Nursing Homes in North Carolina
Adults 65 and older comprise 17% of North Carolina's 10,698,973 people. Many of these seniors may experience disability, illness or injury and rely on a nursing home to help maintain their quality of life. While an assisted living facility can usually handle minor medical requirements, nursing homes are better equipped to accommodate seniors with complicated ongoing care and rehabilitation needs. These facilities employ social workers, activity directors, therapists, dietitians and registered nurses and can typically provide more holistic care for frail individuals.
In 2022, North Carolina had about 32,266 residents in 426 nursing homes, down slightly from 36,687 in 2015. However, trends show the population is aging, and the government estimates that seniors 65 and older will comprise 21% of all residents by 2040. The 65+ population will increase by 52%, but the 85+ population will jump by 116%, likely resulting in a much higher demand for nursing home care.
This guide discusses ways seniors can pay for nursing home care in North Carolina. It also includes free resources that provide information and assistance with accessing Medicaid and Medicare within the state.
Popular Cities in North Carolina
Cost of North Carolina Nursing Homes
The average cost of nursing homes in North Carolina is $206 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in North Carolina?
The North Carolina Department of Health and Human Services is responsible for managing Medicaid and has enrolled 2,322,435 people in the state. Seniors can use Medicaid to pay for nursing home care in North Carolina, provided they meet income and asset limits and are assessed as needing this level of care due to illness or disability.
Waivers available through the state's Medicaid program can enable seniors requiring skilled nursing care to receive suitable care while living at home, which delays or avoids the need to move into a nursing home. For example, the CAP/DA program provides seniors with medical and personal care alongside access to specialized rehabilitation equipment and home modifications. The Money Follows the Person project can provide additional financial support for seniors to pay for utilities and buy necessities such as furniture.
Eligibility for Medicaid in North Carolina
Income and asset limits differ depending on whether an applicant is married. North Carolina's Aged Blind and Disabled Medicaid has a monthly income limit of $1,133 for single seniors, which increases to $1,526 for couples, regardless of whether both or only one spouse applies for the benefit. Asset limits allow $2,000 for individuals or $3,000 for couples if both people apply. If only one spouse requires Medicaid, the person remaining in the community may keep up to $148,620.
North Carolina's Medically Needy Pathway can allow seniors with income above the monthly limit to become eligible for Medicaid by applying deductions for medical expenses such as prescriptions, rehabilitation equipment, hospital charges and visits to doctors and specialists. Spend downs also offer a way to reduce assets to meet the eligibility limit. Seniors should consider seeking legal and financial assistance before using either of these options.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $13,596 | $2,000 |
| Two-Person Household (Only One Spouse Applying) | $18,312 | $2,000 for applicant and $148,620 for nonapplicant |
| Two-Person Household (Both Spouses Applying) | $18,312 | $3,000 |
*Per year
In addition to meeting income and asset limits, seniors must meet other criteria for eligibility, including the following:
- U.S. citizenship
- North Carolina residency
- A medical need for nursing home care
Applying for Medicaid in North Carolina
Seniors can apply for Medicaid in North Carolina through several methods:
- Online: North Carolina's Department of Health and Human Services ePASS portal allows seniors to submit all required information and track the application process online.
- Phone: Individuals can call their local DSS office to commence the application process over the phone or contact the Department of Health and Human Services at (800) 662-7030 for assistance in finding an office.
- Mail: Application forms can be printed and mailed or delivered in person to a DSS office.
- In person: It's also possible to complete the application process at a DSS office with assistance from staff.
It's also possible to complete the application at a DSS office with assistance from staff.
What Information You Will Need
The types of documents needed for the Medicaid application depend on an individual's financial situation, as all forms of income and assets must be declared. Seniors may require the following information:
- A Social Security number
- Proof of identity, U.S. citizenship and North Carolina residency
- Copies of pay stubs and bank statements
- Financial statements or letters for other forms of income such as child support or veterans' benefits
- Information documenting any owned properties
- Medical and life insurance policies
- Details of all vehicles owned by the household
Additional Medicaid Support & Resources in North Carolina
These resources assist families with accessing nursing home care through Medicaid in North Carolina. Free legal aid is also available to help seniors determine their eligibility for benefits and take care of financial concerns.
| Contact | Service | |
|---|---|---|
| North Carolina Department of Health and Human Services | (800) 662-7030 | The NCDHHS manages Medicaid in North Carolina, so it's a valuable source of information for seniors. The department can help confirm eligibility for benefits and provide more details about waivers that may allow seniors to remain at home while receiving nursing care through Medicaid. |
| North Carolina Association of Area Agencies on Aging | (704) 372-2416 | The North Carolina Association of Area Agencies on Aging maintains a list of all AAAs operating in the state and includes contact details. AAAs provide information about Medicaid, nursing care and community programs seniors may find helpful when applying for benefits. |
| North Carolina Legal Aid | (866) 219-5262 | North Carolina Legal Aid provides free services for low-income seniors to help them manage their estates or solve care disputes. Seniors may also find it worthwhile to seek legal aid while planning a Medicaid application if their income or assets exceed the eligibility limit. |
Can You Use Medicare to Pay for Nursing Home Care in North Carolina?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet several specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers several specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in North Carolina
Medicare may cover nursing home care in certain situations such as when skilled nursing is required following a hospital stay. However, it usually doesn't cover long-term care, so it's essential for seniors to understand what they're entitled to. The following organizations provide free information.
| Contact | Service | |
|---|---|---|
| North Carolina SHIIP Program | (855) 408-1212 | The Medicare and Seniors' Health Insurance Information Program assists seniors with understanding what each Medicare part covers. It also provides plan comparisons and information about financial assistance to help seniors choose the right insurance for their needs. |
| North Carolina Department of Insurance | (855) 408-1212 | The North Carolina Department of Insurance regulates insurance plans in the state and can provide information about Medigap plans. Seniors might consider these extended coverage plans if they need services or treatments unavailable under basic Medicare. |
| North Carolina Area Agencies on Aging | (800) 662-7030 | Area Agencies on Aging offer information and services relevant to specific counties throughout North Carolina. A senior's local agency can assist with confirming Medicare eligibility or applying for benefits. The AAA can also refer individuals to a SHIIP counselor for further assistance. |
| North Carolina Senior Law Project | (877) 579-7562 | The Senior Law Project assists seniors with applying for Medicare and determining other benefits they may be eligible for. The project maintains a free legal aid hotline for questions regarding insurance and other legal or financial concerns. |
Other Financial Assistance Options for Nursing Home Care in North Carolina
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in North Carolina
| Licensing Requirements | Nursing homes require a license from the North Carolina Division of Health Service Regulation. A license remains in effect for 12 months and may be renewed at the end of the year by submitting all necessary information 30 days before the license expiration. |
| Staffing Requirements | Nursing homes must employ a physician as medical director and a registered nurse as director of nursing. Enough licensed nurses must be available to care for each patient's needs, and a registered nurse is to be available for eight consecutive hours each day. |
| Staff Training Requirements | Staff must be made aware of all facility policies and operation standards. Facilities must provide ongoing training and only allow caregivers to perform duties consistent with their education and qualifications. |
| Admission Restrictions | Seniors can only be admitted to nursing homes in North Carolina by a physician. Facilities must only accept patients if they can provide the level of care required and must acquire all relevant medical information within 48 hours of admission. |
| Care Planning Requirements | Facilities must perform a comprehensive health assessment within 14 days of patient admission under the coordination of a registered nurse. Care plans must be reviewed at least every 90 days. |
| Dietary and Nutritional Services Requirements | Nursing homes must provide a palatable diet that meets seniors' nutritional needs. Patients must receive at least three daily meals that contain sufficient protein and nutrients and follow their physician-ordered diet plans. |
| Specialized Rehabilitative Services | Physical, occupational and speech therapies must be available for patients and managed by qualified, licensed staff. All progress should be documented for the interdisciplinary team to review. |
| Medication and Pharmaceutical Services | Facilities must provide pharmaceutical services supervised by a pharmacist. Medicine assessments must occur every 31 days to ensure prescribed drug therapies are safe, appropriate and effective. |
| Activities Requirements | Ongoing activities must be available to meet seniors' personal interests and physical, mental and social well-being. A recreation therapist or other suitably qualified individual must serve as the activities director. |
| Infection Control Requirements | An infection control program must be in place to prevent diseases and keep residents safe. Records must be kept detailing isolation and corrective actions taken to manage pathogen spread, and staff must be screened for infectious conditions upon hire. Tuberculosis screening must be repeated annually. |
| Medicaid Coverage | Medicaid pays for nursing home care in North Carolina for low-income seniors aged 65+ assessed as needing this level of care. However, individuals must meet other eligibility requirements, such as residency, and may need to fund part of their nursing care with their own income. |
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