North Carolina expanded Medicaid in December 2023 after a decade-long policy debate, becoming the 40th state to do so. The expansion has already added more than 500,000 newly eligible adults to coverage, but the state’s safety net remains essential. Many of the 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 the workhorse of the system, blending federally funded community health centers, a robust NAFC network (the state has one of the strongest free clinic associations in the country), hospital charity care, and the newly expanded NC Medicaid program.
This guide explains the four main pathways, what each costs, and how to qualify. 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, are required to serve everyone regardless of insurance. NAFC member free clinics deliver volunteer-staffed care at no cost. Sliding-scale practices and faith-based clinics extend reduced fees by household income. Hospital charity care under ACA §501(r) covers larger bills at nonprofit North Carolina systems including Atrium Health, Novant Health, Duke Health, UNC Health, and Cone Health.
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 filled the gap.
FQHCs in North Carolina and sliding-scale fees
North Carolina has more than 40 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 include primary care, pediatrics, dental, behavioral health, women’s health, and pharmacy.
Sliding-scale fees follow the HHS Poverty Guidelines: $15,060 single, $31,200 family of four in 2024. At or below 100% FPL most FQHCs charge a nominal $20 to $35 per visit; discounts run up to 200% FPL. FQHCs accept NC Medicaid, Medicare, private insurance, and self-pay.
The North Carolina Community Health Center Association (NCCHCA) is the state’s HRSA cooperator and maintains a public directory of every member health center.
NAFC and free volunteer-staffed clinics in North Carolina
North Carolina’s NAFC 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 a state-level affiliate of NAFC.
Free clinics charge nothing, restrict eligibility to uninsured adults at or below 200% FPL, and run on volunteer physicians, nurses, dentists, and pharmacists. Hours are usually evenings and Saturdays. Services 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.
Hospital charity care under ACA Section 501(r)
Every nonprofit hospital in North Carolina must comply with IRS Section 501(r), meaning a written Financial Assistance Policy, public posting, and capped charges for FAP-eligible patients. Most North Carolina systems extend coverage up to 200% to 400% FPL, though specific thresholds vary across systems.
You have at least 240 days from your first post-discharge bill to apply. Apply early, ask for the Financial Assistance Policy by name, and request a written copy.
NC Medicaid (expansion) and NC Health Choice
North Carolina’s Medicaid expansion took effect on December 1, 2023. NC Medicaid now covers adults up to 138% FPL (about $20,783 a year for a single person in 2024). Children, pregnant people, parents, and people with disabilities qualify under separate, more generous income rules. NC Health Choice was the state’s CHIP program for children up to 211% FPL; under expansion it has been folded into NC Medicaid for most enrollees.
Apply year-round through NC Medicaid or the federal Healthcare.gov marketplace. FQHCs typically have certified application counselors. KFF tracks North Carolina enrollment data and uninsured rate trends since expansion launched.
How to find free clinics in North Carolina near you
The HRSA Find a Health Center tool maps every FQHC by ZIP. NC 211 connects callers with local navigators 24/7, covering approximately 99% of US ZIP codes nationally. The NAFC locator handles volunteer free clinics specifically.
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. Most North Carolina community health centers expanded telehealth during the pandemic and have kept it.
What to bring to a clinic visit
Bring a photo ID (North Carolina driver’s license, state ID, passport, or consular ID), proof of North Carolina address (utility bill, lease, mail), and proof of household income (recent pay stubs, last tax return, Social Security or unemployment letter, or a self-attestation form for cash income). Bring your insurance card if you carry coverage. Bring a current medication list and any past medical records.
If you plan to apply for NC Medicaid during the visit, also bring Social Security numbers for everyone in the household and immigration documents if relevant. FQHCs serve patients regardless of immigration status.
Frequently Asked Questions
Are FQHCs in North Carolina really free?
At or below 100% FPL, FQHCs typically charge a nominal $20 to $35 per visit, and federal rules prohibit them from refusing care for inability to pay. Ask about the nominal fee policy when scheduling.
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. More than 500,000 new enrollees joined in the first months of expansion, and the program continues to onboard newly eligible residents.
Can undocumented immigrants use North Carolina free clinics?
Yes. FQHCs and NAFC free clinics serve patients regardless of immigration status. NC Medicaid is restricted to citizens and certain lawfully present immigrants, but emergency Medicaid covers ER care for income-eligible noncitizens.
Do North Carolina free clinics help with prescriptions?
Many do. FQHCs operate onsite 340B pharmacies with deeply discounted drug prices, and NAFC clinics often enroll eligible patients in manufacturer patient assistance programs for free brand-name drugs. Bring your medication list.
How do I find a free dental clinic in NC?
Many FQHCs operate dental clinics with sliding-scale fees, and several NAFC clinics provide free dental cleanings and basic restorative work. The NC Dental Society also coordinates Missions of Mercy events that provide free care to uninsured patients periodically.
Getting affordable care in North Carolina
North Carolina’s safety net is unusually deep, especially in NAFC clinics, partly because the state delayed Medicaid expansion for a decade. Between FQHCs in every region, one of the country’s strongest NAFC 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.
When to seek emergency care: Free clinics, FQHCs, and sliding-scale clinics are not equipped to handle medical emergencies. Call 911 or go to the nearest emergency room if you experience chest pain, signs of stroke, severe difficulty breathing, severe bleeding, head injury with loss of consciousness, or a mental health crisis (call or text 988). Federal law (EMTALA) requires emergency rooms to stabilize you regardless of your ability to pay, and ACA §501(r) charity care can apply to ER bills at nonprofit hospitals.