visit, also bring Social Security numbers for everyone in the household and any relevant immigration documents. FQHCs serve patients regardless of immigration status. Requirements can differ by clinic, so ask what to bring when you call to confirm your appointment.
Frequently Asked Questions
Are FQHCs in North Carolina really free?
Not always free, but affordable. At or below 100% FPL, FQHCs typically charge a nominal fee (often about $20 to $35 per visit), and federal rules bar them from refusing care for inability to pay. Ask each center about its nominal-fee policy and sliding scale when you schedule, since the details vary.
What changed with NC Medicaid expansion?
Medicaid expansion took effect December 1, 2023. Adults up to 138% FPL now qualify for NC Medicaid, including many who previously fell into the coverage gap. Enrollment has grown well past half a million — beyond 600,000 — and the program continues to add newly eligible residents. Confirm current eligibility and figures with NC Medicaid.
Can undocumented immigrants use North Carolina free clinics?
Yes. FQHCs and NAFC free clinics serve patients regardless of immigration status. Full NC Medicaid is limited to citizens and certain lawfully present immigrants, but Emergency Medicaid can cover emergency care for otherwise income-eligible noncitizens. Ask the clinic what applies to your situation.
Do North Carolina free clinics help with prescriptions?
Many do. FQHCs often operate on-site 340B pharmacies with discounted drug prices, and free clinics frequently help eligible patients enroll in manufacturer patient-assistance programs for brand-name drugs. Bring your medication list, and ask each clinic what prescription help it offers.
How do I find a free dental clinic in NC?
Many FQHCs operate dental clinics with sliding-scale fees, and several free clinics provide dental cleanings and basic restorative work. The NC Dental Society also coordinates periodic Missions of Mercy events that offer free care to uninsured patients. Dental capacity is limited and fills quickly, so call ahead to check availability.
Getting affordable care in North Carolina
North Carolina’s safety net is unusually deep, especially in its free and charitable clinics, partly because the state delayed Medicaid expansion for a decade. Between FQHCs in every region, one of the country’s strongest free-clinic networks, hospital charity care under §501(r), and the newly expanded NC Medicaid program, almost every uninsured North Carolinian has at least one viable affordable option. For ongoing primary care without insurance, our guide to direct primary care explains how flat-fee monthly memberships work alongside the safety net. Neighboring states with comparable networks include South Carolina, Virginia, and Tennessee. Whichever pathway you use, call to confirm current hours, services, and eligibility before you go.
Disclaimer: This article is general cost and resource information, not medical, legal, or financial advice. Clinic hours, services, eligibility rules, fees, poverty guidelines, and Medicaid thresholds change often and vary by location; the figures here are general estimates that may be out of date. Always call the specific clinic to confirm current hours, services, and eligibility, and verify program details with HRSA, NC Medicaid (NC DHHS), or a benefits counselor before relying on them. Free and low-cost clinics are not equipped for emergencies — for chest pain, signs of stroke, severe difficulty breathing, severe bleeding, or a head injury with loss of consciousness, call 911; for a mental health crisis, call or text 988. Federal law (EMTALA) requires emergency rooms to stabilize you regardless of ability to pay.
Sources
- Health Resources and Services Administration (HRSA) — Find a Health Center; Health Center Program data
- HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) — Poverty Guidelines (2026)
- North Carolina Department of Health and Human Services (NC DHHS) — NC Medicaid expansion
- Internal Revenue Service (IRS) — Section 501(r) requirements for charitable hospitals
- National Association of Free & Charitable Clinics (NAFC) — Find a Clinic
- North Carolina Community Health Center Association (NCCHCA) — member health center directory
- KFF — Status of state Medicaid expansion decisions and enrollment tracking