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Medicaid Waivers and Assisted Living

North Carolina has no Medicaid waiver dedicated to assisted living. CAP/DA pays for in-home services only, and room and board in an adult care home is instead covered through State/County Special Assistance.

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Short answer

North Carolina does not run a Medicaid waiver dedicated to assisted living. Its one Medicaid HCBS waiver relevant to seniors, CAP/DA, pays for in-home services only. Room and board inside an adult care home is instead covered through State/County Special Assistance, a state- and county-funded cash program -- not a Medicaid waiver.

CAP/DA: in-home only

Community Alternatives Program for Disabled Adults (CAP/DA) is NC's Medicaid HCBS waiver (1915(c)) for adults 18+ who need a nursing-facility level of care but wish to remain in their own home/community. It covers 18 in-home and community-based services including adult day health, in-home aide services, home modifications/equipment, meal preparation, respite care, personal emergency response systems, specialized medical supplies, case management, and consumer-directed care allowing beneficiaries to hire/supervise their own caregivers.

Special Assistance: room and board, not a waiver

North Carolina does NOT have a Medicaid HCBS waiver specifically covering room-and-board or services in assisted living/adult care homes. There is no 'CAP/AL' or equivalent ALF waiver in NC's Medicaid waiver portfolio. Room and board in adult care homes for low-income residents is instead covered through the State/County Special Assistance (SA) program, which is explicitly a state- and county-funded cash supplement program, NOT a Medicaid waiver (see nf_medicaid/merp-adjacent note below). SA recipients are also automatically eligible for Medicaid, which then covers medical/personal care costs, but SA itself pays the room-and-board portion.

Personal Care Services, layered on top

Medicaid State Plan Personal Care Services (PCS) can pay for hands-on personal care within a licensed adult care home for Medicaid-eligible residents, layered on top of Special Assistance's room-and-board payment.

Source: NC Special Assistance program

Source: CAP/DA program

Questions families ask

What hospital serves Franklin County seniors, and who handles Adult Protective Services reports in Louisburg?

Franklin Regional Medical Center in Louisburg is the county's central hospital hub for senior medical and emergency care. Adult Protective Services reports for Franklin County residents, including those in Louisburg, Youngsville, and Franklinton, go through Franklin County DSS Adult Services, since APS is administered at the county level across North Carolina rather than through a single statewide hotline; call 911 for immediate danger. For general aging services and options counseling, Franklin County uses the Kerr-Tar Regional Council of Governments Area Agency on Aging (1-866-506-6223), not the Central Pines/Triangle J office that covers most of the rest of the Triangle.

What Area Agency on Aging and hospital system serve Harnett County, and how do Lillington and Dunn differ for senior care access?

Harnett County is covered by the Central Pines Regional Council (Triangle J) Area Agency on Aging, reachable at 1-800-310-9777, the same regional office serving Wake, Durham, Orange, Johnston, and Chatham counties. Cape Fear Valley Health is the dominant hospital system, with Cape Fear Valley Central Harnett Hospital in Lillington serving the county's northern hub along US-421, and Cape Fear Valley Betsy Johnson Hospital in Dunn serving the southern part of the county near the I-95/US-421 corridor along with a concentration of the county's skilled nursing and assisted living facilities. For Adult Protective Services, contact Harnett County DSS directly.

My mother lives in Angier — is she closer to Harnett County resources or should we look toward Fuquay-Varina and Wake County instead?

Angier sits near the Wake/Harnett county line, so your mother realistically has a choice between Cape Fear Valley Health facilities within Harnett County and Fuquay-Varina or broader Wake County providers to the north — proximity and personal physician relationships often matter more than the county line itself. For benefits and services administration, though, the county of residence controls: if she lives in Harnett County, Medicaid applications and Adult Protective Services reports go through Harnett County DSS, and aging services referrals go through the Central Pines/Triangle J Area Agency on Aging (1-800-310-9777), the same regional office used across most of the Triangle.

What's the real difference between independent living and assisted living in North Carolina?

Independent living communities in North Carolina are generally unlicensed housing arrangements — essentially age-restricted apartments or cottages with amenities like dining and activities, but no state-regulated personal care services included. Assisted living, by contrast, falls under North Carolina's single 'adult care home' license category (Chapter 131D, 10A NCAC 13F), which requires the facility to provide and be inspected on actual hands-on personal care like help with bathing, dressing, and medication management. If your parent just needs a maintenance-free lifestyle with social opportunities, independent living may suffice; if they need regular help with daily activities, only a licensed adult care home is equipped and legally required to provide it.

How is memory care different from regular assisted living in North Carolina, and what should I ask a facility to prove it?

In North Carolina, 'memory care' isn't a separate license — it's a Special Care Unit (SCU) designation that a facility adds to its existing adult care home license under G.S. 131D-8 and 10A NCAC 13F .1300, requiring state approval of a specific disclosure statement covering staffing, programming, and physical safety features like secured entrances. Ask any facility claiming to offer memory care for a copy of that state-required SCU disclosure statement, not just marketing materials, and confirm the SCU designation is current by checking NC DHSR's facility search tool. Regular assisted living without an SCU designation may still accept residents with early dementia, but isn't required to meet the added security and staff-training standards.

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