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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 
NC Division of Medical Assistance - High quality health care through Medicaid and Health Choice for Children.

Who is Eligible - Medicaid for Long-Term Care

Click here to learn more about Medicaid Reform

Medicaid may help pay for nursing homes and intermediate care facilities, as well as long-term care in the home. There are income limits, resource limits and transfer of asset requirements. You do not have to sell your house. The home, a car and all personal possessions are not countable resources.

Medicaid allows financial protection for the married spouse at home.

Nursing Facilities and Intermediate Care Facilities

Your income must be less than the cost of care in the facility at the Medicaid rate. Medicaid must approve the need for the level of care. You must use some of your income to help pay for the cost of care. This is called the “patient monthly liability.” Medicaid will pay the rest to the facility.

Your spouse can keep all of the income he/she receives for himself. He or she may be able to receive some of your income as well.

In-Home Long-Term Care


Community Alternatives Program (CAP)

Currently, there ar four Community Alternatives Programs that help people who need long term care stay in their own homes. CAP provides both medical and non-medical services to prevent or delay care in a facility.

CAP funds are limited and only a specific number of people may participate in each program.

  • Community Alternatives Program for Children (CAP/C)

  • The Community Alternatives Program for Disabled Adults (CAP/DA) provides an array of home and community based services to adults with disabilities 18 years of age and older who are at risk of institutionalization. The services are designed to provide an alternative to institutionalization for beneficiaries in this target population who prefer to remain in their primary private residences, and would be at risk of institutionalization without these services.  The CAP/DA program is intended for situations where no household member, relative, caregiver, landlord, community, agency, volunteer agency, or third party payer is able or willing to meet all medical, psychosocial, and functional needs of the beneficiary.  There are two program options under the CAP/DA Program.

  • The CAP/DA program is available to all North Carolina Counties. CAP/DA Lead Agency List (PDF, 78KB)

  • The two options under the CAP/DA Program are:
  •      1. CAP/DA, the traditional option; and
  •      2. CAP/Choice, the consumer-directed option.

  • CAP/Choice, an option under the CAP/DA program, is consumer-directed care for disabled adults who wish to remain at their primary private residence and have increased control over their own services and supports. Beneficiaries and their caregivers direct their own services and supports which are provided in their own primary private residence and community. It offers beneficiaries the choice, flexibility and control over the types of services they receive, when and where the services are provided, and by whom the services are delivered.

Money Follows the Person Demonstration Grant Project

Money Follows the Person is a state demonstration project that helps Medicaid-eligible individuals who live in hospitals, nursing homes or intermediate care facilities for people with intellectual or developmental disabilities (ICF-I/DD) to return to their own homes and communities.
In order for a person to qualify, the person must:

Worried that your needs may be too great? Read these inspiring participant stories.
Visit DMA’s Money Follows the Person web page or download this Two-Page Program Summary Sheet to learn more about the program.


Program For All-Inclusive Care For The Elderly (PACE)

PACE provides care to the individual in the home, such as in-home personal care services and home health care.  PACE provides a PACE Center that includes a primary care clinic, therapy, personal care, and dining.

To be eligible to participate in PACE, you must be:

  • 55 years of age or older;
  • Be determined to need the level of care required under the State Medicaid plan for coverage of nursing facility services;
  • Reside in the PACE organization’s service area;
  • Be able to live in a community setting at the time of enrollment without jeopardizing his/her health or safety based on criteria set forth in the program agreement and meet any additional program-specific eligibility conditions imposed under its respective PACE Program Agreement.

Only public and not-for-profit organizations may develop and operate PACE programs. They are certified through the Federal government. Currently there are 10 PACE sites in North Carolina. They are:

  • Elderhaus, Inc. of Wilmington
  • Piedmont Health Senior Care of Burlington
  • Piedmont Health Senior Care of Pittsboro
  • Life Saint Joseph of the Pines of Fayetteville
  • PACE of the Triad of Greensboro
  • PACE@Home of Newton
  • Carolina Senior Care of Lexington
  • PACE of the Southern Piedmont of Charlotte
  • VOANS Senior CommUnity Care of Durham
  • Senior Total Life Care of Gastonia

More programs are in development. More information about PACE.

Transfer of Assets

If you or your representative give away assets or sell them for less than market value, you may be ineligible to receive Medicaid for 3 to 5 years.

The sanction period is based upon the value of the assets transferred out of your name. There are certain circumstances where assets may be given away without penalty. Your local County Department of Social Services (DSS) can provide more detail information.

Estate Recovery

When a Medicaid recipient receiving any of the above long-term care services dies, Medicaid seeks to recover certain expenses. There will be a claim filed against the estate. Under certain circumstances, estate recovery may not apply. Your local County Department of Social Services (DSS) can provide more detail information.

If you think you may be eligible for long-term care services, see "How to Apply."

 

April 1, 2014