Winston-Salem Senior AdvisorWhat is State/County Special Assistance?
Special Assistance is a cash supplement, paid with state and county money, that helps low-income residents of licensed adult care homes and family care homes pay for room, board and care; anyone who receives it is also eligible for NC Medicaid.
| State/County Special Assistance in 2026 | Monthly amount |
|---|---|
| Basic Rate, adult care home or family care home | $1,397 |
| Enhanced Rate, special care unit | $1,792 |
| Personal needs allowance kept by the resident | $70 |
| Countable income must be under (Basic) | $1,467 |
| Countable income must be under (Enhanced) | $1,862 |
Source: NCDHHS Dear County Director letter EFS-SA-04-2025 (2026 Special Assistance rates), effective January 1, 2026. Each income limit is the rate plus the $70 allowance.
The Basic Rate applies in an ordinary adult care home or family care home and the Enhanced Rate in a special care unit. The resident keeps a $70 personal needs allowance each month, and the home accepts the Special Assistance payment plus the resident's own income as full payment. Rates are adjusted every January with the Social Security cost-of-living change.
Who qualifies for Special Assistance in North Carolina?
People aged 65 or older, or 18 to 64 and disabled, who live in or are moving to a licensed adult care home that accepts Special Assistance, whose countable income is below the rate plus $70, and whose countable resources are $2,000 or less for one person.
The need for adult care home care is documented on the FL-2. Countable income is mostly Social Security and pensions; the home itself is generally not a countable resource while the person intends to return to it, but cash, investments and second properties are. Rules on transfers and exclusions are detailed, so let the county caseworker make the determination rather than ruling yourself out.
Where do Winston-Salem families apply for Special Assistance?
At the department of social services in the county where the applicant lives: Forsyth County DSS on North Highland Avenue in Winston-Salem (336-703-3800), Davidson in Lexington or Thomasville (336-242-2500), Davie in Mocksville (336-753-6250), Stokes in Danbury (336-593-2861) and Yadkin in Yadkinville (336-849-7910).
Bring proof of identity, income, bank balances and insurance, the FL-2 and the name of the adult care home. Applications can take several weeks, and the county may ask for months of bank statements. Ask the home whether it will hold the bed while the application is pending and whether any private payment is expected meanwhile.
Do all adult care homes around Winston-Salem accept Special Assistance?
No. Each home chooses whether to accept it and how many such residents to take, and many of the larger private-pay buildings in Forsyth County do not, so ask the question in the first phone call.
Smaller adult care homes and family care homes are more likely to accept it, particularly in Davidson, Stokes and Yadkin counties and in parts of Winston-Salem. When a home does accept it, ask whether a current private-pay resident who becomes eligible can stay, and get the answer in writing. A move forced by money is one of the hardest transitions a resident can face.
What is Special Assistance In-Home?
Special Assistance In-Home (SAIH) can pay the same kind of monthly cash supplement to someone who qualifies for adult care home placement but chooses to stay at home, to help pay for what keeps them safe there.
SAIH has a limited number of slots and its own case management, so the county decides who receives it. It can be the difference for a parent living alone in Walkertown or Yadkinville who needs a little help each day but would rather not move. Ask the county DSS adult services unit about it when you apply.
What it is, and what it is not
| Special Assistance is | Special Assistance is not | |
|---|---|---|
| Form | A monthly cash supplement paid toward care | A voucher accepted everywhere |
| Where | Licensed adult care homes and family care homes | Nursing homes or unlicensed housing |
| Who runs it | NCDHHS, through each county DSS | Medicare |
| Extra benefit | Eligibility for NC Medicaid | A waiver of the home's other rules |
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.
