TABLE OF CONTENTS
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.
|Home Care||Home Health Care|
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:
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:
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.
|Income Limits*||Asset Limits|
NC Medicaid is open to all qualifying individuals, regardless of their age. It has other eligibility requirements in addition to financial criteria, including:
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:
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.
|Contact||Area Served||Services Provided|
|NC Medicaid Ombudsman||(877) 201-3750||Statewide||The NC Medicaid Ombudsman helps you enroll in Medicaid and the Personal Care Services program and can answer questions regarding your rights and the responsibilities you have under Medicaid. The ombudsman can also help you find solutions to issues preventing you from obtaining Medicaid services and connect you with advisors and options counselors who help you obtain other public benefits that may help you age in place. All services are free and confidential.|
|American Council on Aging||Online Only||Statewide||The American Council on Aging provides current information on NC Medicaid’s financial eligibility criteria and the programs available to help older adults qualify for services if their income or assets are too high.|
|Legal Aid of North Carolina||(866) 219-5262||Statewide||Legal Aid of North Carolina is a statewide nonprofit legal organization that specializes in helping seniors obtain public benefits such as NC Medicaid and the CAP/DA waiver.|
|NC Medicaid Contact Center||(888) 245-0179||Statewide||The NC Medicaid Contact Center can answer your questions about the application process and the options you have if your application is rejected. The contact center is available on weekdays from 8 a.m. to 5 p.m.|
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:
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.
|Contact||Area Served||Services Provided|
|Senior Centers||Senior Centers Directory||Statewide||North Carolina has numerous senior centers scattered throughout the state where you can participate in educational, fitness and special interest classes, games and special events. Centers offer supportive services such as low-cost home-delivered and congregate meals, legal assistance, in-home assistance and transportation, which can help reduce out-of-pocket care expenses. Membership fees and hours of operation vary by location.|
|Medicare and Seniors’ Health Insurance Information Program||(855) 408-1212||Statewide||The Medicare and Seniors’ Health Insurance Information Program can help you make important decisions regarding your health insurance coverage by answering questions about Original Medicare and the private Medicare options that are available in your region, some of which may cover in-home care. This program is administered by trained volunteers who aren’t affiliated with any health insurance companies and aren’t authorized to sell policies, ensuring that you get unbiased information.|
|Area Agencies on Aging||(800) 662-7030||Statewide||North Carolina has a network of Area Agencies on Aging, each of which serves those aged 60 and over in designated regions of the state through information and direct services. Your local AAA can help you obtain services that support your independence, including home-delivered meals, attendant care, friendly visits and phone calls and transportation services for medical appointments and errands. AAAs also provide information and referrals for community-based services.|
|North Carolina Department of Military and Veterans Affairs||(844) 624-8387||Statewide||The North Carolina Department of Military and Veterans Affairs administers a range of state benefits to qualifying veterans, including income and property tax breaks, the North Carolina Assistive Technology Program and hunting and fishing licenses, as well as federal benefits that may reduce out-of-pock home care costs. The department has county offices where you can speak with an advisor who specializes in filing applications for benefits and can connect you with services in the community.|
|RSVP||(800) 942-2677||Statewide||The Retired and Senior Volunteer Program provides volunteer opportunities to North Carolina residents aged 55 and over. Opportunities vary by region and throughout the year and may include activities such as serving as classroom aides, teaching classes in senior centers and sorting food in food banks. Volunteers may have benefits such as transportation reimbursement, free meals and supplemental liability insurance.|
|North Carolina Division of Aging and Adult Services||(919) 855-3400||Statewide||The Division of Aging and Adult Services administers numerous programs to support seniors’ independence and quality of life. Through this division, you can learn about Home Care Independence, a consumer-directed in-home care program that enables you to hire friends and family members as caregivers. The division also has options counselors who help you plan for current and future care needs.|
|NC211||2-1-1||Statewide||NC211 is a statewide information and referral program that helps you find community-based services in your region. Its specialists listen to your concerns and needs and recommend low-cost services in the community to help you maintain your independence, including durable medical equipment loans, prescription drug assistance and home-delivered and congregate meals.|
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.
|What Types of Care Can Be Provided?||Home care agencies in North Carolina are staffed with in-home aides who provide a broad range of hands-on non-medical services such as bathing, dressing, toileting, feeding and mobility. They may also provide home management assistance, including cooking, cleaning, shopping and laundry. Agencies that provide nursing services, medical social services and therapy must be licensed as home health agencies.|
|Are Care Plans Required?||Before you receive in-home care, a health care practitioner must conduct and sign an initial assessment in your home. This assessment includes information on the status of your social, mental, environmental, economic and physical health, as well as the areas in which you need assistance.|
|Can Home Care Providers Assist with Medication Management?||In-home aides are permitted to help you with self-administered medications that are ordered by someone authorized by state law to prescribe. This may include medication reminders, opening containers and placing pre-measured medication in your hand.|
|Are There Special Requirements for Screening Home Care Aides?||Licensed home care agencies are required to conduct criminal background checks on applicants. If an applicant has one or more convictions, they may still be eligible for hire, depending on factors such as the nature of their crime, when it occurred, their age at the time of the conviction and parole or employment records. There are no screening requirements for unlicensed home care agencies.|
|Are Home Care Aides Required to Undergo Special Training?||The state doesn’t have training requirements for home care aides. However, aides who aren’t listed on the nurse aide registry must be able to demonstrate proficiency with core personal care skills, including assisting with:
Agencies must have their own systems in place for verifying proficiency.
|Does Medicaid Cover Home Care in North Carolina?||NC Medicaid covers in-home care directly through its regular program and through the Community Alternative Program for Disabled Adults.|
|How Do I Report Abuse of Myself or a Loved One?||The Department of Social Services operates Adult Protective Services, which investigates reports of elder abuse, neglect or exploitation. If you or someone you know is experiencing abuse, call your local office.|
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.