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.

$4010

North Carolina

$4500

The United States

$5250

Virginia

$3612

South Carolina

$4105

Tennessee

$3535

Georgia

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.

$4400

Charlotte

$5388

Raleigh

$3800

Greensboro

$4923

Winston-Salem

$3000

Fayetteville

$5254

Wilmington

$4998

Asheville

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.

$4010

Assisted Living

$4385

Home Care

$4385

Home Health Care

$1197

Adult Day Health Care

$7483

Nursing Home Care (semiprivate)

$8213

Nursing Home Care (private)

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

Annual Income Limits

Asset Limits

Single Applicant

$12,888

$2,000

Two-Person Household
(One Spouse Applying)

$12,888

$2,000 for applicant
$137,400 for non-applicant

Two-Person Household
(Both Spouses Applying)

$17,424

$3,000

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.

Resource

Contact

Description

(888) 245-0179

North Carolina's Medicaid Contact Center is available to help beneficiaries and health care providers with questions related to health insurance benefits. The helpline is open Monday through Friday during business hours.

(877) 201-3750

North Carolina's Medicaid Ombudsman can answer questions about the transition to managed care, which began in July 2021. If you're having trouble accessing your benefits, staff members can provide referrals to legal aid partners and other agencies.

(877) 362-8471

If you have concerns about Medicaid fraud or have been billed for services that were never provided, call the state's Medicaid Tip Line for information or to make a report.

(800) 662-7030

The DHHS Customer Service Center can help you find information about health care, financial assistance and other safety net programs provided by the state or county.

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.

How to Apply

How It Works

Aid and Attendance

Learn more and apply online at va.gov.

Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.

Reverse Mortgages

Learn more about your options and how to apply at ftc.gov

If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.

Long-Term Care (LTC) Insurance

Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.

Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.

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. 

Resource

Contact

Description

211

North Carolina has 16 regional Area Agencies on Aging that help seniors who require assisted living or are interested in community-based alternatives. These government-sponsored agencies are a one-stop destination for information about services and financial assistance programs that can help you maintain your independence.

(800) 772-1213

The Social Security Administration operates offices in more than three dozen cities across the state. You can find information and manage your Social Security benefits online. Local agents can assist with applications, survivors' benefits and referrals to other agencies.

The long-term care ombudsman is available to assist residents who have concerns about assisted living or need help selecting a facility that meets their needs. These specially trained advocates can also help with issues related to estate planning, Social Security, Medicare and Medicaid.

(855) 408-1212

Whether you're enrolling in Medicare for the first time, want to change plans or need more information about your options, SHIIP is there for you. This free program provides advice about Medicare and long-term care insurance. It can also help with insurance supplements, billing issues and financial assistance programs.

(866) 219-5262

This statewide legal aid society helps qualifying residents with housing, health care, government benefits, estate planning and related topics. The nonprofit provides self-help resources that anyone can use to learn more about applicable laws and ways to find relief.

(800) 698-2411

The VA operates an extensive network of medical facilities and community-based centers that serve veterans and qualifying spouses or dependents. These include a number of community-based outpatient clinics, seven regional vet centers and four VA hospitals. In addition to providing health care, staff members can help with applications for Aid & Attendance and other benefits that are relevant to seniors who require assisted living.

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

Rules for North Carolina Communities

Are loved ones allowed to visit to provide emotional support?

Yes

Are relatives allowed to visit for end-of-life care?

Yes

Are residents required to quarantine after visiting with a loved one?

No

Are visitors required to wear PPE (including masks) in order to visit residents?

Yes

Are non-medical contractors (such as hairdressers and entertainers) 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 checked for elevated temperatures?

Yes

Are visitors required to answer questions about health, travel, and potential virus contact?

Yes

Outings & Social Activities

Rules for North Carolina Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Yes

Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?

No

Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

*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

Rules for North Carolina Communities

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

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

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.

NORTH CAROLINA LAWS AND REGULATIONS

Assisted Living Service Plan Requirements

North Carolina requires adult care homes, also called assisted living facilities, to assess new residents within 72 hours of admission. A comprehensive needs assessment and plan of care must be completed within 30 days. The plan of care must be reassessed annually or within 10 days following a significant change in health. Individuals who require placement in a special care unit must be assessed before admission.

Assisted Living Admission Requirements

Assisted living facilities are prohibited from admitting residents who require full-time skilled nursing or medical monitoring. Temporary exceptions can be made with a physician's approval. Individuals who pose a threat to others, have a mental illness or require treatment for substance abuse are not eligible for admission.

Assisted Living Scope of Care

Assisted living facilities must provide 24-hour staffing to meet residents' scheduled and unscheduled needs. Facilities must also provide recreational activities, transportation and environmental services. Skilled nursing may be provided in-house or through a third-party home health provider on a case-by-case basis. Facilities must also provide three daily meals and three snacks, including special diets and feeding assistance if needed.

Assisted Living Medicaid Policy

North Carolina's Community Alternatives Program for Disabled Adults is a Medicaid waiver that can pay for meals, personal care and many services provided in an adult care home. Medicaid's State-County Special Assistance benefit can provide a monthly stipend for room and board.

Assisted Living Facility Requirements

Apartment-style accommodations or suites may be provided but are not required. In most cases, bedrooms can be shared by no more than two residents. Bathrooms can be shared by up to five residents, and at least one bathtub or shower must be provided for every 10 residents.

Medication Management Regulations

Assisted living residents may self-administer medications if they're able. Otherwise, assistance can be provided by a qualified medication aide who has completed a state-approved competency evaluation. After passing the exam, aides must complete six hours of continuing education annually. Residents' medication records must be reviewed quarterly by a pharmacist, RN or prescriber. Additional training is required for diabetes care.

Staffing Requirements

North Carolina has specific staffing ratios for each shift based on the size and type of facility. Assisted living communities must employ a qualified administrator or supervisor at all times. A licensed health care professional must be available to assess residents' medical needs. Facilities must employ a dedicated activities director, and at least one staff member trained in CPR must be on-site at all times.

Staff Training Requirements

Direct-care workers in North Carolina must complete a state-approved training program and competency evaluation. Most programs include 80 hours of training, including 34 hours of clinical work experience. Additional training may be required for dementia and extra services, such as diabetes care. Facility administrators and supervisors must complete 30 hours of continuing education every two years and at least 12 hours of continuing education annually.

Background Checks for Assisted Living

Direct-care workers must pass a comprehensive background check before employment. The state maintains a registry of qualified personnel, including nurses aides and medication aides. Individuals who have a history of abuse or theft as determined by the registry are prohibited from working in assisted living facilities. Facility administrators must also pass a background check.

Requirements for Reporting Abuse

North Carolina requires health care facilities to report instances of suspected abuse or neglect within 24 hours. Facilities must also post information to inform residents about their rights and ways to report concerns. Complaints can be made to the intake center by calling (800) 624-3004. Reports can also be mailed or faxed.

Assisted Living Facilities in North Carolina (114)