Winston-Salem Senior AdvisorWhat happens when a parent's savings run out in assisted living?
If the adult care home accepts State/County Special Assistance and the parent qualifies, Special Assistance can pay up to $1,397 a month (the 2026 Basic Rate) or $1,792 in a special care unit, but if the home does not accept it, the parent may have to move.
That is why the most useful question to ask before choosing an adult care home is whether it accepts Special Assistance and lets private-pay residents convert. If your parent is already in a home that does not, start looking at homes that do several months before savings run out, while there is still time to choose.
How does Medicaid help when nursing home money runs out?
NC Medicaid pays for long-term nursing home care once a resident's countable resources are down to $2,000 and other rules are met; the resident keeps a $70 monthly allowance and contributes the rest of their income, and Medicaid pays the remainder.
Nearly all nursing homes in the five counties accept Medicaid, but confirm that the specific home will keep a resident who converts from private pay. Start the application at the county department of social services a month or two before the money runs out, because approval takes time and the county will ask for financial records.
Can Medicaid pay for care at home instead?
Yes, for people who meet nursing facility level of care, through CAP/DA, NC Medicaid's waiver for help at home, though there are often waiting lists, and in Davidson and Davie counties PACE through Carolina SeniorCare is another option.
CAP/DA pays for aide hours, adult day health, respite and some home modifications, but not rent or food. Special Assistance In-Home can add a monthly cash supplement for some people who would otherwise need an adult care home. Ask the county DSS about both.
Could a veteran or surviving spouse qualify for VA help?
Possibly: VA pension with Aid and Attendance can pay a veteran with no dependents up to $2,424 a month, or a surviving spouse up to $1,558, minus countable income after care costs, for those who meet service, need and net worth rules.
Because unreimbursed care costs reduce countable income, a veteran paying for an adult care home can qualify even with Social Security income. Apply free through a county veterans services officer. See VA Aid and Attendance for the full rules.
What mistakes should a Forsyth County family avoid when money is short?
Don't give away money or the house to qualify faster, because Medicaid looks back 60 months and the VA three years; don't wait until savings hit zero to apply; and don't pay anyone to file a VA or Medicaid application you can file for free.
An elder law attorney is worth the fee when assets or a spouse at home are involved. For basic questions, the Piedmont Triad Regional Council Area Agency on Aging ((336) 904-0300) and the county DSS can explain the programs at no cost.
What it is, and what it is not
| Planning ahead means | Waiting too long means | |
|---|---|---|
| Setting | Choosing a home that accepts Special Assistance or Medicaid | A forced move when money runs out |
| Applications | Filing a month or two before the money ends | Weeks of unpaid bills while waiting |
| Assets | Spending down on care and allowed purchases | Gifts that trigger penalties |
| Advice | Free county and aging-agency counseling, an attorney if needed | Paying fees for free applications |
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.
