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NC Department of Health and Human Services
Division of Medical Assistance Home
 
 
NC Division of Medical Assistance - High quality health care through Medicaid and Health Choice for Children.

Who is Eligible - Medicaid for Long-term Care

Medicaid may help pay for nursing homes and intermediate care facilities, as well as long-term care in the home. There are income limits, resource limits and transfer of asset requirements. You do not have to sell your house. The home, a car and all personal possessions are not countable resources.

Medicaid allows financial protection for the married spouse at home.

Nursing Facilities and Intermediate Care Facilities

Your income must be less than the cost of care in the facility at the Medicaid rate. Medicaid must approve the need for the level of care. You must use some of your income to help pay for the cost of care. This is called the “patient monthly liability.” Medicaid will pay the rest to the facility.

Your spouse can keep all of the income he/she receives for himself. He or she may be able to receive some of your income as well.

In-Home Long-Term Care

Community Alternatives Program (CAP)

Currently, there ar four Community Alternatives Programs that help people who need long term care stay in their own homes. CAP provides both medical and non-medical services to prevent or delay care in a facility.

CAP funds are limited and only a specific number of people may participate in each program.

  • Community Alternatives Program for Children
  • Community Alternatives Program for Disabled Adults (CAP/DA) provides a package of services to allow adults (age 18 and older) who qualify for nursing facility care to remain in their private residences. The program is available in all North Carolina counties. CAP/DA Lead Agency List (44 KB PDF)
  • The Community Alternatives Program for Persons with Mental Retardation or Developmental Disabilities (CAP-MR/DD) provides community services to individuals of any age who qualify for care in an intermediate care facility for the mentally retarded (ICF-MR). The program is available statewide through local area mental health, developmental disabilities and substance abuse programs.
  • CAP/Choice is for disabled adults and uses non-traditional case management services. The program is only available in Cabarrus, Duplin, Forsyth and Surry counties. While it provides the same services provided in CAP/DA, it also provides four additional services: care advisor, financial management, personal assistant and services, equipment or supplies to increase independence in daily tasks.

Money Follows the Person Demonstration Grant Project

Money Follows the Person is a program that allows people in nursing homes or other institutions who are elderly or have disabilities to move out of a nursing home or institution and receive assistance to live in their own homes in their own communities. More information about Money Follows the Person

Program For All-Inclusive Care For The Elderly (PACE)

PACE provides care to the individual in the home, such as in-home personal care services and home health care. PACE provides a PACE Center that includes a primary care clinic, therapy, personal care, and dining.

Only public and not-for-profit organizations may develop and operate PACE programs. They are certified through the Federal government. Currently there are two PACE organizations in North Carolina. They are Elderhaus, Inc. of Wilmington, NC and Piedmont Health Senior Care of Burlington, NC. More programs are being explored.

Transfer of Assets

If you or your representative give away assets or sell them for less than market value, you may be ineligible to receive Medicaid for 3 to 5 years.

The sanction period is based upon the value of the assets transferred out of your name. There are certain circumstances where assets may be given away without penalty. Your local County Department of Social Services (DSS) can provide more detail information.

Estate Recovery

When a Medicaid recipient receiving any of the above long-term care services dies, Medicaid seeks to recover certain expenses. There will be a claim filed against the estate. Under certain circumstances, estate recovery may not apply. Your local County Department of Social Services (DSS) can provide more detail information.

If you think you may be eligible for long-term care services, see "How to Apply."

 

October 13, 2009