How families actually pay for care
North Carolina expanded Medicaid under the ACA effective December 1, 2023 -- a separate eligibility pathway from long-term-care Medicaid for seniors, which has its own income and asset tests. NC has no assisted-living-specific Medicaid waiver; State/County Special Assistance, a non-Medicaid cash program, fills that gap instead.
Medicaid expansion vs. long-term-care Medicaid
North Carolina expanded Medicaid under the ACA effective December 1, 2023. ACA expansion Medicaid (covering low-income adults ages 19–64 generally) is a SEPARATE eligibility pathway from long-term-care Medicaid (aged/blind/disabled, nursing facility, and HCBS waiver eligibility), which has its own, generally lower income/asset tests described below. Expansion did not change nursing facility or waiver financial eligibility rules.
CAP/DA: North Carolina's in-home Medicaid waiver
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. Not applicable — CAP/DA serves people living in their own home, not a facility, so it does not pay room and board.
State/County Special Assistance: not a Medicaid 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.
Nursing facility Medicaid, 2026
| Asset limit, single | $2,000 (per NC DHHS 2026 Basic Medicaid Eligibility Requirements, Aged/Blind/Disabled resource limit) |
|---|---|
| Asset limit, couple (both applying) | $3,000 (per NC DHHS 2026 Basic Medicaid Eligibility Requirements, Aged/Blind/Disabled resource limit for a couple) |
| Personal Needs Allowance | $70/month for an institutionalized individual |
| Community Spouse Resource Allowance | $31,584 – $157,920 |
| Minimum Monthly Maintenance Needs Allowance | $2,643.75 to $3,948.00/month (Minimum/Maximum Monthly Maintenance Needs Allowance for the community spouse, before excess shelter allowance adjustments) |
Confirm current figures with NC Medicaid before publishing -- these change annually.
VA Aid and Attendance
VA Aid & Attendance and Housebound are not separate benefits with their own payment — they are add-on allowances that raise a veteran's or survivor's Maximum Annual Pension Rate (MAPR) under the VA Improved Pension / Survivors Pension program. The veteran/survivor must first qualify for a VA pension (wartime service, income/net worth limits), and then the A&A or Housebound rate replaces the base MAPR with a higher figure if they meet the clinical need (e.g., need help with activities of daily living, or are substantially confined to their home). Current maximum annual rates and full detail are on our VA Aid and Attendance page.
