Medicaid Long-Term Care Guide in North Carolina
Long-term care eligibility, benefits, and how to apply through the North Carolina Department of Health and Human Services, Division of Medical Assistance (DMA).
What makes North Carolina Medicaid different
North Carolina's Medicaid program is jointly funded by the state and federal government but administered by the state under federally set parameters. The Division of Medical Assistance (DMA) is the administering agency. In addition to nursing home care, NC Medicaid pays for services in assisted living facilities, family care homes (adult foster care), and non-medical supports to help frail seniors remain living at home.
Administered by the North Carolina Department of Health and Human Services, Division of Medical Assistance (DMA).
Program Types
Institutional / Nursing Home Medicaid
An entitlement; anyone who is eligible will receive assistance. Benefits are provided in Medicaid-certified nursing homes.
Level of care: Nursing Home
Medicaid Waivers / Home and Community Based Services (HCBS)
Not an entitlement; the number of participants is limited and waiting lists may exist. Benefits are intended to delay nursing home admissions and may be provided at home, adult day care, family care homes, or in assisted living.
Level of care: Nursing Home
Regular Medicaid / Aged Blind and Disabled
An entitlement; anyone who meets the eligibility requirements receives assistance. While Regular Medicaid is not Long-Term Care Medicaid, limited long-term care services, such as personal care assistance or adult day care, may be available.
Level of care: Help with ADLs
2026 North Carolina Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid*
Medicaid Waivers / Home and Community Based Services†
Regular Medicaid / Aged Blind and Disabled
*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $70.00 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.
Explore North Carolina Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to North Carolina.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — North Carolina
How the main LTC programs available in North Carolina compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $14–17/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | $45–60/day | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
North Carolina Medicaid programs
Innovations Waiver
Coordinated Caregiving (SFC)
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in North Carolina
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Structured Family Caregiving (SFC) — tax-free daily stipend
Available in North CarolinaHow to enroll: Contact Careforth (careforth.com) or FreedomCare (freedomcare.com) — both operate in North Carolina and handle enrollment at no charge.
Consumer-directed care — hourly pay
Available in North CarolinaHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: DHHS · ncdhhs.gov/medicaid
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in North Carolina
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in North Carolina. The process typically takes 45–90 days from application to first paycheck.
Apply in North Carolina: DHHS · ncdhhs.gov/medicaid
Medicaid Eligibility Screener — North Carolina
Answer 7 quick questions — we'll check the financial and care requirements for North Carolina and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly all income from any source is counted, including employment wages, alimony, pension payments, SSDI, SSI, IRA withdrawals, and stock dividends.
- Nationally, Holocaust restitution payments are not counted as income.
- In NC, the VA Aid & Attendance, which is above and beyond the Basic VA Pension, does not count.
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,644 (eff. 7/1/25 – 6/30/26). If a non-applicant spouse's income is under this amount, income can be transferred from the applicant spouse.
- A non-applicant spouse can increase their Spousal Income Allowance if housing/utility costs exceed a shelter standard of $794 / month (eff. 7/1/25 – 6/30/26), up to a Maximum MMMNA of $4,066.50 / month.
- For Regular Medicaid, both spouses' income is counted. There is no MMMNA for a non-applicant spouse.
- In North Carolina, persons determined eligible for SSI are automatically approved for Medicaid.
- Countable assets include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside.
- In North Carolina, IRAs are counted as assets.
- Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one's primary home.
- All assets of a married couple are considered jointly owned regardless of the Medicaid program.
- The CSRA allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660 (2026). If the non-applicant's share is under $32,532, up to $32,532 can be retained.
- There is no CSRA for Regular Medicaid.
- The home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.
- If this is not the case, there is a home equity interest limit of $730,000 (in 2026).
- Home equity is the value of the home minus any outstanding debt. Equity interest is the amount of equity owned by the applicant.
- If neither the applicant nor qualifying family live in the home, the applicant must have Intent to Return.
- There is no home equity interest limit for Regular Medicaid.
- The home is NOT exempt from Medicaid's Estate Recovery Program. After a beneficiary's death, North Carolina's Medicaid agency attempts reimbursement of care costs through the deceased's estate.
- North Carolina has a 60-month Look-Back Period for Nursing Home Medicaid and Medicaid Waiver applications.
- Medicaid checks all past asset transfers, including those by a spouse, to ensure none were sold or gifted under fair market value.
- Violations result in a Penalty Period of Medicaid ineligibility.
- The Look-Back Period does not apply to Regular Medicaid.
- The U.S. Federal Gift Tax Rule ($19,000 per recipient in 2026) does not extend to Medicaid eligibility — gifting under this rule violates the Look-Back Period.
- MMMNA: $2,644 · CSRA: $162,660 · CSRA Min: $32,532
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,644 (eff. 7/1/25 – 6/30/26). Income can be transferred from the applicant spouse if the non-applicant's income is below this level.
- A non-applicant can increase their Spousal Income Allowance if housing/utility costs exceed the shelter standard of $794 / month, up to a maximum of $4,066.50 / month.
- The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (min $32,532) in 2026.
- For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.
- Medically Needy Pathway — North Carolina has a Medically Needy / Spend-Down program. The MNIL is $242 / month for a single individual and $317 / month for a married couple (unchanged for many years). The spend-down is calculated for a 6-month period. Medical expenses (insurance premiums, prescriptions, doctor visits, hospitalizations, medical supplies) can be used. The medically needy asset limit is $2,000 (individual) and $3,000 (couple).
- Asset Spend-Down — Spend excess assets on non-countable items such as home improvements (new air conditioning, furniture), home modifications (wheelchair ramps, grab bars, stair lifts), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof the Look-Back Rule was not violated.
- Medicaid Planning — Work with a Medicaid Planning Professional to employ strategies to become eligible and protect your home from Medicaid's Estate Recovery Program.
North Carolina does not use Qualified Income Trusts (Miller Trusts). The Medically Needy / Spend-Down program is available for persons over the income limit. Note that the Nursing Home Medicaid income limit is tied to the Medicaid pay rate for the facility, which is significantly higher than the Waiver/Regular Medicaid limits.
North Carolina Medicaid Programs
Community Alternatives Program for Disabled Adults (CAP/DA) Waiver
Pays for adult day health care, in-home personal care assistance, minor home modifications, and other services that help persons who are disabled or elderly live at home. The CAP/Consumer-Directed option allows beneficiaries to choose their own care providers and hire family members, including adult children and spouses, as personal caregivers paid by the Medicaid program.
Personal Care Services (PCS)
A Medicaid State Plan benefit that provides a personal care attendant in the home for an approved number of hours. Unlike CAP/DA, PCS is an entitlement and does not have a waiting list.
Program of All-Inclusive Care for the Elderly (PACE)
Combines the benefits of Medicaid, including long-term care services, and Medicare into one program. Additional benefits, such as dental and eye care, may be available.
Money Follows the Person (MFP)
A federal program that helps institutionalized persons who are eligible for Medicaid to transition back home or to another community setting.
How to Apply
- Apply online at ePASS
- Apply in person at a local Division of Social Services (DSS) office
- Call a local DSS office to apply by phone
- Print and submit a completed Medicaid application to a local DSS office
It is imperative that applicants be certain they meet all eligibility requirements prior to applying. Seniors with excess income and/or assets should consider Medicaid Planning to ensure eligibility requirements will be met.
More North Carolina Long-Term Care Resources
North Carolina Long-Term Care Costs
Compare assisted living, home care, and nursing home costs.
North Carolina Senior Services Directory
Find local aging agencies, support programs, and community resources.
Veterans Long-Term Care Benefits
Aid & Attendance, caregiver programs, and VA nursing home coverage.
Take the Next Step for North Carolina Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- North Carolina Department of Health and Human Services, Division of Medical Assistance (DMA) — North Carolina Medicaid — Official site