North Carolina Medicaid for Seniors & Long-Term Care

The Community Alternatives Program for Disabled Adults (CAP/DA) is NC's Section 1915(c) HCBS waiver serving adults who would otherwise require nursing facility care. CAP/DA allows eligible enrollees to receive care at home or in the community rather than in an institution — typically the preferred option for people who want to remain in their homes.

Not all services are available to every enrollee; the care plan is individualized based on assessed needs. CAP/DA has limited slots, and enrollment depends on availability in your region.

NC operates additional Section 1915(c) waivers beyond CAP/DA: CAP/C (Community Alternatives Program for Children) for children with complex medical needs who require nursing-level care, CAP/IDD for individuals with intellectual and developmental disabilities managed through Tailored Plans, and the NC Innovations Waiver, an IDD-specific waiver with slots managed by regional Tailored Plans. For IDD-related waiver services, the relevant Tailored Plan for your region — Alliance Health, Partners Health Management, Trillium Health Resources, or Vaya Health — coordinates the application process and manages the waitlist.

Program of All-inclusive Care for the Elderly (PACE) is available in select NC counties for adults age 55 and older who meet nursing facility level of care but choose to live in the community. PACE wraps medical care, personal care, adult day services, and social services into a single coordinated program. Not all counties in NC have a PACE organization — check with NCDHHS or search the CMS PACE locator to determine availability in your area.

NC Medicaid covers nursing facility care for enrollees who meet the clinical and financial criteria. The nursing facility must be Medicaid-certified. Once approved, Medicaid pays the facility directly — the enrollee contributes their income (minus a personal needs allowance of $70/month) toward the cost of care.

Spousal impoverishment protections under federal law (42 U.S.C. § 1396r-5) apply when one spouse enters a nursing facility and the other remains in the community. The community spouse is entitled to retain a Community Spouse Resource Allowance (CSRA) of up to approximately $162,660 (2026 federal maximum) and a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the institutionalized spouse's income, with the floor and cap updated each January by CMS. The institutionalized spouse's countable resource limit remains $2,000; the primary home (while the community spouse occupies it), one vehicle, and personal effects are exempt. Your county DSS can calculate the specific amounts for your situation.

North Carolina participates in Medicaid estate recovery, as required by federal law under 42 U.S.C. § 1396p. After an enrollee who received Medicaid long-term care services passes away, NCDHHS may file a claim against the estate for the cost of services paid by Medicaid. Recovery applies to nursing facility care, HCBS waiver services, and related hospital and prescription costs for enrollees age 55 and older.

Certain hardship exemptions exist — for example, when a surviving spouse, minor child, or blind or disabled child is living in the home. A Medicaid planning attorney can help families understand what protections apply and how to plan for estate recovery before applying for long-term care Medicaid.

Long-term care Medicaid rules are complex and change periodically. Contact your county Department of Social Services or consult a licensed elder law attorney for guidance specific to your situation.