Medicaid for North Carolina Residents Needing Assisted Living or Home Health Care

North Carolina's main Medicaid program doesn't pay for assisted living facilities or home health care in the same way it does for nursing home care. But it does offer a few waiver programs and special assistance programs that can help pay the costs.

(For more on nursing home coverage, see Nolo's article on when Medicaid pays for nursing homes in North Carolina.)

Medicaid Coverage of Assisted Living Services in North Carolina

Assisted living facilities are generally less expensive and less medically intensive than nursing homes, but they aren't cheap by any means. And most North Carolina residents living in assisted living facilities pay their own costs.

Assisted Living Benefits in North Carolina

Generally speaking, Medicaid doesn't cover room and board fees in assisted living facilities. But if you have little income and few assets, you might qualify for a state or county program that helps pay for assisted living facilities (discussed below).

If you don't qualify for these programs, you may be able to use home health care benefits at an assisted living facility (ALF) to help pay for some services. So while you may need to pay for your own room and board at an ALF, you might be able to get certain home health aide services, like medication management, bathing assistance, or personal care aide services paid for through a Medicaid program, which can lower the cost of assisted living. (A doctor must prescribe these services, and you must show you need help with your activities of daily living.)

State and County Special Assistance for Adult Care Home Residents

If you receive Supplemental Security Income (SSI) and live in an assisted living facility (adult care home) in North Carolina, you might qualify for a benefit called State and County Special Assistance (SA). The SA program pays for room and board expenses up to $1,359/month (in 2025), plus you'll receive a $70 monthly personal needs allowance.

People with dementia who live in specialized care units for Alzheimer's and related disorders can also qualify for SA benefits. The program pays up to $1,743/month (in 2025) for a special care unit, plus the $70 personal care allowance. The rates are adjusted annually, based on the Social Security cost-of-living change.

If you don't receive SSI, to qualify for SA, your countable income must be less than $1,428.51 per month (in 2025) and you must have less than $2,000 in countable assets (not including your car, home, and personal property). If you're seeking to live in a special care unit, your countable income must be less than $1,812.51 per month.

North Carolina's Special Assistance In-Home Program

A separate program, called the Special Assistance In-Home (SAIH) program, provides a similar benefit for people with low incomes who could live in an assisted living home but want to stay in their own homes. SAIH is an income supplement you can use to help cover living expenses, such as food and shelter or other costs that enable you to live at home safely, such as:

• in-home aide services
• essential household items, and
• home repairs and modifications.

To apply for SA or SAIH, contact your local county Department of Social Services office.

Medicaid Coverage of Home Health Services in North Carolina

Home health care can include a variety of services, including:

• skilled nursing or therapy services
• home health aide services like medication management or bathing assistance, and
• personal care aide services like meal preparation or cleaning.

If you already receive Medicaid in North Carolina for doctor and hospital visits, the program will pay for some home health services like nursing, therapy, medical supplies, and equipment. Your doctor must prescribe home health services for you as part of a plan of care for a particular condition.

Medicaid might also pay for personal care services, but only as prescribed by your doctor according to a plan of care, and only up to 80 hours per month. To qualify for personal care services, you must show that you need help with your activities of daily living.

North Carolina Medicaid HCBS Waiver and PACE Programs

If you have an ongoing need for personal care services, you can apply for assistance from one of North Carolina's Medicaid home and community-based service (HCBS) waiver programs or its PACE Program (see below).

North Carolina operates two HCBS Medicaid waiver programs: the Community Alternatives Program for Disabled Adults (CAP/DA) and CAP/Consumer-Directed (formerly called CAP/Choice). Both CAP waiver programs pay for community-based services aimed at helping Medicaid beneficiaries live at home or in the community instead of an institution. To qualify for either waiver, you must:

• be 65 or older, blind, or disabled
• need a nursing facility level of care, and
• show that you're at risk of institutionalization within 30 days without these services.

You must apply for these HCBS service waivers. Because Medicaid waivers aren't entitlements, they serve a limited number of people, so you might face a waiting list.

North Carolina's CAP/DA Waiver

The CAP/DA program provides a wide range of home and community-based services for participants, such as:

• adult day health
• personal care aide
• home modification and mobility aids
• meal preparation and delivery
• respite services
• personal emergency response services
• transition services
• assistive technology, and
• case management.

With CAP/DA, an agency arranges the services for you and oversees your plan of care.

North Carolina's CAP/Consumer-Directed Waiver

If you prefer to select and train your own HCBS providers, you can apply for the CAP/Consumer-Directed waiver. The consumer-directed CAP waiver offers all the services that CAP/DA offers, but you or your designated representative direct your own care. You get to choose, hire, and supervise your personal care providers, which can be family members—including adult children and spouses.

North Carolina's Medicaid waiver program pays your caregiver's salary. To help you, the CAP/Consumer-Directed waiver also pays for people to advise you, such as a:

• personal assistant
• care advisor, and
• financial manager.

To find out more about the CAP/DA and CAP/Consumer-Directed waiver programs, contact the CAP Case Management Agency in your county. (You can download a list of agencies here.)

Waivers for People With Developmental Disabilities

North Carolina has other waiver programs for individuals with developmental disabilities and for children with fragile medical conditions. For more information about these waivers, contact the NC Medicaid Contact Center at 888-245-0179.

North Carolina's PACE Programs

Programs of All-Inclusive Care for the Elderly (PACE) currently operate in several communities in North Carolina. To qualify for PACE, you must:

• be 55 or older
• live in an area served by a PACE agency
• meet North Carolina's nursing home level of care standard
• be able to live safely in the community with PACE services, and
• meet program-specific eligibility conditions imposed under the respective PACE agreement.

If you don't receive Medicaid, you can use Medicare to pay for PACE, or you can pay for the program yourself.

PACE participants receive their services from an interdisciplinary team of professionals like:

• physicians
• nurses, and
• social workers.

The team works together to coordinate individualized care and services to keep seniors in their own homes and communities.

If you receive Medicaid and participate in a PACE program, Medicaid pays for all the services recommended by your care team. If you're interested in a PACE program, contact the program directly to apply. Contact the PACE program serving your community to learn more.

Get Help Moving Out of a Nursing Home in North Carolina

North Carolina operates a federal program called the Money Follows the Person (MFP) that helps people move out of institutions and into less restrictive settings. You might qualify for MFP program assistance if:

• you're a senior (65 or older) or disabled
• you have lived in an institution for at least 90 days, and
• you meet the nursing facility level of care but want to live in your home or a community-based setting.

MFP provides a variety of services designed to help you live independently in your home, including:

• homemaker and chore help
• day services
• home accessibility adaptations, and
• home health aide services.

To apply, call the North Carolina Money Follows the Person Project by calling 855-761-9030 or emailing the NC Department of Health and Human Services at [email protected].

Supportive Services for North Carolinians Who Don't Qualify for Medicaid

If you don't qualify for Medicaid and don't meet the nursing home level of care, you might still qualify for some services like transportation, meals, and in-home help. North Carolina's Area Agencies on Aging administer various programs that offer support to seniors.