North Carolina
What is the Definition of North Carolina Medicaid Long-Term Care?
Medicaid is a health care program designed for low-income individuals of all ages. In this section, we focus on long-term care Medicaid eligibility for elderly residents of North Carolina, aged 65 and older. Medicaid in NC helps pay for a variety of services, including care in nursing homes, assisted living facilities, and family care homes (adult foster care homes). In addition to institutional care, NC Medicaid provides non-medical services and supports that assist frail seniors in remaining in their homes. There are three key categories of Medicaid long-term care programs available to seniors in North Carolina:
1) What is Institutional / Nursing Home Medicaid?
This is an entitlement program, meaning anyone who qualifies will receive assistance. However, the benefits are available exclusively in nursing homes.
2) What are Medicaid Waivers / Home and Community-Based Services (HCBS)?
Unlike the previous program, this is not an entitlement, meaning there are limited slots, and waiting lists may apply. The services are meant to delay nursing home admission and may be provided at home, adult day care, family care homes, or in assisted living settings.
3) What is Regular Medicaid for the Aged, Blind, and Disabled?
This is also an entitlement program, with benefits available to those who meet the eligibility requirements. Limited long-term care services like personal care assistance or adult day care are included.
North Carolina’s Medicaid program is funded by both state and federal governments but is managed by the state under federal guidelines. The North Carolina Department of Health and Human Services (DHHS), through the Division of Medical Assistance (DMA), administers the program.
The American Council on Aging offers a free, quick, and easy Medicaid Eligibility Test for seniors.
What are the Income and Asset Limits for Eligibility?
Different Medicaid long-term care programs in North Carolina have various financial and medical eligibility requirements, which change annually and depend on marital status. Additionally, North Carolina provides alternative pathways for eligibility.
What are the Simplified Eligibility Criteria for a Single Nursing Home Applicant?
In 2025, a single Medicaid Nursing Home applicant must meet the following criteria:
- Income under the Medicaid pay rate (estimated to be between $8,004 and $11,093 per month).
- Assets under $2,000.
- Requires Nursing Home Level of Care (NHLOC).
How Do the Limits Differ for Other Applicants?
The table below provides reference information for various applicant scenarios, such as a single applicant, married applicants, or one spouse applying for Medicaid.
| Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) |
|---|---|---|---|
| Institutional / Nursing Home Medicaid | Income limit < $8,004–$11,093/mo* | $3,000 asset limit | $2,000 for applicant & $157,920 for non-applicant |
| Medicaid Waivers / HCBS | $1,305/month† | $1,763/month† | $1,305/month for applicant† |
| Regular Medicaid / Aged Blind & Disabled | $1,305/month | $1,763/month | $1,763/month |
*Note: All of a beneficiary’s monthly income (except for some allowances) must be paid to the nursing home.
What is Considered Countable and Non-Countable Income?
What is Countable Income for Medicaid Eligibility?
Countable income includes wages, alimony, pension payments, Social Security Income, IRA withdrawals, and dividends. There are some exceptions such as VA Aid & Attendance payments and Holocaust restitution, which are not counted.
How Does Medicaid Treat Income for a Married Couple?
For a married couple, only the income of the applicant is counted. The non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA), which helps prevent impoverishment. The MMMNA in NC is $2,644 (effective 7/1/25 to 6/30/26). Additionally, if the non-applicant’s housing costs exceed $794/month, they may receive further assistance.
What are the Rules for Assets and Asset Spend Down?
What are Countable vs. Non-Countable Assets?
Countable assets include cash, investments, bank accounts, and real estate. Non-countable assets include personal belongings, household items, and one’s primary home.
How are Assets Treated for Married Couples?
When only one spouse applies, the couple’s assets are considered jointly owned. However, the Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain a larger portion of the couple’s assets, up to $157,920 in 2025.
What is the Medicaid Look-Back Rule?
North Carolina has a 60-month look-back period, during which Medicaid reviews all asset transfers. Any transfer that appears to be made under fair market value to meet Medicaid’s asset limit could result in a Penalty Period of ineligibility.
How Does the Home Exemption Work for Medicaid?
A home is generally exempt from Medicaid’s asset limit as long as the applicant or their spouse lives there. If neither resides in the home, the applicant must show intent to return. There is a $730,000 equity interest limit for the home in 2025.
What are the Medical / Functional Need Requirements?
To qualify for Medicaid long-term care, an applicant must demonstrate a medical need for services. For Nursing Home Medicaid and Medicaid Waivers, this requires a Nursing Home Level of Care (NHLOC).
How Can Seniors Qualify if They Exceed the Financial Limits?
1) What is the Medically Needy Pathway?
North Carolina offers a Medically Needy program for applicants with income above the eligibility limit, but they can still qualify by incurring high medical bills.
2) What is Asset Spend Down?
Individuals with assets exceeding the Medicaid limit can “spend down” excess assets on non-countable items like home improvements or prepaying funeral expenses.
3) What is Medicaid Planning?
For individuals over-income or over-asset, Medicaid planning allows for strategies to qualify for Medicaid while protecting assets.
What Specific Medicaid Programs are Available in North Carolina?
Community Alternatives Program for Disabled Adults Waiver (CAP/DA)
This program covers services like adult day health care and in-home personal care assistance for those who are disabled or elderly.
Personal Care Services (PCS)
PCS provides home-based personal care attendants, and it’s an entitlement benefit.
Program of All-Inclusive Care for the Elderly (PACE)
PACE combines Medicaid and Medicare benefits, providing comprehensive services.
Money Follows the Person (MFP) Program
MFP helps individuals transition from institutional care back to home or community-based living.
How Can One Apply for North Carolina Medicaid?
Seniors can apply for Medicaid in North Carolina through ePASS, in person at their local DSS office, or by submitting a paper application. It is essential to ensure eligibility before applying. If income or assets are a concern, Medicaid Planning services may be helpful.
