Most US long-term care is paid for by Medicaid — not Medicare. Medicare covers short rehab stays after a hospital admission, then stops. The bill for ongoing nursing-home care, memory care, or significant in-home support has to come from somewhere, and for the majority of North Carolina seniors that source is NC Medicaid.1

North Carolina runs its Medicaid program through the Division of Health Benefits at NC DHHS. Since July 2021 most beneficiaries receive their benefits through Standard Plans operated by contracted Medicaid Managed Care entities. Long-term services and supports are provided through traditional fee-for-service NC Medicaid or through one of the home- and community-based waivers — primarily the Community Alternatives Program for Disabled Adults (CAP/DA).

Three eligibility tests, in order

1. Medical eligibility

Before the financial math starts, your parent needs to be medically eligible — meeting nursing-facility level of care through the NC Long-Term Care Functional Screen or the independent CAP/DA assessment. The functional screen measures ability to perform activities of daily living: bathing, dressing, toileting, transferring, eating. Failing several is the threshold.2

Schedule the assessment early. Waits run from a couple of weeks in urban counties to two months in rural areas. If you’re applying for CAP/DA, the assessment is part of the CAP/DA intake.

2. Income

For Medicaid long-term care in NC, the gross monthly income limit is roughly $2,901/monthin 2026 — this is 300% of the federal SSI benefit rate and changes each January. If your parent’s gross income from all sources (Social Security, pension, IRA payouts, annuity income) exceeds the cap, they are notautomatically disqualified. They’ll need a Qualified Income Trust(Miller Trust) that diverts above-cap income so it doesn’t count toward eligibility.

3. Assets

The applicant’s countable assetsmust be at or below $2,000 on the date of application. “Countable” is doing the work in that sentence.

Not counted (in most cases):

Counted:

The 60-month look-back, in plain English

NC (like every state) reviews any transfer of assets for less than fair market value made in the 60 months before the Medicaid application. If the caseworker finds one, Medicaid assesses a penalty period— a window during which the applicant is otherwise eligible but Medicaid won’t pay.

The penalty math is straightforward: the value of the transfer divided by NC’s penalty divisor. The divisor approximates the statewide average monthly cost of nursing-facility care (recent figures around $7,000-$8,500). A $50,000 gift becomes roughly a 6-7 month penalty. The clock does not start until your parent is otherwise eligible — spent down and in care — so the penalty hits at exactly the moment families need Medicaid most.

NC Medicaid Managed Care: Standard Plans vs Tailored Plans

NC Medicaid Managed Care went live in July 2021. Most beneficiaries are enrolled in Standard Plans operated by contracted prepaid health plans (AmeriHealth Caritas, Carolina Complete Health, Healthy Blue, UnitedHealthcare, and WellCare are the prepaid health plans active across NC).3

Tailored Plans launched July 2024 for beneficiaries with significant behavioral-health needs, intellectual or developmental disabilities, or traumatic brain injury. Tailored Plans are operated by LME/MCO entities (Alliance, Trillium, Vaya, Partners, Eastpointe) and integrate physical health, behavioral health, and pharmacy under one contract.

For long-term-care purposes, the plan distinction matters primarily for service coordination. The financial eligibility rules are the same; the day-to-day experience of finding providers, getting prior authorizations, and accessing specialized services can differ meaningfully between Standard and Tailored.

The community-spouse situation (one spouse in care, one not)

If one spouse needs care and the other doesn’t, NC follows the federal spousal-impoverishment rules. The well spouse (the community spouse) keeps:

Most one-spouse-needs-care situations can be planned to a non-catastrophic outcome with 12–24 months of lead time. Talk to an NC elder-law attorney before doing anything — the spousal rules involve precise calculations and a snapshot-date rule that DIY planners frequently get wrong.

The CAP/DA waiver: getting Medicaid to pay for in-home care

The Community Alternatives Program for Disabled Adults (CAP/DA) is NC’s primary home- and community-based services waiver for older adults and adults with disabilities. Eligible participants receive in-home personal care, home modifications, adult day health, respite, and (importantly) consumer-directed care — the option to hire and pay a caregiver of their choice, including an adult child.4

CAP/DA has a waiting list in many NC counties. If in-home care is the goal, get on the list early. The slot count is set by the state legislature each session and has historically been smaller than demand.

NC Medicaid estate recovery

NC, like every state, has a Medicaid Estate Recovery Program (MERP). After the death of a Medicaid recipient who received LTC benefits at age 55 or older, NC files a claim against the probate estate for the value of LTC services paid. NC pursues recovery only through probate— meaning assets that pass outside of probate (through joint tenancy, beneficiary designation, or a properly funded revocable trust) are generally not subject to recovery.5

Practical implication: pre-application planning often includes Transfer-on-Death deeds, beneficiary designations on financial accounts, and trusts for the same probate-avoidance reasons that apply to non-Medicaid families. The estate-recovery exposure magnifies the value of doing it.

What to do this month

For the broader picture on Medicaid eligibility nationally see our Medicaid pillar overview. For NC-specific legal and estate-planning content see Legal & Financial in NC.