Seniors looking for affordable assisted living options may want to consider making North Carolina their home state. Approximately 16.7% of North Carolina’s population are seniors aged 65 and older, and the state’s average assisted living cost of $4,010 per month is lower than several nearby states and significantly lower than the national median. While health care costs in North Carolina are slightly higher than the national average, the state offers a variety of financial assistance programs and has a lower-than-average overall cost of living. Additionally, North Carolina houses two U.S. News’ nationally-ranked hospitals.

This guide provides an overview of assisted living costs in North Carolina and information on the Community Alternatives Program for Disabled Adults, the state’s Medicaid waiver for seniors seeking long-term care. It also includes information about other financial assistance options, as well as a list of free and low-cost resources that serve area seniors.

How Much Does Assisted Living Cost in North Carolina?

According to the Genworth 2021 Cost of Care Survey, assisted living in North Carolina costs an average of $4,010 per month. This is nearly $500 lower than the national average of $4,500. Assisted living costs in Tennessee and Virginia are higher than those in North Carolina at $4,105 and $5,250, respectively. Seniors in South Carolina pay $3,612 for this level of care, and Georgia has the lowest assisted living costs in the region at $3,535 per month.

The Cost of Assisted Living in North Carolina’s Top Cities

Assisted living rates in North Carolina vary widely, depending on location and local costs of living. Costs range from $2,700 in Goldsboro to $5,388 in the Raleigh Area. Seniors in Jacksonville pay approximately $400 less than the statewide average at $3,600 per month, while their counterparts in the Charlotte Area and Wilmington pay significantly more at $4,400 and $5,254 per month, respectively.

The Cost of Assisted Living vs. Other Types of Care

Fortunately, older adults in North Carolina have several senior care options available to them. The least expensive is adult day health care, which costs $1,197 per month; however, this type of care doesn’t include housing costs or daily meals. Seniors who require assistance with the activities of daily living may opt for assisted living services for $4,010 per month. Those who prefer to receive their care at home pay $4,385 for both homemaker and home health aid services, which is nearly $400 more than average assisted living rates. Nursing home care is the most expensive senior care option in North Carolina at $7,483 per month. 

Can You Use Medicaid to Pay for Assisted Living in North Carolina?

North Carolina’s Medicaid program only covers basic medical care and doesn’t directly pay for long-term care or assisted living in the state. Instead, North Carolina offers the Community Alternatives Program for Disabled Adults, or CAP/DA, to seniors who require long-term care. This program is designed to help seniors and adults with disabilities receive the long-term care supports necessary to delay their need for nursing home care for as long as possible.

Medicaid’s Coverage of Assisted Living in North Carolina

North Carolina’s CAP/DA Medicaid waiver program provides home and community-based services designed to help seniors remain in their home or a community-based setting, such as an assisted living facility. 

Waiver Programs for Assisted Living in North Carolina

Community Alternatives Program for Disabled Adults

The CAP/DA waiver program allows its senior enrollees to receive services designed to help them remain in their home or assisted living facility and out of an institutional or nursing facility. All seniors who enroll in CAP/DA must undergo a needs assessment performed by a CAP/DA case manager. To qualify, the case manager must determine that the senior needs at least one of the waiver program’s services, and the senior must have disabilities or impairments that require an institutional level of care.

The types of home- and community-based services a senior may receive through the program include:

• Adult day health services
• Assistive equipment and technology
• Medical supplies
• Community transition services
• Meals
• Coordinated care
• Community transition assistance
• Personal assistance
• Assistance with activities of daily living such as eating, bathing and toileting
• Case management
• Consumer-directed services that allow seniors or a designated person to choose caregivers and directly hire and manage a personal assistant as an employee

To apply, seniors must request a referral from their local CAP/DA case manager.

Eligibility for Medicaid in North Carolina

Because Medicaid is intended to provide health care for low-income individuals who would otherwise be unable to pay for care, North Carolina’s Medicaid program for the aged, blind and disabled sets maximum income and assets thresholds seniors may not exceed if they wish to enroll.

Seniors who are single must have an annual income of $12,888 or less and assets that do not exceed $2,000. Married seniors may not exceed a combined annual income of $17,424, and their combined assets may total no more than $3,000. Medicaid defines assets as financial resources, such as cash, money in bank accounts and investments (a senior’s home, cars, furniture and other material goods are not included in the asset limit).

2022 Medicaid Income Limits for Seniors in North Carolina

	Income Limits*	Asset Limits
Single Applicant	$12,888	$2,000
Two-Person Household (Only One Person Applying)	$17,424	$3,000
Two-Person Household (Both People Applying)	$17,424	$3,000

*per year

Outside of those requirements, applicants must also:

• Be a U.S. citizen
• Be at least 65 years or older
• Be blind
• Have a disability

Applying for Medicaid in North Carolina

Seniors can apply for Medicaid in North Carolina by calling the program directly at (800) 662-7030. They can also apply through the state’s online application portal or print and mail a paper application.

Before You Apply: 

Before applying for Medicaid, seniors should gather the necessary documents to prove their eligibility for the program. These documents include:

• Proof of citizenship and identity, such as your ID, birth certificate and Social Security card
• Two documents verifying that you live in North Carolina
• Your pay stubs for the past month
• A list of assets including cars, property and bank statements
• Documents showing any other financial benefits or income you may receive

Where to Go to Get Help

There are several agencies and resources in North Carolina that seniors can contact for help with their Medicaid and CAP/DA waiver applications. These resources can help seniors learn more about the program and the benefits it provides, as well as what to do if their application is denied.

Resource	Contact	Service
Department of Social Services (DSS) office	Find your local DSS office here.	The Department of Social Services office can provide assistance with Medicaid applications.
NC CARE-LINE	1 (800) 662-7030	The NC CARE-LINE provides information and referrals for those seeking Medicaid assistance.
American Council on Aging	Seniors can ask questions about Medicaid through the site’s forum here.	The American Council on Aging website is a free resource to help seniors learn about the Medicaid application process and their Medicaid health care options.
NC Medicaid Division of Health Benefits	(888) 245-0179	Seniors can access information about North Carolina’s Medicaid health care options, along with providers, available programs and eligibility information, through this website.

Can You Use Medicare to Pay for Assisted Living in North Carolina?

Unfortunately, Medicare does not cover the cost of assisted living in North Carolina. Unlike nursing homes, assisted living facilities are not considered to be “clinical settings’ and so are not eligible for Medicare coverage. That being said, you can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

For more information about Medicare visit medicare.gov.

Are There Other Financial Assistance Options for Assisted Living in North Carolina?

	How to Apply	How It Works
Aid and Attendance	Apply online at va.gov.	If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse Mortgages	Research and learn about the different types at ftc.gov	If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) Insurance	Learn about how to receive LTC insurance benefits at acl.gov.	While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free Assisted Living Resources for Seniors in North Carolina

There are several agencies and organizations located throughout North Carolina that can help seniors with long-term care planning. Through these services, seniors can get more information about assisted living services, financial aid, counseling and other support services.

Resource	Contact	Service
Special Care Assistance Program/Special Assistance Adult Care Home Special Care Unit Program	Apply through your local county department of social services.	Seniors and adults with disabilities can receive financial assistance toward room and board in an assisted living facility through North Carolina’s Special Care Assistance Program.
Long-term Care Ombudsman Program	Contact your regional ombudsman directly.	Long-term care ombudsmen help protect the rights and well-being of seniors in long-term care. The ombudsman can provide seniors and their loved ones with information and guidance on assisted living options and any relevant legal matters or concerns.
Department of Veterans Affairs’ Benefit Services	1 (844) 624-8387	Veterans in North Carolina can get help applying for state and federal benefits from the Department of Veterans’ Affairs Benefit Services. Service officers can help older adults apply for the Aid & Attendance Pension program, which may help cover assisted living costs. Seniors may also qualify for placement in a veterans’ home, which may make assisted living more affordable.
North Carolina Area Agencies on Aging	Find your local agency’s contact information here.	Local Area Agencies on Aging provide a variety of senior resources and programs, such as caregiver support, transportation services and counseling.
US Department of Housing and Urban Development Section 202 Supportive Housing for the Elderly Program.	Find your local Multifamily Regional Center office here.	In some instances, North Carolina seniors with very low incomes may qualify to receive financial assistance toward room and board in an assisted living facility through HUD’s Section 202 Supportive Housing for the Elderly Program.

COVID-19 Rules for Assisted Living in North Carolina

The following information is based on research done on several government websites, including covid19.ncdhhs.gov and cms.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?	Yes
Can I visit my relative in person for end-of-life compassion care?	Yes
Will my loved one be required to self-quarantine after I visit him or her?	No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?	Yes
Are Hairdressers and other non-medical contractors still allowed in senior living facilities?	Yes
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?	Yes
Are visitors being screened for elevated temperatures?	Yes
Are visitors being asked questions about health, travel, and potential virus contact?	Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?	Yes
Are residents of senior living facilities who leave and return required to self-quarantine?	No (Conditions Apply)
Are senior living facilities required to cancel all group outings?	No
Are residents still eating together in the dining hall?	Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?	Yes (Conditions Apply)

Safety Measures for Staff & Contractors

Are staff members and contractors being screened for elevated temperatures?	Yes
Are staff members and contractors being tested for Coronavirus?	Yes (Conditions Apply)
Are staff members and contractors being asked questions about health, travel, and potential virus contact?	Yes

Safety Measures for Residents

Are staff members required to regularly screen residents for coronavirus symptoms?	Yes
Are residents relied on to screen themselves and self-report potential coronavirus symptoms?	No
Are staff members required to take residents’ temperatures?	Yes
Are residents being tested for coronavirus?	Yes (Conditions Apply)

Assisted Living Laws and Regulations in North Carolina

In North Carolina, assisted living facilities, or adult care homes, are regulated by the Adult Care Licensure Section of the Division of Health Service Regulation. This agency licenses North Carolina’s assisted living facilities, performs annual inspections and assists with any complaint investigations.