North Carolina Medicaid for seniors and long-term care
Last verified: June 2026
LTC Medicaid rules are separate from standard NC Medicaid — apply through your county DSS
NC has a separate application process for long-term care Medicaid
How NC Medicaid covers long-term care
NC Medicaid provides two primary long-term care pathways: nursing facility placement and home- and community-based services (HCBS) through waiver programs. Both pathways require the applicant to meet a medical level-of-care standard — essentially demonstrating that the person needs nursing-facility-equivalent care. Financial eligibility rules are separate from standard Medicaid and include an asset test.
The asset limit is $2,000 for a single individual. Certain assets are exempt: a primary home (subject to conditions), one vehicle, personal and household items, and pre-paid funeral arrangements within limits. The home exemption is conditional — it stops applying in some situations and is subject to estate recovery after death.
CAP/DA — NC's primary home-based waiver for adults
The Community Alternatives Program for Disabled Adults (CAP/DA) is NC's Section 1915(c) HCBS waiver serving adults who would otherwise require nursing facility care. CAP/DA allows eligible enrollees to receive care at home or in the community rather than in an institution. This is typically the preferred option for people who want to remain in their homes.
Services available through CAP/DA include personal care assistance, home health aide services, adult day health programs, respite care for family caregivers, home-delivered meals, assistive technology, and care coordination. Not all services are available to every enrollee — the care plan is individualized based on assessed needs.
CAP/DA has limited slots. A waitlist may apply, and enrollment depends on availability in your region. Contact your county DSS or call NCDHHS to inquire about current wait times. Getting on the waitlist as early as possible matters.
Other HCBS waiver programs
NC operates additional Section 1915(c) waivers beyond CAP/DA:
- CAP/C (Community Alternatives Program for Children) — for children with complex medical needs who require nursing-level care
- CAP/IDD — for individuals with intellectual and developmental disabilities; managed through Tailored Plans
- NC Innovations Waiver — IDD-specific waiver with slots managed by regional Tailored Plans
For IDD-related waiver services, the relevant Tailored Plan for your region (Alliance Health, Partners Health Management, Trillium Health Resources, or Vaya Health) coordinates the application process and manages the waitlist. Contact your regional Tailored Plan directly for IDD-related waiver inquiries.
PACE — an alternative for adults 55 and older
Program of All-inclusive Care for the Elderly (PACE) is available in select NC counties for adults age 55 and older who meet nursing facility level of care but choose to live in the community. PACE wraps medical care, personal care, adult day services, and social services into a single coordinated program. Not all counties in NC have a PACE organization — check with NCDHHS or search CMS's PACE locator to determine availability in your area.
Nursing facility coverage
NC Medicaid covers nursing facility care for enrollees who meet the clinical and financial criteria. The nursing facility must be Medicaid-certified. Once approved, Medicaid pays the facility directly — the enrollee contributes their income (minus a personal needs allowance) toward the cost of care.
Spousal impoverishment protections under federal law apply when one spouse enters a nursing facility and the other remains in the community. The community spouse is entitled to retain a Community Spouse Resource Allowance (CSRA), set by federal and state formula, and a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the institutionalized spouse's income. Your county DSS can calculate the specific amounts for your situation.
NC's estate recovery program
North Carolina participates in Medicaid estate recovery, as required by federal law under 42 U.S.C. § 1396p. After an enrollee who received Medicaid long-term care services passes away, NCDHHS may file a claim against the estate for the cost of services paid by Medicaid. Recovery applies to nursing facility care, HCBS waiver services, and related hospital and prescription costs for enrollees age 55 and older.
Certain hardship exemptions exist — for example, when a surviving spouse, minor child, or blind or disabled child is living in the home. A Medicaid planning attorney can help families understand what protections apply and how to plan for estate recovery before applying for long-term care Medicaid. This page is informational only and is not legal or financial advice.
Long-term care Medicaid rules are complex and change periodically. This page does not constitute legal, financial, or medical advice. Contact your county Department of Social Services or consult a licensed elder law attorney for guidance specific to your situation. Verify current rules at medicaid.ncdhhs.gov. Last verified: June 2026.
Spousal impoverishment protections at a glance
Federal law (42 U.S.C. § 1396r-5) protects the community spouse when the other spouse enters a nursing facility. NC applies these protections through county DSS eligibility determinations.
| Protection | 2025 amount | Notes |
|---|---|---|
| Community Spouse Resource Allowance (CSRA) | Up to ~$157,920 | Federal maximum; verify current NC figure with county DSS or an elder law attorney |
| Minimum Monthly Maintenance Needs Allowance (MMMNA) | Set annually | Community spouse retains income to cover living expenses; floor and cap updated each January by CMS |
| Institutionalized spouse asset limit | $2,000 | Countable resources only; primary home (while community spouse occupies), one vehicle, and personal effects are exempt |
Verify current CSRA and MMMNA amounts with your county DSS or a licensed NC elder law attorney. Source: 42 U.S.C. § 1396r-5; NCDHHS nursing facility Medicaid rules.
CAP/DA waitlist: get on it as early as possible
The Community Alternatives Program for Disabled Adults (CAP/DA) is NC Medicaid's primary home- and community-based waiver for adults who would otherwise require nursing facility care. CAP/DA allows eligible enrollees to receive personal care, home health aide services, adult day health programs, respite care, and other support at home.
CAP/DA has limited enrollment slots. A waitlist typically applies, and how long you wait depends on regional availability and need. Getting on the waitlist before a crisis — while the person can still live at home with family support — is strongly recommended. Contact your county DSS or call NCDHHS at 1-888-245-0179 to inquire about current waitlist status in your county.
PACE provides an alternative for adults 55+ in select NC counties
What North Carolina long-term care Medicaid covers
- Nursing facility care (indefinite, once medical and financial criteria are met)
- CAP/DA — personal care, home health aide, adult day health, and respite at home or in the community
- CAP/C — home-based services for children with complex medical needs
- CAP/IDD and NC Innovations Waiver — for individuals with intellectual and developmental disabilities (through Tailored Plans)
- PACE — all-inclusive day health and community care for adults 55+ in select counties
- Transportation to medical appointments
- Assistive technology and home modifications (through HCBS waivers)
- Care coordination through your CHC-enrolled managed care plan
North Carolina participates in Medicaid estate recovery