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What Happens When the Money Runs Out

Spend-down, Medicaid waiver transitions, and why you should ask a community about this before you move in.

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Home›Costs & Paying›What Happens When the Money Runs Out
Short answer

If private funds run out, the options generally are a Medicaid HCBS waiver for care inside a licensed community, Medicaid nursing facility coverage, or moving to a community that holds a waiver provider agreement. Confirm your state's specific programs before relying on this.

Ask before you move in, not after

This is the single most consequential question families skip. A community that does not hold a Medicaid waiver provider agreement will ask your parent to leave when private funds are exhausted — often with short notice, at the point when moving is hardest.

Ask directly: do you hold a Medicaid waiver provider agreement, and how many current residents use it? A community can technically hold an agreement and still have no waiver capacity available.

How families pay for care. NC's CAP/DA waiver pays for in-home services only; State/County Special Assistance (not a Medicaid waiver) helps with adult care home room and board. Read the full explanation →
The local long-term care ombudsman. NC Division of Aging and Adult Services (NCDHHS) runs the Office of the State Long-Term Care Ombudsman, with 16 Offices of the Regional Long-Term Care Ombudsman housed within regional Area Agencies on Aging. covers Wake, Durham, Orange, Chatham, Johnston, Lee and Moore counties at 1-800-310-9777 (Central Pines Regional Council / Triangle J region toll-free Ombudsman line, covering Wake, Durham, Orange, Chatham, Johnston, Lee, and Moore counties); Franklin County is a different region. Read the full explanation →

Questions families ask

What is State/County Special Assistance, and is it a Medicaid waiver?

State/County Special Assistance (SA) is a state- and county-funded cash supplement that helps pay the room-and-board cost for eligible low-income residents of licensed adult care homes and family care homes — it is explicitly not a Medicaid waiver or Medicaid program itself. SA recipients do become automatically eligible for Medicaid, which then covers separate medical and personal-care costs, but the SA cash payment for room and board comes from state and county funds, not the Medicaid program.

Did North Carolina's 2023 Medicaid expansion change anything about nursing home coverage for my father in Durham?

No — North Carolina's ACA Medicaid expansion, effective December 1, 2023, created a separate eligibility pathway covering low-income adults ages 19–64 generally, and it did not change the eligibility rules, income limits, or asset limits for long-term-care Medicaid (the aged/blind/disabled category covering nursing facility and waiver services). Nursing facility Medicaid eligibility continues to run through its own, generally lower, income and asset tests.

What are the asset limits to qualify for nursing facility Medicaid in North Carolina in 2026?

For 2026, the NC DHHS Aged/Blind/Disabled resource limit for nursing facility Medicaid is $2,000 for a single applicant and $3,000 for a married couple where both spouses need coverage, per NC DHHS's Basic Medicaid Eligibility Requirements. These limits are far lower than the ACA expansion Medicaid category's rules and apply specifically to the long-term-care eligibility pathway.

What's the income limit to qualify for nursing home Medicaid in North Carolina?

NC's general nursing facility Medicaid income cap is approximately $2,982/month, derived by applying the standard rule of 300% of the 2026 SSI federal benefit rate ($994/month) used in NC's aged/blind/disabled long-term-care Medicaid category. This is a derived estimate based on the SSA-published 2026 SSI rate rather than a figure independently confirmed in the current MA-2270 policy manual excerpt, so families should verify the exact current figure with NC Medicaid or a county DSS caseworker before relying on it for planning.

How much money can a nursing home Medicaid resident in North Carolina keep for personal expenses each month?

NC's nursing facility Medicaid Personal Needs Allowance (PNA) is $70 per month for an institutionalized individual, or up to $140/month combined for a married couple sharing a room in the same facility. Nursing facility Medicaid residents generally must apply nearly all of their remaining monthly income toward the cost of care beyond this allowance, per the NC DHHS MA-2270 policy manual.

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