Two versions of the program
| Special Assistance for adult care home residents | Special Assistance In-Home (SAIH) | |
|---|---|---|
| Where you live | An adult care home, family care home or group home approved for Special Assistance (special care units for Alzheimer's or related disorders get a different rate) | Your own home |
| Care need | Need placement in an adult care home or special care unit | Adult care home level of care, verified by a doctor, and a services assessment showing you can stay home safely |
| What it pays | A cash supplement toward room and board; the facility must accept the state rate | A monthly payment for food, shelter, clothing and other daily needs |
Who qualifies
Under G.S. 108A-41, you must:
- Be 65 or older, or 18 to 64 and permanently and totally disabled or legally blind.
- Need adult care home or special care unit placement, and live there or be seeking it "if not for" Special Assistance (the in-home version).
- Have countable monthly income no higher than the basic rate (or the enhanced rate with an Alzheimer's or dementia diagnosis) plus a personal needs allowance set by the General Assembly.
- Have resources within the program's limit. Your home, the land it sits on and contiguous land are not counted.
- Have lived in North Carolina for at least 90 days before receiving assistance, and be a U.S. citizen or qualified non-citizen.
How it connects to Medicaid and Medicare
- Automatic Medicaid. NCDHHS says people who are eligible for Special Assistance "are automatically eligible for Medicaid." Medicaid can then pay for personal care services, such as help with bathing and dressing.
- Medicare stays primary. Medicare still covers doctors, hospitals and drugs, and Medicaid makes you eligible for Extra Help.
- Estate recovery. NC Medicaid can file a claim against the estate of a Special Assistance recipient 55 or older for Medicaid-paid personal care services; small estates and certain survivors are protected (DHB-5052SA).
How to apply
- Contact your county DSS. Apply at your county Department of Social Services; someone can apply for you.
- Bring proof. Income (Social Security, SSI, VA, pensions), bank statements, property and insurance information, your Social Security number, proof of age and a state-issued ID.
- For in-home help, complete the assessment. An Adult Services case manager reviews whether you can stay home safely and what services you need.
For other long-term care options, see CAP/DA and NC Medicaid and Medicare. To review Medicare coverage after a move to an adult care home, you can request a call from a licensed insurance agent.
Related questions
What is the CAP/DA waiver?
Medicaid services at home.
Does NC Medicaid pay for nursing home care?
When more care is needed.
Does NC Medicaid take your house after death?
Estate recovery in North Carolina.
Sources
- NCDHHS — State and County Special Assistance for Adult Care Home Residents
- NCDHHS — State and County Special Assistance for In-Home Residents
- NCDHHS — The State/County Special Assistance In-Home Program for Adults (brochure, 12/2025)
- N.C. General Statutes § 108A-41, Special Assistance eligibility
- NC Medicaid — DHB-5052SA, Special Assistance estate recovery notice (rev. 05/2023)
- Medicare.gov — Long-term care
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 pay for nursing home care?
- 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 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
Frequently asked questions
Does Medicare pay for an adult care home or assisted living in North Carolina?
No. Medicare doesn't pay for room and board or custodial care in assisted living or an adult care home. Special Assistance and Medicaid personal care services are North Carolina's main public help for those costs.
How much does Special Assistance pay?
The North Carolina General Assembly sets a basic monthly rate and a higher enhanced rate for people with Alzheimer's disease or dementia. Your payment is the rate, plus a personal needs allowance, minus your countable monthly income. Your county DSS can give you the current rates.
How long does a Special Assistance application take?
NCDHHS says the eligibility decision can take up to 45 days for applicants 65 or older and up to 60 days for applicants 18 to 64.
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