Winston-Salem Senior AdvisorDoes NC Medicaid pay for a long nursing home stay?
Yes. NC Medicaid pays for long-term nursing home care for residents who need that level of care and meet the financial rules, and it is the main payer for long-stay residents in North Carolina once Medicare's short skilled benefit ends.
The home must be certified for Medicaid and willing to accept the resident under Medicaid, which nearly all nursing homes in the five counties are. A resident who enters as private pay and later qualifies can usually convert in place; confirm that in writing before admission, especially at continuing care campuses with their own rules.
What are the Medicaid financial rules for a nursing home resident?
For a single person, countable resources must be $2,000 or less; the home is often excluded while there is an intent to return or a spouse lives there; and income is not a bar, because the resident pays most of it toward the cost of care each month.
That monthly payment is the patient monthly liability: the resident keeps a $70 personal needs allowance, health insurance premiums can be deducted, and the rest of the income goes to the nursing home, with Medicaid paying the balance. Applications go to the county department of social services; the process asks for months of bank records, so start gathering them early.
What happens to the spouse who stays at home?
Federal spousal impoverishment rules protect a share of the couple's assets and a monthly income allowance for the spouse still living at home, with the limits updated every January.
The protected amounts are calculated from a snapshot of the couple's assets at the start of the nursing home stay. Because the rules and the dollar figures change each year and the calculation has real consequences, a couple with significant savings should talk with an elder law attorney before applying. Do not move or give away assets on your own in the meantime.
What is the Medicaid look-back for nursing home care?
Medicaid looks back 60 months from the application for gifts or transfers made for less than fair value, and an uncompensated transfer creates a penalty period during which Medicaid will not pay for nursing home care.
Paying a grandchild's tuition, signing a house over to a child or making large gifts can all count. Some transfers are allowed, such as to a spouse or to a disabled child, and fair-value purchases do not trigger a penalty. NC Medicaid also seeks repayment from some estates after a recipient dies, so ask about estate recovery when planning.
How does a Winston-Salem family start the Medicaid process?
Apply at the department of social services in the county where the person lives, or online through ePASS, and tell the nursing home's business office the application is under way so it can help with paperwork and verification.
Bring identification, income records, five years of financial statements if asked, insurance cards and any prepaid funeral contract. Approval can take a month or more. Ask the nursing home how it bills during that time, and keep copies of everything you submit. The Medicare, Medicaid and VA questions cover common snags.
What it is, and what it is not
| NC Medicaid for nursing home care does | NC Medicaid for nursing home care does not | |
|---|---|---|
| Coverage | Pay long stays for eligible residents | Pay an adult care home's room and board |
| Income | Take most income as the patient monthly liability | Require income below a fixed cap |
| Spouse | Protect assets and income for a spouse at home | Leave the at-home spouse with nothing |
| Transfers | Look back 60 months for gifts | Ignore recent gifts or transfers |
Based on N.C.G.S. Chapter 131D, 10A NCAC 13F and 13G, DHSR and NCDHHS documents, NC Medicaid, CMS, the VA, CareScout and the local agencies named above; see our editorial standards for how each is checked.
