NC Medicaid · Paying for Care

How NC Medicaid Pays for Long-Term Care

By Asheville Senior Care Guide · Updated July 2026

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Medicaid is the single largest payer of long-term care in the country, and for many Buncombe County families it is what makes an extended nursing home stay or ongoing in-home care possible. But North Carolina Medicaid is genuinely complicated, with strict financial rules, a five-year look-back, and several different programs that most people have never heard of. This guide explains, in plain language, what it covers, whether you might qualify, and how to apply here in Buncombe County.

What Medicaid covers that Medicare will not

This is the crucial distinction. Medicare is health insurance; it pays for short-term, skilled care and rehab, but it does not pay for long-term custodial care, the ongoing help with daily living that most people in a nursing home or assisted living actually need. Medicaid does. Once Medicare’s short window runs out, Medicaid is how most families fund a long-term stay.

The three ways Medicaid pays for long-term care in NC

Do you qualify? The 2026 financial rules

Medicaid long-term care is need-based, so eligibility turns on income and assets. The core 2026 numbers for North Carolina:

North Carolina is a “medically needy” spend-down state. That means even if your income is above the limit, you can still qualify by spending the excess on your care each month. In a nursing home, the reality is that almost all of a resident’s monthly income (Social Security, pension) goes to the facility, minus the $70 personal needs allowance and any premiums, and Medicaid pays the remaining balance of the bill.

Protecting a spouse who still lives at home

Families are often terrified that a spouse entering a nursing home will bankrupt the one still at home. North Carolina has specific protections against exactly that. The “community spouse” (the one remaining at home) can keep the house and one vehicle, can retain up to $162,660 of the couple’s countable assets in 2026, and is guaranteed enough monthly income to live on, a minimum of $2,705 per month as of July 2026, transferred from the applicant spouse if needed. These rules are the single biggest reason to talk to an elder law attorney before spending down savings on your own.

The five-year look-back

How to apply in Buncombe County

You can apply for NC Medicaid online through the state’s ePASS portal (epass.nc.gov), by phone, or in person at the Buncombe County Department of Social Services. For the home-based CAP/DA waiver or PACE, you contact the local program directly to request an assessment once Medicaid eligibility is established. The key local and state contacts:

Note that NC Special Assistance is a separate, related program that helps pay for assisted living and adult care homes rather than nursing facilities. If assisted living is what you are weighing, see our NC Special Assistance guide.

Frequently asked questions

Does NC Medicaid pay for nursing home care?

Yes. North Carolina Medicaid pays for long-term nursing facility care for those who meet its medical and financial rules, and most Buncombe County nursing homes accept it.

What is the Medicaid look-back period in North Carolina?

Five years. NC reviews the previous 60 months of financial records for gifts or below-market asset transfers when you apply for long-term care Medicaid.

What is the 2026 asset limit for NC Medicaid long-term care?

$2,000 in countable assets for a single applicant. A community spouse can keep the home, a vehicle, and up to $162,660 of countable assets in 2026.