Special Assistance Medicaid in North Carolina

Special Assistance is a Medicaid program designed to provide financial assistance paying for “room and board” at an assisted living facility. To qualify, the applicant must reside in an assisted living facility certified by Medicaid and meet income and asset requirements

For regular assisted living, the maximum monthly gross income is $1247.50. If residing in an assisted living memory care unit, the maximum monthly gross income to qualify is $1580.50. These are strict limits and if an applicant is even a penny above, he/she will not qualify for any assistance while in assisted living.

Assets

The applicant must have no more than $2000 in countable assets. If an asset is not “countable”, its value is not included in the $2000 limit.

In most cases, the Medicaid applicant’s home is not a countable asset. In North Carolina, the applicant’s intention to return home makes the home non-countable. Even if it is unlikely that the applicant will be able to return home, the mere intent is enough to protect the asset. Even if there is no intention of returning home, it is not countable if his or her spouse or dependent lives there. Even though the home is usually exempt, proper planning and care must be taken to avoid estate recovery, wherein Medicaid placed a lien on the home after the Medicaid beneficiary’s death.

Lookback Period

Special Assistance Medicaid employs a lookback period of three years. If the Medicaid applicant has made any gifts or transferred property out of his/her name for less than fair market value, this is deemed a “sanctionable transfer” which results in a penalty. The penalty is always a length of time that Medicaid will delay coverage because of the transfers. For every $2000 worth of transfers, Medicaid will apply a 1 month penalty. The penalty does not apply to transfers made solely to the Medicaid applicant’s spouse.

Applying for Special Assistance Medicaid

In North Carolina, Special Assistance Medicaid is administered by the Division of Medical Assistance division of the Department of Health and Human Services. Applications are made to local county Department of Social Services. Application procedures vary by county and in most cases, extensive documentation is required. You must be prepared to document all of your current assets and income, as well as the past three years of financial transactions. Failure to provide all required documentation can result in lengthy delays or denial of what would be an otherwise approvable application. Proper legal guidance is essential in ensuring that proper procedure are followed, thereby maximizing your chances for approval.