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North Carolina's Assisted-Living Medicaid Support, Explained

North Carolina has no Medicaid HCBS waiver for assisted-living-style care. State/County Special Assistance -- a cash program, not a waiver -- fills that role instead.

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Short answer

North Carolina has no Medicaid HCBS waiver dedicated to assisted-living-style care. State/County Special Assistance -- a state- and county-funded cash program, not a Medicaid waiver -- fills that role instead, paying toward room and board for eligible low-income adult care home residents.

How it actually works

No — North Carolina does not have a standalone state-funded 'assisted living benefit' program by that name. There is also no Medicaid HCBS waiver dedicated to assisted-living room and board.

  • State/County Special Assistance (SA) — a state- and county-funded (non-Medicaid-waiver) cash supplement paying toward room and board for eligible low-income adult care home/family care home residents, with automatic Medicaid eligibility for recipients (source: https://www.ncdhhs.gov/divisions/social-services/special-assistance/state-and-county-special-assistance-adult-care-home-residents).
  • A separate, higher SA payment rate applies to Adult Care Home residents with Alzheimer's disease or a related disorder who reside in a licensed Special Care Unit.
  • Medicaid State Plan Personal Care Services (PCS), which can pay for hands-on personal care within a licensed adult care home setting for Medicaid-eligible residents, layered on top of SA-funded room and board.

SA is explicitly a state/county-funded cash-assistance program, not a Medicaid HCBS waiver — do not describe it as a 'Medicaid waiver' in published content. Confirm current SA payment rate levels directly with the local county DSS or the NC DHHS Special Assistance Manual, as they change periodically (see https://policies.ncdhhs.gov/document/special-assistance-manual/).

Source: NC Special Assistance program

Questions families ask

How do I actually apply for CAP/DA if my mother lives in Raleigh?

Apply for long-term-care Medicaid generally through Wake County's Department of Social Services, and apply for CAP/DA specifically by contacting a local CAP/DA case management entity serving Wake County; the CAP/DA program is administered overall by the NC Division of Health Benefits/NC Medicaid within NCDHHS. The NC Medicaid Contact Center (888-245-0179) can help direct families to the correct local starting point.

Is CAP/DA the same thing as Medicaid paying for assisted living in Wake County?

No. CAP/DA is a home- and community-based waiver that serves people living in their own home, not in a licensed adult care home or assisted living facility, so it does not pay for assisted living room and board or services. North Carolina has no Medicaid waiver dedicated to assisted living; room and board there is instead covered through the non-Medicaid State/County Special Assistance program.

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.

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