Special Assistance (SA) is a program for individuals who need to live or are living in licensed SA approved facilities but cannot afford the cost. SA recipients must meet certain income, resource, and other eligibility criteria. An eligible recipient must be eligible for SSI, or ineligible solely due to income. SA supplements the recipient’s income and enables her/him to pay for room and board. SA is administered by the Division of Aging and Adult Services (DAAS) through the county departments of social services (DSS).
If an individual is eligible for SA, he/she is also automatically eligible for full Medicaid. Medicaid helps pay for medical expenses including hospital care, physician visits, prescription medications, treatments, and medical transportation. Medicaid may pay for personal care services in some circumstances.
SA applicants/recipients are required to have a current medical FL-2 form. The DMA Adult Care Home FL-2 form completed and signed by a licensed physician, nurse practitioner, or physician assistant, provides detailed medical information about the applicant/recipient. The FL-2 must confirm that the applicant/recipient needs domiciliary (assisted living, adult care home, group home, supervised living, or hospice residential care) and not skilled nursing level of care.
The SA recipient may keep $46 per month for personal needs. The Division of Health Service Regulation (DHSR) has specific rules when a facility manages a resident’s personal funds. See 10A NCAC 13F .1104, Accounting for resident’s personal funds.
To accept room and board payments from an SA recipient, a facility must be licensed by the DHSR and submit to the DAAS, a Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964 (referenced as the “Civil Rights Agreement” form).
Facility types that may receive payments from SA recipients include:
Family Care Homes licensed for 2- 6 residents licensed under 10A North Carolina Administrative Code (NCAC)
Adult Care Homes (assisted living facilities) licensed for 7 or more residents;
Facilities licensed under NC General Statute 122C. which include:
Supervised living facilities licensed under 10A NCAC 27G.5600.A or 27G.5600.C
Specialized community residential centers licensed under 10A NCAC 27G. 2101.
Hospice residential facilities that have a Memorandum of Agreement with the Division of Aging and Adult Services.
There is an exception to allowable payments in licensed facilities. North Carolina General Statute 108A-47 prohibits payments of Special Assistance to any person residing in an adult care home that is owned or operated, in whole or in part, by (1) a member of the Social Services Commission, any county board of social services, or any board of county commissioners; (2) an official or employee of the Department of Health and Human Services, unless the official has been appointed temporary manager of the facility pursuant to NCGS 131E-237, or of any county department of social services; or other local agency designated to administer Special Assistance. This applies also to the spouse of an individual in (1) or (2).
3. Where can a facility obtain a Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964, the Civil Rights Agreement form?
Each facility must have on file with the DAAS, a Civil Rights Agreement (form DSS-1464-ia). This is a federal law as well as a NC statutory requirement to participate in the SA program. Facilities must assure that they will not discriminate against their residents on the basis of race, color, national origin, age, sex, religion, political beliefs or disability. A new form must be completed when there is a change in the license or ownership of the facility. The form must be completed, signed, and either mailed, faxed, or scanned and emailed to Monica Nealous at the DAAS.
NC Division of Aging and Adult Services
Attention: Monica Nealous
2101 Mail Service Center
Raleigh, NC 27699-2101
Fax 919-715-0023 Monica.Nealous@dhhs.nc.gov
The Civil Rights Agreement form and information links are found at:
4. What is the room and board rate that facilities can charge a resident of an SA approved facility for room and board?
The SA basic rate is established by the General Assembly and is reviewed annually. The rate is the maximum monthly amount that an SA approved facility can charge a Special Assistance recipient. The current basic rate, effective October 1, 2009 is $1,182. A facility may choose to offer a lower rate to SA recipients.
Assisted living or adult care facilities with licensed special care units (SCU) may charge a higher rate for individual receiving SA. The SA SCU rate was established by the General Assembly effective October 2005. The current SCU rate is $1,515. The rate is the maximum monthly amount that an SA facility may charge an SA recipient in a licensed SA SCU. SA recipients in an SCU must have an FL-2 that indicates a diagnosis of Alzheimer’s or related disorders. Disorders/diseases that meet diagnosis criteria include Alzheimer’s disease, multi-infarct dementia (vascular dementia), Creutzfeldt-Jakob disease, Pick’s disease, dementia with Lewy bodies, Parkinson’s disease, Huntington’s disease.
5. Where can individuals apply for Special Assistance?
An individual must apply for SA at the county DSS. The applicant may send someone to apply for them or have someone go with them to assist them with the application process. If they have a representative payee, legal guardian or POA that person should assist them with the application process.
If an applicant is currently residing in a facility, the application must be made in the county where the applicant last resided in a private living arrangement. A private living arrangement is where the person resided in their own home or the home of another person. The home could be an apartment, mobile home, house, or other non-institutional setting. If traveling to the official county of residence presents a hardship, the county where the SA applicant is physically located usually will agree to take a “courtesy” application for the county of residence. Both counties must agree to this, however.
From the date of application, the eligibility determination process can take up to 45 days for applicants age 65 or older and up to 60 days for applicants age 64 and under. If the county DSS is awaiting a Social Security decision the application may pend up to 12 months.
6. How does the facility receive the room and board payment from the resident?
SA benefits are authorized by the county DSS for the recipient. The resident should have a contract with the facility to pay a specific rate for room and board, which cannot be more than the rate established by the General Assembly. Using the SA benefit and other income, the SA recipient or his/her representative pays the facility up to the state maximum room and board rate.
The SA recipient is allowed to keep $46 a month to meet personal needs (Medicaid co-payments, personal items, etc). He/she may be allowed to keep up to $20 each month from other income to spend on their personal needs. An exception to the $20 exclusion is an SA recipient who has earned income. These applicant/recipients are also allowed other exclusions from their earnings.
7. When may a Special Assistance recipient expect to receive his/her monthly benefit?
Effective October, 2013, Special Assistance benefits will begin being issued electronically and will be available by the 7th business day of the month. Please see the attached letter sent to providers regarding the options for issuance of electronic payments.
8. What if a resident is only a resident of the facility for part of a month?
When a resident becomes eligible for SA after the first day of the month, he/she will receive a partial SA payment for that month based on the per diem for the appropriate SA rate. The per diem is the SA rate divided by the number of days in the month, then multiplied by the number of days the applicant was eligible during the month.
If an applicant/recipient leaves the facility before the end of the month, the DSS case worker must be notified within 5 calendar days. Depending on the situation, the SA recipient may owe money from the SA payment to the facility and/or the DSS. See DHSR adult care rules 10 A NCAC 13F.1106 pertaining to the settlement of the cost of care.
DHSR Adult Care rules state that in no situation involving a recipient of SA may a facility require payment for more than 30 days since SA is not authorized unless the resident is actually residing in the facility or it is anticipated that he will return to the facility within 30 days.
9. What should the facility do with the SA benefit when a resident dies?
If the resident dies, the facility staff must notify the County DSS immediately. The facility must pay back the DSS for any funds deposited into their account on behalf of the SA recipient. The DSS will be responsible to return any unused benefits to the Clerk of Superior Court who administers the funds. According to DHSR rules, the facility is entitled to a per-diem rate for the nights that the resident spent in the facility.