Does NC Medicaid pay for nursing home care?

What Medicare covers first

Medicare Part A covers care in a skilled nursing facility for up to 100 days per benefit period, after a qualifying inpatient hospital stay, if you need daily skilled care. In 2026, days 1–20 have no coinsurance, and days 21–100 cost $217 a day. Medicare doesn't pay for long-term custodial care, the everyday help most nursing home residents need.

How NC Medicaid decides

• Medical need: a special NC Medicaid review team decides whether you need nursing facility care.
• Financial eligibility: the Department of Social Services in your county reviews your income and resources. NC's chart MA-2252 sets the resource limit for one person.
• Your home: it isn't counted while you, your spouse or a dependent relative lives there, or while you intend to return (MA-2230). A federal home equity limit applies to long-term care (MA-2242).
• Transfers: the county looks back 60 months for gifts or sales below market value (MA-2240).

How your income is used

Many states cap income for nursing home Medicaid. North Carolina doesn't. Under NCDHHS manual MA-2270, the county compares your income with the nursing home's private rate. If your income plus predictable medical expenses don't cover that rate, you can qualify. Once you qualify:

1. You keep a personal needs allowance. NCDHHS sets this monthly amount for clothing and personal items.
2. Some deductions come off. These can include an allowance for a spouse or dependents at home and unmet medical expenses, such as health insurance premiums.
3. The rest is your patient monthly liability. You pay it to the nursing home, and Medicaid pays the remainder up to its rate.

After you qualify

• Medicare stays primary. You keep Medicare for hospital care, doctors and Part D, and you get Extra Help automatically. Medicare plan changes are allowed more often while you live in a nursing home (42 CFR 422.62(a)(4)).
• NC Medicaid Direct. People with Medicare and Medicaid, and long-stay nursing home residents, are outside the managed care health plans (G.S. 108D-40).
• Estate recovery. NC Medicaid can claim nursing facility costs from the estate of a member 55 or older, or of any age if permanently institutionalized (G.S. 108A-70.5).

If you'd rather stay home, see CAP/DA and PACE in NC Medicaid and Medicare. To review Medicare coverage for a parent in a nursing home, you can request a call from a licensed insurance agent.

Related questions

Sources

• NC Medicaid — Nursing Facilities
• NCDHHS — MA-2270, Long Term Care Need and Budgeting (revised 06/16/2026)
• NCDHHS — MA-2230, Financial Resources (revised 06/30/2026)
• NCDHHS — MA-2252, Non-MAGI Medicaid income and reserve limits
• NCDHHS — MA-2240, Transfer of Assets
• N.C. General Statutes § 108A-70.5, Medicaid Estate Recovery Plan
• Medicare.gov — Skilled nursing facility care
• eCFR — 42 CFR 422.62, MA election periods

More questions in this guide

• Are people with Medicare and Medicaid in NC Medicaid managed care?
• Can I have NC Medicaid and Medicare at the same time?
• Did NC Medicaid expansion change anything for people on Medicare?
• Does NC Medicaid take your house after you die?
• Medicare vs. Medicaid in North Carolina
• What is a dual eligible special needs plan in North Carolina?
• What is Special Assistance in North Carolina?
• What is the CAP/DA waiver in North Carolina?
• What is the Medicaid look-back period in North Carolina?

Part of the guide: NC Medicaid and Medicare together · All questions

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