Long-Term Care Medicaid in North Carolina: 2026 Guide

In North Carolina, Medicaid is run by NC Medicaid, part of the North Carolina Department of Health and Human Services (NCDHHS), and eligibility is decided by your county Department of Social Services (DSS). Long-Term Care Medicaid can pay for nursing home care and for care at home through the Community Alternatives Program for Disabled Adults (CAP/DA) and PACE. North Carolina does not use a fixed income cap for nursing home care. This guide explains the 2026 rules in plain language.

At a glance: North Carolina 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with NC Medicaid before relying on them.

What Long-Term Care Medicaid covers in North Carolina

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.

CAP/DA (Community Alternatives Program for Disabled Adults). This is North Carolina’s main home and community-based program for adults 18 and older with disabilities and adults 65 and older who are at risk of nursing home placement. It is for people who need a nursing facility level of care and at least one waiver service. Services can include in-home aide help, adult day health, home-delivered meals, respite, equipment and changes to the home, arranged by a CAP/DA case management agency in your county. CAP/DA has a limited number of slots, so there may be a wait.

PACE (Program of All-Inclusive Care for the Elderly). For people 55 and older who live in a PACE service area and need a nursing facility level of care. A PACE team provides and coordinates all care, often at a PACE center.

Assisted living and adult care homes. Medicaid does not pay room and board in an adult care home. Some personal care services there may be covered for eligible residents.

Who qualifies

A person generally must:

• be 65 or older, or blind or disabled;
• live in North Carolina and be a U.S. citizen or qualified non-citizen;
• need a nursing facility level of care. For nursing homes, this is set through the state’s level-of-care process. For CAP/DA, the county case management agency arranges the assessment;
• meet the income and asset rules below, as decided by the county DSS.

Income rules

North Carolina does not have a fixed income cap for nursing home Medicaid. A nursing home applicant is financially eligible if their countable monthly income, after allowed deductions, is less than the facility’s private rate for 31 days. Because nursing home costs are high, many people with moderate or higher incomes qualify this way. Income then goes toward the cost of care.

Income rules for CAP/DA differ from the nursing home rule. Ask your county DSS how your income is counted for home care.

Once you are on Medicaid in a nursing home, most of your income goes to the facility. You keep a personal needs allowance of $70 a month ($140 for a couple), and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable assets, and a couple $3,000.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home site (equity up to $752,000 for nursing home care) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and irrevocable prepaid funeral contracts, within DSS rules

The $752,000 home equity limit does not apply if a spouse, a child under 21, or a blind or disabled child lives in the home.

Spousal protections

• Assets: The spouse at home keeps half of the couple’s countable assets, but not less than $32,532 or more than $162,660 in 2026, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income. If it is below $2,705 a month (from July 1, 2026), part of the applicant’s income can go to them. Extra is allowed for housing costs above $812 a month, up to $4,067 a month.

Look-back and penalties

When you apply, North Carolina looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($11,904 a month).

Example: Suppose you gave your son $50,000 three years before applying. $50,000 divided by $11,904 is about 4.2 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in North Carolina

North Carolina’s Medicaid Estate Recovery Program is run by NC Medicaid.

• What is recovered: Medicaid paid for nursing facility care, CAP services and related hospital and prescription costs, for people 55 and older or permanently in a nursing facility.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: NC Medicaid can waive or put off recovery in some situations. Ask NC Medicaid for the current rules, including any small-estate limits.
• Family members and estate administrators can contact NC Medicaid Estate Recovery with questions.

How to apply

• Online: ePASS, North Carolina’s benefits website
• In person or by mail: at your county Department of Social Services
• For CAP/DA: contact the CAP/DA case management agency for your county (NC Medicaid lists them by county). It handles the referral and assessment.
• For PACE: contact the PACE organization that serves your area.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in North Carolina

• NC Medicaid and your county DSS: Medicaid applications and eligibility.
• Area Agencies on Aging: local information on long-term care options.
• SHIIP (Seniors’ Health Insurance Information Program): North Carolina’s free Medicare counseling program (SHIP), through the NC Department of Insurance.
• North Carolina Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and adult care homes.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including North Carolina:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). North Carolina’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect North Carolina’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• North Carolina CAP/DA Waiver
• North Carolina Medicaid Personal Care Services

Frequently asked questions

Is there an income limit for nursing home Medicaid in North Carolina? There is no fixed dollar cap. You can qualify if your countable income is less than the nursing home’s private rate for 31 days. Most of your income then goes toward care.

What is CAP/DA? It is North Carolina’s Medicaid program for care at home for adults who would otherwise need a nursing home. A local case management agency arranges the services.

How much can my spouse keep? In 2026, half of the couple’s countable assets, at least $32,532 and up to $162,660, plus the home, a car and belongings, and income of at least $2,705 a month.

Does my home count? Not while you, your spouse or a dependent relative lives there. For nursing home care, equity above $752,000 can block payment unless a spouse or a young or disabled child lives in the home.

How long is the penalty for a gift? Divide the gift by $11,904 to get the number of months. A $20,000 gift would mean about 1.7 months without Medicaid payment for long-term care.

Will the state take my home after I die? NC Medicaid can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with NC Medicaid before relying on them.

Sources

• NCDHHS, MA-2230 Financial Resources
• NCDHHS, MA-2231 Community Spouse Resource Protection
• NCDHHS, MA-2240 Transfer of Assets
• NCDHHS, MA-2242 Home Equity Value
• NCDHHS, MA-2270 Long-Term Care Need and Budgeting
• NC Medicaid, CAP/DA
• NC Medicaid, CAP/DA case management agencies by county
• ePASS
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.