North Carolina Medicaid for Senior Care
Complete guide to Medicaid eligibility, coverage, and application process for nursing homes, assisted living, and home care in North Carolina.
7.6 million Medicaid long-term care recipients nationwide
North Carolina Department of Health and Human Services (NCDHHS) - Division of Health Benefits
Processing Time
30-45 days for standard Medicaid; CAP waiver enrollment can take 60-90 days due to screening requirements and county-level capacity variations
North Carolina Medicaid Eligibility Requirements (2026)
To qualify for Medicaid long-term care in North Carolina, applicants must meet both financial eligibility criteria (income and assets) and medical criteria (level of care needs). North Carolina follows federal Medicaid guidelines with some state-specific variations.
Income Limits
Individual Applicant
$2,982/month
Married Couple (One Applying)
$5,964/month
Income includes Social Security, pensions, annuities, interest, dividends, and rental income.
Asset Limits
Individual Applicant
$2,000
Community Spouse (At-Home Spouse)
$3,000
Primary residence, one vehicle, personal belongings, and prepaid burial arrangements are exempt from asset limits.
5-Year Look-Back Period
North Carolina Medicaid reviews all financial transactions for the 60 months prior to application. Asset transfers or gifts during this period can result in a penalty period of Medicaid ineligibility. The penalty is calculated by dividing the transferred amount by $7,956/month average (semi-private), $8,733/month (private) (the average monthly nursing home cost in North Carolina).
Medical Eligibility
Applicants must demonstrate need for nursing facility level of care through a state assessment. This typically requires assistance with 2-3 Activities of Daily Living (bathing, dressing, toileting, transferring, eating) or cognitive impairment requiring supervision.
Assessments are performed by state-designated evaluators (nurses or social workers) and typically take 45-90 minutes. The assessment can occur at home, in a hospital, or at the care facility.
What Medicaid Covers in North Carolina
Nursing Home Care
Medicaid pays 100% of nursing home costs in North Carolina once eligibility is established. The average monthly cost is $7,956/month average (semi-private), $8,733/month (private). Recipients contribute most of their monthly income toward care costs, keeping only $50-75 for personal needs.
Coverage includes room, board, 24-hour nursing care, meals, medications, therapy services, and all medical care provided at the facility.
Assisted Living Coverage
CAP Waivers - Adult Care Home Services: North Carolina's CAP/DA and CAP/C waivers include coverage for individuals living in Adult Care Homes (North Carolina's term for assisted living facilities). Medicaid covers personal care services, medication administration, and care coordination through the waiver programs. Room and board costs are not covered—residents pay housing costs (often $1,000-2,000/month for Medicaid beds) from their monthly income.
Note: This program covers personal care services but does not cover room and board costs. Residents need approximately $1,500-$2,500/month from Social Security or other income to cover housing expenses.
Home and Community-Based Services (HCBS) Waivers
North Carolina offers 3 HCBS waiver programs that provide in-home care and community services as an alternative to nursing facility placement.
Community Alternatives Program for Disabled Adults (CAP/DA)
Serves adults age 18+ (including elderly) with physical disabilities who meet nursing facility level of care. Provides adult day health, case management, home modifications, in-home aide services, institutional respite, personal care, skilled nursing, specialized supplies/equipment. Approximately 11,000 participants.
Program Details →Community Alternatives Program for Elderly and Disabled (CAP/C)
Serves individuals age 65+ who meet nursing facility level of care. Similar services to CAP/DA including adult day health, case management, home modifications, in-home aide, personal care, respite. Specifically designed for elderly individuals.
Program Details →Program of All-Inclusive Care for the Elderly (PACE)
Comprehensive medical and social services for frail elderly (55+) who meet nursing home level of care but prefer community living. Available in select counties through PACE organizations.
Program Details →How to Apply for Medicaid in North Carolina
North Carolina Medicaid applications typically take 30-45 days for standard Medicaid; CAP waiver enrollment can take 60-90 days due to screening requirements and county-level capacity variations. Starting the process early and submitting complete documentation helps avoid delays.
Application Methods
You can apply for Medicaid in North Carolina through:
- Online at ePASS.nc.gov (NC FAST system)
- Phone: 1-888-245-0179 (NC Medicaid Contact Center)
- Download application at epass.nc.gov and mail to local county Department of Social Services
- In-person at county DSS office (100 county offices statewide)
Step 1: Gather Required Documents
Before starting your application, collect:
- •Birth certificate and Social Security card
- •Proof of citizenship (passport, naturalization)
- •5 years of bank statements
- •Investment and retirement account statements
- •Property deeds and mortgage statements
- •Life insurance policies
- •Social Security award letter
- •Pension benefit statements
- •Medicare card
- •Doctor's statement of care needs
Step 2: Submit Your Application
Complete and submit your application through one of the methods listed above. If applying online or by mail, keep copies of all submitted documents.
Step 3: Medical Assessment
A state assessor will evaluate level of care needs. This assessment typically takes 45-90 minutes and covers functional abilities, medical needs, cognitive status, and safety concerns.
Step 4: Financial Review
Medicaid staff review all financial documents and investigate any transfers or gifts made in the past 60 months. They may request additional documentation during this process.
Step 5: Receive Determination
You'll receive written notification of approval or denial. Approved applications include the effective date of coverage (often retroactive up to 3 months), patient responsibility amount, and covered services.
Get Free Application Help
Free Medicaid application assistance is available in North Carolina from:
- •Area Agency on Aging: Call 1-800-677-1116 (Eldercare Locator) to find your local office
- •SHIP counselors: Free Medicare/Medicaid counseling
- •Nursing facility social workers: In-facility application support
- •Elder law attorneys: Paid help for complex financial situations ($2,000-$5,000)
North Carolina-Specific Programs and Resources
Medicare Savings Programs (QMB/SLMB/QI)
QMB pays Medicare premiums, deductibles, and coinsurance. SLMB pays Medicare Part B premium. QI pays Part B premium (limited funding).
Learn MoreSpecial Assistance (SA) for Adult Care Homes
State-funded program providing supplemental payments to help Medicaid beneficiaries afford room and board in Adult Care Homes. Combined Medicaid + SA payment helps cover housing costs.
Learn MoreNC Innovations Waiver
While primarily for individuals with intellectual/developmental disabilities, some older adults with lifelong disabilities qualify.
Learn MoreNeed Help with North Carolina Medicaid?
Contact North Carolina Department of Health and Human Services (NCDHHS) - Division of Health Benefits for specific questions about eligibility, application status, or covered services.