What Is NC Special Assistance?

Most families searching for assisted living funding in North Carolina start with Medicare, and quickly discover it doesn’t cover it. What they rarely hear about until they’re deep in the admissions process is NC Special Assistance: a state program that quietly helps thousands of North Carolina seniors afford assisted living every year.

If you have a parent or spouse who needs assisted living in Buncombe County and you haven’t looked into Special Assistance yet, this guide is for you. It covers exactly who qualifies, how much it pays, how the application works locally, and what to do right now.

North Carolina Special Assistance (SA) is a state-funded supplement to Supplemental Security Income (SSI) that helps low-income adults pay for care in a licensed adult care home (the official NC term for what most people call an assisted living facility). Unlike nursing home Medicaid, which requires exhausting most of your assets before qualifying, Special Assistance is based primarily on income, not assets. This distinction matters enormously for families who have some savings but limited monthly income.

The program is administered by the NC Division of Social Services and paid out through county DSS offices. In Buncombe County, that means Buncombe County DSS handles all local applications and ongoing case management.

How Much Does It Pay?

Special Assistance pays a set monthly amount directly to the licensed adult care home on the resident’s behalf. The payment amount is established by the state and updated periodically. As of 2025, the standard SA rate is approximately $1,228 per month.

Here’s how that works in practice: a resident receiving $1,400/month in Social Security and $1,228/month in Special Assistance has $2,628/month going toward their care. If a facility charges $3,800/month, the family would owe about $1,172/month rather than the full $3,800.

The resident retains a small personal needs allowance (typically around $66/month) for personal items. The remainder of their income goes to the facility.

Who Qualifies?

To be eligible for NC Special Assistance, an applicant must meet several criteria:

How to Apply in Buncombe County

The application is handled through Buncombe County Department of Social Services. Here’s how the process works step by step:

1. Contact Buncombe County DSS to request a Special Assistance application. You can call their main line at (828) 250-5500 or visit in person at 40 Coxe Ave, Asheville. Ask specifically for the Adult Services division.
2. Gather documentation. You’ll need: proof of age (birth certificate or passport), Social Security award letter showing current monthly benefit, proof of any other income, proof of NC residency, and information about the facility the person is entering or currently in.
3. Complete the application. A DSS caseworker will review income, care needs, and facility eligibility. The caseworker may contact the facility directly for care-needs documentation.
4. Await the eligibility determination. Processing typically takes 30–45 days. Benefits, if approved, are often backdated to the date of application. Apply as early as possible, even before a placement is finalized.
5. Annual renewal. Special Assistance eligibility is reviewed annually. DSS will contact you when renewal paperwork is due.

Special Assistance and Memory Care

Special Assistance can apply to memory care units within licensed adult care homes, not just standard assisted living. If a facility holds an adult care home license and accepts SA residents in their memory care unit, the same program and payment rates apply.

However, standalone memory care facilities licensed separately, or memory care units within facilities that don’t accept SA, won’t qualify. The question to ask on any memory care tour is: “Is this unit licensed as an adult care home, and do you accept Special Assistance residents?”

Combining Special Assistance With Other Benefits

Special Assistance works alongside other programs. It’s not an either/or situation. Common combinations families in Buncombe County use:

• SA + VA Aid & Attendance: Veterans or surviving spouses who qualify for both can stack the benefits, covering a much larger portion of monthly costs. A veteran receiving $2,300/month in A&A plus $1,228 in SA plus their Social Security could have $4,500–$5,000/month toward care.
• SA + Medicare Part B: SA covers room and board; Medicare Part B continues to cover physician visits and outpatient services within the facility.
• SA + Medicare hospice: A resident on SA who develops a terminal diagnosis can receive Medicare hospice services within the facility while SA continues to cover room and board.
• SA + long-term care insurance: If a person has an LTCI policy, its benefits may cover some or all of the gap between SA and the facility’s private-pay rate.

What Families Often Get Wrong

A few common misconceptions that delay families from applying or cause them to assume they don’t qualify:

• “We have too much in savings to qualify.” The basic Special Assistance program has no asset limit. Savings don’t disqualify someone. What matters is the relationship between monthly income and the facility’s cost. Many families with meaningful savings still qualify because their monthly income is modest.
• “We already applied for Medicaid and were denied.” Special Assistance is a separate program from NC Medicaid. A denial for one doesn’t mean denial for the other. SA has different eligibility rules and is worth applying for independently.
• “The facility will handle it.” While facilities can help, the application is ultimately the family’s responsibility. Don’t assume it’s been started or submitted. Follow up directly with DSS.
• “We should wait until placement is confirmed.” Apply as early as possible. Benefits can be backdated to the application date, not the approval date. Waiting costs money.

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