Nursing Homes in North Carolina: Cost & Medicaid (2026)

A nursing home in North Carolina runs about $116,800 a year for a shared room, slightly above the national median.1 For those who qualify, NC Medicaid helps pay that bill.2

This guide walks through what a nursing home is, how to check a facility's quality before you choose one, what it actually costs in North Carolina, and how NC Medicaid pays for long-term nursing-facility care.

In This Guide

• Key Takeaways
• What a Nursing Home Is
• How to Check a Facility's Quality
• What a Nursing Home Costs in North Carolina
• Does North Carolina Medicaid Pay for Nursing Homes?
• Frequently Asked Questions

What a Nursing Home Is

A nursing home, often called a skilled nursing facility, is for people who can't care for themselves anymore and may need ongoing medical care, in the National Institute on Aging's description. Assisted living, by contrast, is for people who may need some help with daily tasks but don't need around-the-clock care.4 The federal Administration for Community Living puts the difference plainly: a nursing home includes all the services of an assisted living facility, plus full-time nursing care, 24 hours a day.4 That round-the-clock nursing is the line between the two.

People arrive at a nursing home along two different paths, and it's worth keeping them straight because they're paid for differently. The first is short-term skilled care after a hospital stay. Medicare helps with that short stay under specific conditions, covering up to 100 days per benefit period, usually after a qualifying three-day inpatient hospital stay, with a daily coinsurance after day 20.5 The second path is long-term custodial care: ongoing help with daily activities like bathing and dressing, when that's the only care someone needs. Medicare does not pay for that long-term custodial care.5 That's the care families worry about affording, and it's where Medicaid can help those who qualify.

How to Check a Facility's Quality

Quality varies widely from one nursing home to the next, and North Carolina gives you several free tools to vet a place before you commit. Use more than one. Each shows you something the others don't.

Start with state oversight. The North Carolina Division of Health Service Regulation (DHSR), part of the North Carolina Department of Health and Human Services, licenses nursing homes through its Nursing Home Licensure and Certification Section.3 Homes in the Medicare and Medicaid program, which is most North Carolina nursing homes, are inspected every nine to 15 months by nurses, pharmacists, dietitians, and social workers who have passed a federal test. When surveyors find a problem, they write a Statement of Deficiency, and the home must provide a plan of correction for each problem cited.3 When you tour a facility, ask to see its most recent survey results and look for a pattern of repeat deficiencies rather than reacting to a single old citation.

Next, check the federal star rating on Medicare Care Compare. For every Medicare- and Medicaid-certified nursing home, the Centers for Medicare & Medicaid Services publishes an overall rating from 1 to 5 stars. Medicare cautions that the stars are not a substitute for visiting the home yourself.3 That overall rating combines three things: health inspection results, staffing, and quality measures. Each of the three also gets its own star rating, so you can look at a home's staffing score separately from its overall score.3

Finally, know where to take a concern. DHSR's Nursing Home Licensure and Certification Section receives about 3,000 nursing home complaints a year. Its surveyors investigate complaints, and the person who complained gets a letter with the findings.3

What a Nursing Home Costs in North Carolina

Nursing-home care is expensive everywhere, and North Carolina lands close to the country as a whole. According to the CareScout (Genworth) Cost of Care Survey, the 2025 statewide medians were about $116,800 a year (roughly $9,733 a month) for a semi-private room and about $129,575 a year (roughly $10,798 a month) for a private room.1 That semi-private figure runs slightly above the national median of about $114,975. These are medians from an industry survey, not government rates and not maximums. CareScout cautions that any one provider's cost may differ significantly from the median, and that costs vary widely depending on where care is delivered, the services needed, and the level of support required.1

To put that in context, the same 2025 survey put North Carolina assisted living at a median of about $74,400 to $77,955 a year, depending on which CareScout publication you read.1 A semi-private nursing-home room costs noticeably more than that, and non-medical home care, at a median of about $68,640 a year, costs less still.1 If assisted living or care at home can safely meet the need, that gap is worth weighing. If a nursing home is the right place, the next section covers how Medicaid can help.

Does North Carolina Medicaid Pay for Nursing Homes?

Yes, and this is the single most important thing to understand about paying for a North Carolina nursing home. NC Medicaid, administered by NCDHHS, helps pay the cost of nursing-facility care for an eligible person.2 This coverage pays for care in a facility.

Qualifying turns on two findings that run on separate tracks. Here's how the pieces fit together.

Level of care. Your medical need for nursing-facility care is documented on an FL-2, North Carolina's Long-Term Care Services prior approval form. A hospital social worker, a physician, a medical facility representative, the local agency, or a Local Management Entity can start it.2 This is the clinical side of eligibility, separate from the money side below.

The financial test. Your county Department of Social Services (DSS) decides long-term-care financial eligibility.2 For a single aged, blind, or disabled applicant, the countable-resource limit is $2,000, and countable resources above that make an applicant ineligible. Where a spouse remains at home, a community spouse allowance is deducted from the resident's income before the resident's share of the cost is set.2 Because the exact limits depend on your household and can change, confirm the current figures with your county DSS or the NC Medicaid Contact Call Center before you apply.

The income contribution. A nursing-home resident on Medicaid contributes most of their monthly income toward the cost of care, called the patient monthly liability, after deductions that include a $70 personal needs allowance.2 Medicaid then helps pay the rest of the cost of care.

The five-year look-back. Federal law sets a look-back date 60 months (five years) before your Medicaid application.2 Giving away money or property for less than fair market value on or after that date makes a nursing-home applicant ineligible for a penalty period, so giving assets to family in a rush to qualify can delay coverage rather than speed it up. The state must waive the penalty where denying eligibility would cause undue hardship.

Estate recovery. Federal law requires the state to seek recovery from the estate of anyone who was 55 or older when they received nursing-facility care and certain related services.2 North Carolina's estate recovery notice says it waives recovery when the estate's total assets are under $50,000 or total Medicaid paid was under $10,000, and it can defer recovery while a spouse is living, while a surviving child is under 21 or is blind or disabled, or while an approved undue-hardship applicant continues to meet the hardship criteria.2 You apply for NC Medicaid through your county DSS or the NC Medicaid Contact Call Center.

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.