Assisted Living in North Carolina

North Carolina is an excellent location for assisted living. The state is home to more than 1.76 million senior citizens who enjoy a pleasant Southern climate and scenic surroundings that extend from the coastal plains to the Blue Ridge Mountains.

Although North Carolina ranks 39th in the nation for its senior-friendly amenities, according to the 2022 Senior Living Report, it received more favorable ratings for community involvement, health care and affordability. The cost of living is about 9% lower than the national average, and housing and transportation are particularly budget-friendly. Assisting living is also more affordable than the national average. You can expect to pay about $4,010 per month, depending on your location and the type of facility.

In this guide, you’ll find more information about long-term care prices, financial assistance programs and assisted living regulations. We’ve also provided a number of resources related to Medicaid and healthy aging.

The Cost of Assisted Living in North Carolina

The median cost of assisted living across the Tar Heel State is $4,010 per month, according to Genworth Financial’s 2021 Cost of Care Survey. This study shows that residents save about 10% compared to the national average of $4,500. Looking at the Southeast as a whole, seniors in South Carolina and Georgia benefit from below-average rates of $3,612 and $3,535, respectively. Prices in Tennessee are comparable at $4,105. Moving up the Atlantic coast, monthly prices increase by $1,240 in Virginia.

Assisted living prices vary by a significant margin in North Carolina’s largest cities, depending on the local cost of living and other factors. Fayetteville is one of the cheapest cities for assisted living with a median monthly cost of $3,000. Greensboro is $210 per month more affordable than the state median at $3,800. Prices in Charlotte average around $4,400, which is closer to the national average. Rates in Asheville and Winston-Salem are $4,998 and $4,923 per month, respectively. Wilmington is 30% more expensive than average with its median of $5,254, and assisted living prices in Raleigh exceed the state median by $1,378 per month.

The cost of long-term care varies substantially depending on the types of services offered and where the care is provided. Assisted living costs about $375 less per month than in-home care, which includes both home care and home health care. If you want to save money but are still looking for social interaction and personal assistance, you can join an adult day health care program in your community for $1,197 per month. Seniors who aren’t eligible for assisted living for health reasons pay approximately $7,483 per month for semiprivate accommodations in a nursing home and $8,213 for a private room.

Does Medicaid Cover Assisted Living in North Carolina?

Yes, North Carolina covers assisted living directly through its Medicaid State Plan. Personal Care Services (PCS) are part of the state’s Long-Term Services and Supports program. You must be financially eligible for Medicaid for the Aged, Blind and Disabled, and you must meet additional medical criteria as determined by a personal needs assessment.

Specifically, you must have a medical condition, physical disability or cognitive impairment that results in unmet personal care needs. You may qualify if you need:

• Limited help with three or more activities of daily living
• Extensive assistance with at least one of two ADLs
• Complete assistance with one of two ADLs

What Assisted Living Services Are Covered by Medicaid in North Carolina?

If you’re eligible, PCS covers a variety of personal care services provided at home or in a residential setting, including a group home or adult care home, commonly known as an assisted living facility. Personal Care Services are designed to help with a variety of daily activities, including the following:

• Eating
• Bathing
• Dressing
• Grooming
• Toileting
• Mobility 

Many states only pay for assisted living through Medicaid waivers, which means that eligible individuals are placed on a waiting list. While North Carolina’s PCS program has strict financial requirements, all qualifying applicants are eligible for benefits once approved. There may be restrictions regarding how many hours of monthly care you can receive based on your individual requirements.

Other Long-Term Care Benefits

State-County Special Assistance

Individuals who receive Social Security Disability Insurance or Supplemental Security Income are automatically entitled to Medicaid. Additionally, North Carolina offers State-County Special Assistance to help individuals who are aged, blind or disabled and need help paying for the cost of room and board provided by an assisted living facility or adult care home.

The state and county government may provide an extra stipend of $554 per month to individuals in assisted living or up to $887 for those in memory care. When federal benefits are added, beneficiaries may receive $1,228 or $1,561, respectively. You can apply by contacting your local DSS office.

Program of All-Inclusive Care for the Elderly

PACE is another option for seniors aged 55 or older who require a nursing level of care. There are multiple payment options for individuals who qualify for Medicaid, Medicare or are private-pay. With PACE, all medical and long-term care services are provided by a single organization, but the program pays for any services that you need. However, there are geographic restrictions. You must reside in a participating ZIP code. The state has 11 regional PACE programs. You can see if these services are available in your area by visiting the National PACE Association.

Assisted Living Waiver Programs in North Carolina 

North Carolina’s Community Alternatives Program for Disabled Adults (CAP/DA) waiver covers a variety of services typically offered in assisted living. It’s designed to keep residents out of nursing homes and in community-based settings. It may cover short-term respite care in an assisted living facility or nursing home, as well as some of the following services.

• Adult day health care
• Bill pay assistance
• Case management
• Emergency response systems
• Home health aids
• Household services
• Meals and meal prep
• Medical equipment
• Transitional care

You can learn more by calling (919) 855-4340 or reaching out to a designated case management agency in your county. A directory of providers is available online. 

How To Know If You’re Eligible for Medicaid in North Carolina

Medicaid is a health insurance program available to individuals who have limited income and resources. To qualify for Regular Medicaid or Medicaid for the Aged, Blind and Disabled in North Carolina, you must have no more than $1,074 in monthly income if applying individually or $1,452 if applying as a couple. Assets are capped at $2,000 or $3,000. If only you or your spouse requires long-term care, the non-applicant can keep up to $137,400. A home, vehicle and other possessions are also exempt. Income limits are higher for individuals who live in a nursing home and spend most of their income on care.

2022 Medicaid Income Limits for Seniors in North Carolina

In addition to meeting financial requirements, applicants must fall into one of Medicaid’s target groups. The following individuals may qualify:

• Adults aged 65 or older
• Individuals who are blind or disabled
• Medicare beneficiaries
• Adults who require long-term care

How to Apply for Medicaid in North Carolina 

You can apply for Medicaid Long Term Services and Supports online at North Carolina ePass. This system also screens you for related benefits, such as food stamps and utility bills assistance. If you’d rather apply in person, contact the Division of Social Services office in your county to sit down with a caseworker. You can find a complete directory of DSS locations online. You can also request a paper application that can be completed and mailed to your local DSS office.

Information You Will Need 

To qualify for Medicaid, you must provide documentation supporting your eligibility. These records may include:

• A government-issued ID
• Proof of U.S. citizenship or immigration
• Proof of in-state residency
• A Social Security card
• Health and life insurance information
• Proof of income and assets
• Benefits award letters
• Disability information, if applicable

How to Get Help Applying for Medicaid 

If you have questions about Medicaid or need help accessing your benefits or appealing a decision, the following agencies can help. Assistance may also be available through local nonprofit groups.

Does Medicare Cover Assisted Living in North Carolina?

The short answer is that no, Medicare does not cover the cost of assisted living in North Carolina. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in North Carolina.

Other Financial Assistance Options for Assisted Living in North Carolina

Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.

Free and Low-Cost Resources for Seniors in North Carolina

If you’re ready to move into assisted living or are looking for alternatives, contact the following agencies for assistance. Financial benefits may be available, along with other resources, and a personal consultation can help you determine which type of care is best for your needs now and in the future. 

COVID-19 Rules for Assisted Living in North Carolina

The following information is based on research done on several government websites, including The NC Department of Health and Human Services and CDC. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 3/10/22, 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.

Visitation Policies

Outings & Social Activities

*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.

COVID-19 Safety Measures for Staff and Residents

Assisted Living Laws and Regulations in North Carolina

Assisted living facilities in North Carolina must comply with licensing requirements enforced by the Division of Health Service Regulation, Adult Care Licensure Section. These regulations apply to resident care, staffing and training, among other areas.

Frequently Asked Questions