North Carolina Medicaid Income & Asset Limits for Nursing Homes & In-Home Long Term Care

Last updated: December 01, 2023

 

North Carolina Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income people of all ages. While there are a wide variety of coverage groups, this page is focused on long-term care Medicaid eligibility for elderly North Carolina residents, aged 65 and older. In addition to care services in nursing homes, assisted living facilities, and family care homes (adult foster care homes), NC Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which North Carolina seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of participants is limited and waiting lists may exist. Benefits are intended to delay nursing home admissions and may be provided at home, adult day care, family care homes, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged Blind and Disabled – An entitlement; anyone who meets the eligibility requirements receives assistance. Limited long-term care services, such as personal care assistance or adult day care, may be available.

North Carolina’s Medicaid program is jointly funded by the state and federal government, but is administered by the state under federally set parameters. The North Carolina Department of Health and Human Services’ Division of Medical Assistance (DMA) is the administering agency.

  The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.

 

Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying financial and medical (functional) eligibility criteria. Financial requirements change annually, vary based on marital status, and is further complicated by the fact that North Carolina offers alternative pathways towards eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
North Carolina seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under the Medicaid pay rate (est. to be between $6,381 / month and $9,087 / month). 2) Assets under $2,000 3) Require a Nursing Home Level of Care.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a North Carolina Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in North Carolina. More.

April 2023 – March 2024 North Carolina Medicaid Long-Term Care Eligibility for Seniors
Type of Medicaid Single Married (both spouses applying) Married (one spouse applying)
Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required
Institutional / Nursing Home Medicaid Must be less than the amount Medicaid pays for nursing home care (est. $6,381 – $9,087 / mo.)* $2,000 Nursing Home Must be less than the amount Medicaid pays for nursing home care (est. $6,381 – $9,087 / mo.)* $3,000 Nursing Home Must be less than the amount Medicaid pays for nursing home care (est. $6,381 – $9,087 / mo.)* $2,000 for applicant & $154,140 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $1,215 / month† $2,000 Nursing Home $1,644 / month† $3,000 Nursing Home $1,215 / month for the applicant† $2,000 for applicant & $154,140 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,215 / month $2,000 Help with ADLs $1,644 / month $3,000 Help with ADLs $1,644 / month $3,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $70.00 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.

 

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in NC, the VA Aid & Attendance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is counted. Furthermore, the non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a Spousal Impoverishment Rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid poverty.

The MMMNA in NC is $2,465 (eff. 7/1/23 – 6/30/24). If a non-applicant’s monthly income is under this amount, income can be transferred to them from their applicant spouse, bringing their income up to $2,465 / month. In North Carolina, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $740 / month (eff. 7/1/23 – 6/30/24). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total monthly income over $3,853.50. This is the Maximum Monthly Maintenance Needs Allowance. More on how the Spousal Allowance is calculated.

Income is counted differently when only one spouse applies for Regular Medicaid; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.

 

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable assets are calculated towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, checking), and real estate in which one does not reside. In North Carolina, IRAs are also counted. There are also many assets that are non-countable (exempt). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts up to $15,000, and generally one’s primary home.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for the non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant. In 2024, this allows the community spouse (the non-applicant spouse) to retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s half of the assets is under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant.

Medicaid’s Look-Back Rule
North Carolina has a 60-month Medicaid Look-Back Period that immediately precedes one’s Nursing Home Medicaid or Medicaid Waiver application date. During the “look back”, Medicaid checks all past asset transfers to ensure no assets were sold or gifted under fair market value. This includes asset transfers made by one’s spouse. If one has violated the Look-Back Rule, it is assumed it was done to meet Medicaid’s asset limit, and a Penalty Period of Medicaid ineligibility will be calculated. Medicaid’s Look-Back Rule does not apply to Regular Medicaid applicants.

The U.S. Federal Gift Tax Rule, which in 2024, allows individuals to gift up to $18,000 per recipient without filing a Gift Tax Return, does not extend to Medicaid eligibility. Gifting under this rule violates Medicaid’s Look-Back Period.

 

North Carolina Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse living in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is no spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, North Carolina’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

 

Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Home Level of Care (NHLOC) is required. Furthermore, additional criteria may need to be met for specific program benefits. As an example, for a Medicaid Waiver to cover the cost of home modifications, an inability to safely and independently live at home without modifications may be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NHLOC is not necessarily required.

 

Qualifying When Over the Limits

For North Carolina residents, aged 65 and over, who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – North Carolina has a Medically Needy program that allows Medicaid applicants who have income over the eligibility limit to still become income-eligible if they have high medical bills. Also called a “Spend-down” program or a “Medicaid Deductible,” one’s “excess income” is used to cover medical bills, such as insurance premiums, prescription drugs, doctor visits, hospitalizations, and medical supplies. The Medically Needy Income Limit (MNIL) has remained the same for many years, and in 2024, continues to be $242 / month for a single individual and $317 / month for a married couple. The “spend down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. In NC, it is calculated for a 6-month period. Once the “spend down” is met, one will be income-eligible for the remainder of the period. The Medically Needy Asset Limit is $2,000 for an individual and $3,000 for a couple.

2) Asset Spend Down – Persons who have assets over Medicaid’s asset limit can still become asset-eligible by reducing countable assets. One can “spend down” assets by spending excess assets on ones that are non-countable, such as home improvements (installing new air conditioning, purchasing new furniture), home modifications (wheelchair ramps, grab bars, stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates the Look-back Rule and can result in a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

 Our NC Medicaid Spend Down Calculator can assist persons in determining if they might have a Medicaid spend down, and if so, provide an estimate of the amount. Start here.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of long-term care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

 

Specific North Carolina Medicaid Programs

In addition to paying for nursing home care, North Carolina Medicaid offers the following programs relevant to the elderly that helps them to live outside of nursing home facilities.

1) Community Alternatives Program for Disabled Adults Waiver – Commonly called the CAP/DA Waiver, this program will pay for adult day health care, in-home personal care assistance, minor home modifications, and other services that help persons who are disabled or elderly live at home. Program participants have the option to self-direct their own care through an option called CAP/Consumer-Directed (previously called CAP/Choice). This allows beneficiaries to choose their own care providers and allows family members, including adult children and spouses, to be hired as personal caregivers and be paid by the Medicaid program.

2) Personal Care Services (PCS) – This Medicaid service provides for a personal care attendant in the home for an approved number of hours. It is part of the state’s Regular Medicaid program. It is an entitlement, as opposed to CAP/DA, which is approved for a limited number of beneficiaries and may have a waiting list.

3) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.

4) Money Follows the Person (MFP) – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or to another community setting.

 

How to Apply for North Carolina Medicaid

Seniors can apply for Medicaid in North Carolina online at ePASS, in person at their local Division of Social Services (DSS) office, or print and submit a completed Medicaid application to their local DSS office. One’s local DSS office should also be able to provide additional information and application assistance. The application process may vary based on the program for which one is applying.

It is imperative that NC Medicaid applicants be certain that they meet all eligibility requirements prior to applying for Medicaid benefits. Seniors who are uncertain, or who have excess income and / or assets, should make preparations to ensure all eligibility requirements will be met. This is where Medicaid Planning comes in. Applying for Medicaid can be a difficult and drawn out process, and if not done correctly, it can cause a delay or denial of benefits. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.

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