Home Care in North Carolina

According to the 2021 Genworth Cost of Care Survey, seniors in North Carolina pay approximately $4,385 for home care, which includes basic services such as housekeeping, meal preparation and mobility assistance. Home health care features specialized skilled nursing services but has the same average monthly rate as in-home care. By comparison, nationally, home care costs average $4,957, and seniors pay $5,148 for home health care.

North Carolina is among the more affordable cities in the Southeast for home-based care. On average, seniors in this state pay $4,385 for services. Of North Carolina’s bordering states, only Georgia has lower rates of $4,290. In South Carolina, monthly home care fees average $4,433, and in Tennessee, rates come in at $4,576. Seniors in Virginia pay rates closer to the national median at $4,767.

North Carolina is also affordable for those seeking home health care. In this state, you can expect to pay $4,385 per month for home-based skilled nursing services. In Georgia, monthly rates are the same, and in South Carolina, fees are a little higher at $4,481. Seniors in Tennessee pay $4,576, and in Virginia, rates are several hundred dollars higher at $4,954.

While in-home care and home health care rates in North Carolina are competitive at $4,385 per month, more affordable care may be available. You may save several thousand dollars monthly by accessing care in a daytime community setting through adult day care, which costs $1,197 on average for services. Assisted living facilities are closer in price to home-based care at $4,010 per month but provide housing, utility service and meals along with personal care, making it a more affordable option for many. Nursing homes charge higher monthly rates of $7,483 and accommodate those who need around-the-clock medical monitoring and skilled nursing services.

Home care can be a significant expense, and depending on the types of services you need, health insurance programs such as Medicare may not reduce your out-of-pocket costs. Fortunately, NC Medicaid, North Carolina’s Medicaid managed care program, has coverage for in-home care. Through its Personal Care Services program, NC Medicaid pays for an approved number of hours of attendant care. This program is part of the regular Medicaid program, meaning that it’s an entitlement that’s guaranteed to all qualifying beneficiaries.

Under this program, you can access a full range of in-home services. These are provided by in-home aides and include activities of daily living, such as bathing and grooming; instrumental activities of daily living, such as housekeeping and grocery shopping; medication reminders; and companionship.

Your eligibility for these services is determined by an independent assessment conducted through NC Medicaid. To qualify for services, you must have a medical condition or disability and require:

• Partial help with three of the following ADL: eating, dressing, bathing, toileting and mobility
• Partial help with one ADL and extensive help with one ADL
• Partial help with one ADL and full help with one ADL

NC Medicaid also provides in-home care under the Community Alternative Program for Disabled Adults program. This Home and Community-Based Services waiver program provides home-based care as an alternative to nursing home placement for qualifying individuals.

The CAP/DA waiver program provides a full range of in-home care to those who are at risk of nursing home placement. It covers services such as:

• Adult day care
• In-home aide services
• Home modifications
• Meal preparation or home-delivered meals
• Non-medical transportation
• Chore services
• Pest control
• Respite services
• Case management
• Financial management
• Personal assistance

Under this program, participants have the option to self-direct their care, meaning they decide who they receive in-home care from. To be eligible, applicants must be at least 18 years old and determined to require nursing home level care. They must also be eligible for Medicaid and need at least one service the waiver covers. This program is not an entitlement, and applicants may be placed on a wait list.

To begin the application process, individuals must fax a referral request to North Carolina Medicaid at (919) 715-0052.

To be eligible for NC Medicaid, you must meet strict income and asset guidelines. As a single applicant, you can have an annual income of up to $13,596 per year or $1,133 per month. If you’re married, your household income may be up to $18,312 annually or $1,526 monthly. This includes any income you receive including earned income, government benefits, withdrawals from retirement accounts and stock dividends.

Single applicants may have up to $2,000 in countable assets, and two-person households may have up to $3,000. Certain assets are excluded, including your primary dwelling, your vehicle and your personal belongings. If you exceed these limits, you may still qualify for coverage through Medicaid planning, which generally involves strategies for spending down income and assets.

You have several options for submitting a Medicaid application. To apply online, you can visit ePASS, the state’s online benefits platform, or HealthCare.gov, the federal health insurance portal. If you prefer to submit a paper application, you can print an application or obtain one from your nearest Division of Social Services office. You can submit the application to the office in person, through the mail, by fax or via email. Your nearest DSS office can also update you with the status of your application.

What Information You Will Need 

To apply for NC Medicaid, you should be able to provide supporting documents, such as:

• Driver’s license or state-issued ID
• Birth certificate
• Proof of state residency
• Proof of income and assets
• Policy numbers for any other health insurance coverage, such as Medicare

Getting comprehensive coverage through NC Medicaid doesn’t have to be confusing. You have access to several programs and helplines that assist you in navigating the process and getting the coverage you need. The following resources can also help you understand your Medicaid benefits, begin the process of getting coverage for in-home care and appeal adverse decisions.

Medicare doesn’t pay for non-medical home care, but it can cover the cost of the medical version of home care, called “Home Healthcare” in some situations. In order to be eligible, you need to be homebound and have a referral from your doctor for the specific type of medical care that is needed. There are also other restrictions that apply.

Below is an overview of some of the services typically covered by Medicare for those who are eligible:

• Physical Therapy: Physical therapy is used to help patients recover from injuries (broken bones, knee injuries, etc.), and to treat ongoing conditions such as arthritis. Additionally, physical therapy is often provided in the home to help seniors recover from surgeries and procedures, such as a knee or hip replacement.
• Nursing Care: Licensed nurses can provide a number of medical services (such as wound care, changing feeding tubes, etc.) for those who need medical care, but don’t need to stay in a hospital full-time.
• Occupational Therapy: Occupational therapy is designed to help seniors regain or maintain the ability to accomplish normal, daily tasks, such as bathing, dressing, eating, etc., and providers can travel to your home if needed.
• Speech Therapy: Seniors can lose the ability to adequately communicate for many reasons, and speech therapists are there to help seniors regain the ability to communicate using a variety of means. Additionally, speech therapists help to keep seniors independent by modifying diets and teaching special techniques to swallow safely.

As mentioned above, home care is distinctly different from home healthcare, but there is some overlap – so while Medicare doesn’t cover non-medical home care, there are personal care services that may be covered in special circumstances – such as an occupational therapist helping with eating or dressing.

Read our guide to Medicare and Home Care Coverage for more information.

While the above programs can be a great way to make home care affordable for many people, they are not the right solution for everyone. Thankfully, there are other ways to make home care more affordable for you and your family. For more information about your other options, read our section on Other Ways to Pay for this guide.

North Carolina offers a variety of resources to help you find affordable in-home care. Through the following resource table, you can connect with financial advisors, options counselors and information specialists who help you understand the services available in your region and access public benefits that might help reduce out-of-pocket expenses.

In North Carolina, home health care aides are required to be fully vaccinated against COVID-19 unless they have an exemption. Currently, there are no vaccine mandates for those who provide non-medical home care services. These guidelines may change in response to new variants of the virus. To find up-to-date information on vaccine requirements, reach out to your local health department or Area Agency on Aging.

In some cases, home care agencies have best practices that go beyond what’s required by federal law. If you have concerns regarding your exposure to COVID-19, it’s a good idea to reach out to the home care agency directly to discuss their vaccine requirements and other measures they take to control the spread of COVID-19 and other contagious illnesses.

In North Carolina, home care agencies are overseen by the NC Division of Health Service Regulation. This governing body sets minimum regulations to ensure a consistently high standard of care for seniors.

Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. To help you overcome this challenge, we’ve created a helpful checklist below that can help guide you through the process of both determining your needs, and finding a home care agency that will be the best fit for you and your family.

Download PDF Here

Learn More About Home Care in North Carolina’s Top Cities

• Asheville
• Charlotte
• Durham
• Gastonia
• Greensboro
• New Bern
• Wilmington
• Raleigh