When Medicaid in North Carolina Will Pay for Long-Term Care in a Nursing Home

In North Carolina, Medicaid is a common source of funding for long-term care, particularly when people have already used up their own assets to pay for care. And that doesn't take long—in 2024, the average daily cost of a private room in a nursing home in North Carolina was $300 (more than $9,000 per month).

Private health insurance policies generally don't cover long-term care, and Medicare coverage for long-term care services is very limited. Plus, very few people purchase private long-term care insurance policies. That leaves Medicaid to cover the cost of nursing home care.

In North Carolina, the Department of Health and Human Services (DHHS) administers Medicaid through the NC Medicaid Division of Health Benefits.

But not everyone can get Medicaid to pay for nursing home care in North Carolina. To qualify, you must:

• medically require nursing care, and
• have income and assets under the state Medicaid limits.

The eligibility rules for long-term care services like nursing home care differ from other Medicaid services.

How to Apply for Medicaid for Long-Term Care in North Carolina

You can apply for Medicaid online using North Carolina ePASS. For help with your Medicaid application, contact the Department of Social Services office in your county. Walk-ins are welcome, but you can also call ahead to schedule an appointment.

If you'd like to apply by phone, or if you're disabled and need communication help, call the NC Medicaid Contact Center at 888-245-0179 (TTY: 711 or RelayNC.com).

When a Nursing Home Is Considered Medically Necessary in North Carolina

Medicaid will pay for a nursing home only when it's medically necessary. You must show that you "meet the nursing level of care," meaning that you need the kind of care that can only be provided in a nursing home.

To show that you meet a nursing home level of care, your physician must agree you need the kind of services that are only offered in a skilled nursing facility. For example, you can meet the nursing facility level of care by showing that you need:

• the services of a registered nurse for several hours a day
• daily assessments of your condition by a licensed nurse, or
• medication administered frequently by a nurse.

You're likely to meet the nursing home-level care requirement if you:

• have a nasogastric tube
• require dialysis
• require frequent injections, or
• need respiratory therapy.

You're not likely to meet the nursing home level of care requirement if you need only custodial care such as help with activities of daily living, such as:

• bathing
• dressing
• eating
• getting in or out of a bed or chair, or
• using the bathroom

(If you need these services, read the second part of this article to learn when North Carolina Medicaid will pay for assisted living or home health care.)

North Carolina's LTC Medicaid Income Limit

People who receive Supplemental Security Income (SSI) already qualify to receive Medicaid long-term care in North Carolina. If you don't receive SSI, you can qualify for regular Medicaid for the aged, blind, and disabled (ABD) if:

• you're 65 or older, blind, or disabled, and
• you meet the income limit of:
• $1,255/month (in 2025) for a household of one, or
• $1,704/month (in 2025) for a household of two (if both spouses are applying).

Qualifying for Medicaid Through North Carolina's Medically Needy Program

If your income is above the limit for regular Medicaid, you still might qualify for coverage through the Medicaid spend-down program if you're "medically needy." To be eligible as medically needy, you must have medical expenses that meet or exceed North Carolina's medically needy program limits.

To see if you qualify as medically needy for regular Medicaid, North Carolina treats your medical expenses like a deductible. Your medical expenses over six months must meet or exceed your deductible before Medicaid kicks in.

To determine your deductible, the NC Medicaid Division of Health Benefits will calculate by how much your monthly income exceeds the medically needy income limit (MNIL) and then multiply that amount by six (for six months). This amount is your Medicaid deductible.

In 2025, North Carolina's MNIL is $242 per month for an individual and $317 per month for a married couple.

Once you satisfy your deductible, you're eligible for Medicaid for the rest of the six-month period. After six months, NC Medicaid will assess another deductible.

To satisfy your deductible, you must show the Division of Health Benefits that your monthly medical expenses are more than your deductible. You don't have to pay your medical bills for them to count towards your deductible; you just need to show proof that you have the expenses.

North Carolina's Nursing Home Medicaid Income Limit

For Medicaid to cover the cost of living in a nursing home, your monthly income must be less than the amount Medicaid typically pays for nursing home care (around $8,000-$11,000). North Carolina Medicaid doesn't count your spouse's income toward eligibility unless your spouse is also applying for nursing home Medicaid.

And you generally don't have to meet a deductible. Instead, you pay all your countable monthly income—minus a $70 personal needs allowance—to help cover the cost of your nursing home care.

North Carolina's Medicaid Resource Limit

To qualify for Medicaid in North Carolina, you must have no more than $2,000 in resources (assets like money and property). But some property doesn't count toward the resource limit. In North Carolina, your home is exempt up to an equity value of $730,000 (in 2025), as long as:

• you intend to move back home at some point, or
• your spouse or another dependent relative still lives there.

In addition, one car is exempt if it's used for transportation for you, your spouse, or a dependent relative. NC Medicaid also exempts personal belongings and household goods. In North Carolina, retirement accounts (IRAs) count as assets to the extent you can withdraw money from them.

Spousal Maintenance Allowance in North Carolina

If your spouse is going to continue to live independently while you go to a nursing home, North Carolina will allow you and your spouse to keep more income and assets to support that spouse.

Your Income and the Minimum Monthly Maintenance Needs Allowance

First, your spouse (called the "community spouse") has the right to a minimum monthly maintenance needs allowance (MMMNA) under federal spousal impoverishment rules. (42 C.F.R. § 435.725(c)(2).) Those rules entitle your spouse to keep some of your income.

The amount the Division of Health Benefits determines your spouse can keep will depend on how much separate income your spouse has and what your spouse spends on housing. In 2025, North Carolina's the minimum monthly community spouse income allowance is $2,555. A community spouse whose total income is less than the MMMNA amount can keep some of the institutionalized spouse's income, to bring their income up to $2,555 per month.

But if a community spouse has high housing and utility costs, they can keep more of the institutionalized spouse's income, to bring their income up to $3,948 per month.

In addition, if you have dependents who will remain in the community while you go to a nursing home, the state might allow these dependents to keep some of your income. This is called the dependent family member allowance. To qualify for the allowance, you must claim these family members as dependents on your tax return.

How much of your income your other dependents can keep depends on whether they have incomes of their own. The most that a single dependent can keep is about $852 per month.

Your Assets and the Community Spouse Resource Allowance

North Carolina assumes that half of the assets that you had at the time of your first admission to a nursing home (called the "community spouse resource allowance," or CSRA) belong to your spouse, subject to a limit that changes annually.

North Carolina's CSRA maximum limit in 2025 is $157,920. Your spouse can keep half of your joint assets, up to $157,920. North Carolina's minimum CSRA is $31,584. If half of your joint assets don't reach $31,584, your spouse gets to keep $31,584 in assets.

When you apply for Medicaid, the state will tell you how much your community spouse can keep. If your spouse needs more, you can go to court and ask a judge to allow a higher CSRA.

When you apply for Medicaid, your CSRA (the value of your spouse's allowable assets) is subtracted from your total countable assets at the time of your application.

Personal Needs Allowance in North Carolina

If you receive Medicaid and live in a nursing home, you'll be expected to spend almost all of your income on your care. North Carolina allows nursing home residents receiving Medicaid to keep just $70/month as a personal needs allowance.

Read on to find out about when Medicaid will pay for assisted living or home health care in North Carolina.

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