In 2026, the North Carolina Medicaid monthly income limit is about $1,835 for one adult under 65.,, For one aged, blind, or disabled (ABD) applicant, the state's chart lists a $1,330 MAABD-N limit and a $242 medically needy income limit. The two work in sequence. An applicant living at home whose net countable income is at or under $1,330 meets the income test with no deductible. Above $1,330, the county uses the income over $242 to compute a Medicaid "deductible" you meet with medical costs, rather than turning you away.

This guide walks through the 2026 income and asset rules for North Carolina Medicaid long-term care for aged, blind, and disabled (ABD) residents: the $2,000 asset limit, how the spend-down deductible works, the $70 a nursing-home resident keeps, what a spouse at home is protected from, the five-year look-back, and how estate recovery applies.

In This Guide

The $2,000 asset limit and what doesn't count

For a single applicant seeking North Carolina Medicaid coverage of nursing-home or home-and-community-based care, the countable-asset limit in 2026 is $2,000. For a married couple with both spouses applying, it is $3,000.

"Countable" carries the weight here. North Carolina exempts a long list of assets from that limit: the home (subject to a home-equity cap that applies to institutional services), one vehicle used for transportation, household goods and personal effects, and all burial spaces (grave sites, crypts, urns and the like). Burial money works differently. North Carolina can exclude up to $1,500 of otherwise countable liquid assets for burial expenses for each financially responsible person, but only when the applicant has countable resources over the limit. An irrevocable burial arrangement worth $1,500 or more isn't counted itself, but it uses up that exclusion, and burial money kept in the same account as other savings can't be excluded. So the $2,000 ceiling applies to things like bank balances and the equity in a second car, not the roof over your head or the car in the driveway.

When only one spouse needs care, the married couple is in a very different position from a single applicant. Under the spousal-impoverishment rules below, the at-home spouse's protected share comes off the top first, and whatever remains is compared to the $2,000 limit for one person, not the $3,000 couple limit.

Under 65 and not on Medicare yet? The North Carolina Medicaid income limit is simpler, with no asset test

If you are a working-age adult in North Carolina, or the 60-something who has retired early but is not on Medicare yet, most of this guide is not about you. The asset limit, the spend-down deductible, and the long-term-care rules above govern the aged, blind, and disabled track. The everyday, non-long-term-care Medicaid answer for an adult under 65 runs on a completely different rule, and it is the simpler answer to the question "what is the income limit."

North Carolina adopted the Affordable Care Act's Medicaid expansion effective December 1, 2023, covering low-income adults ages 19 to 64. It is one of 41 states, including the District of Columbia, that expanded. Under that pathway, an adult qualifies with income up to 138% of the federal poverty level: the federal limit is 133%, and a standard 5-percentage-point disregard lifts the effective ceiling to 138%. The 2026 federal poverty guideline for one person in the 48 contiguous states is $15,960 a year., North Carolina's own income chart, effective April 1, 2026, lists $1,769 a month for one person at the 133% line, plus a 5% disregard of $66.50, which together come to about $1,835 a month, or roughly $22,000 a year.

Two features make this track far simpler than the ABD rules above:

  • No asset test. This pathway is a MAGI (modified-adjusted-gross-income) group, and federal law bars North Carolina from applying any asset or resource test to it. Savings, a car, and a retirement account do not count against you the way the $2,000 limit counts for a long-term-care applicant.
  • Income is tax-based, and Social Security counts in full. MAGI skips the SSI-style income disregards, such as the $20 general income exclusion (the only subtraction that reaches a Social Security benefit is the 5-percentage-point adjustment already built into the 138% figure), and a Social Security retirement or disability benefit counts in full toward the ceiling, including any portion that is not taxable., For an early retiree drawing Social Security before 65, that benefit can decide whether income lands under the $1,835 line.

Your 65th birthday, or Medicare, ends this pathway. This 138% pathway is written for adults under 65 who are not entitled to or enrolled in Medicare, so turning 65 or gaining Medicare closes this particular door, and it closes on those two conditions rather than on your income.

One clarification worth having: turning 65 does not by itself end MAGI treatment across the board. Federal rules set MAGI methods aside for someone 65 or older only when age is a condition of eligibility for the group being tested, so a person 65 or older who is evaluated as a parent or other caretaker relative is still assessed under MAGI and still faces no asset test. That group has conditions of its own, though: the person has to meet the federal definition of a caretaker relative, and the income standard is set by the state and anchored to its historic AFDC levels, not to the expansion limit. What is true is that requesting long-term care services is itself one of the federal exceptions to MAGI, so a senior seeking long-term care is tested on the aged, blind, and disabled track, which uses SSI-based financial methods instead., The SSI resource limits, $2,000 for an individual and $3,000 for a couple, are the same figures North Carolina uses as its reserve limit on that track, against a federal SSI benefit rate of $994 a month for an individual in 2026.,

Which test sets North Carolina Medicaid eligibility for a senior: ABD, not the MAGI chart

An online calculator may show a senior a "138% of the federal poverty level" figure. That is the MAGI test for the adult expansion group North Carolina added effective December 1, 2023 for adults ages 19 to 64, not the test a senior seeking long-term care faces.

For how other states set these two tests, see our guide to Medicaid income limits by state.

How North Carolina Medicaid income limits work: the deductible

North Carolina's income chart (MA-2252, effective April 1, 2026) lists two limits for aged, blind, and disabled applicants: a MAABD-N limit of $1,330/month for one person ($1,804 for two) and a much lower medically needy (MAABD-M) income limit of $242/month for one person ($317 for two). For an applicant living at home, the county applies them in sequence, not as alternatives. If your net countable income is at or under the N level, you are financially eligible for N coverage, and N coverage never carries a deductible. If it is above the N level, you are not disqualified: the county evaluates you for medically needy (M) coverage instead.

That M coverage runs on a spend-down, and North Carolina has a local name for it: the Medicaid "deductible." The county subtracts the $242 M amount (for one person) from your net countable income and uses that excess to compute your deductible for the certification period, so the deductible is measured from $242, not from $1,330. Once you have incurred medical expenses equal to your deductible, Medicaid can be authorized.

Two situations can change the numbers. If you live in someone else's household, the county decides whether to use the full limits or lower "1/3 reduced" limits ($887 for one person under N, $161 under M). And if your spouse is not applying, the county deems income from your spouse to you when the spouse's net countable income is greater than the state's Living Allowance for an ineligible spouse. Nursing-home residents are budgeted separately, as the next section explains.

This is why North Carolina does not require a Qualified Income Trust (Miller Trust). Federal law makes that trust a route to eligibility only in income-cap states; where a state covers nursing-facility care through the medically needy pathway, the trust is not the route. North Carolina has no such cliff: high income means a larger deductible, not an automatic denial.

Long-term care: what a nursing-home resident keeps

When North Carolina Medicaid pays for nursing-facility care, the resident contributes nearly all of their monthly income toward the cost of that care. What stays with the resident is the Personal Needs Allowance (PNA), a small monthly sum reserved for personal expenses like clothing, a haircut, or a phone. North Carolina raised its PNA to $70/month for an institutionalized individual ($140 for a married couple who share a room), up from the long-standing $30, through DHB Change Notice 13-23 issued December 1, 2023, with the revised policy effective January 1, 2024. The $30 the state moved off is the federal statutory floor, unchanged since 1988; states must set the nursing-facility PNA at or above it and may go higher, as North Carolina did. One bound to know: the four types of personal needs allowance together cannot exceed the medically needy full maintenance level of $242 for an individual, or $317 for a couple sharing a room who both have Medicaid paying cost of care.

Because the state uses a spend-down rather than an income cap, a resident with substantial monthly income isn't shut out by an income limit. They contribute more of that income toward care after the PNA and certain other allowances (for a community spouse, for dependents, and for some health-insurance premiums) are set aside. There is one ceiling to know: the income left after those deductions has to be less than the facility's Medicaid rate for 31 days. If it equals or exceeds that rate, Medicaid won't help with the cost of nursing-home care, and the county goes on to check whether the resident qualifies for other Medicaid services. For the national picture on how the PNA is calculated, see our explainer on the Medicaid personal needs allowance.

The five-year look-back

North Carolina reviews asset transfers made in the 60 months (five years) before a long-term-care application., Giving away money or property, or selling it, for less than its current market value on or after that look-back date, such as signing a house over to a child for a dollar or gifting a grandchild a down payment, can create what North Carolina calls a sanction: a penalty period during which Medicaid will not pay for institutional long-term care. Under federal law, the same penalty also reaches home-and-community-based waiver services.

There are legitimate exceptions (transfers between spouses, transfers to a blind or permanently and totally disabled child, certain caregiver-child home transfers) and legitimate planning approaches. But anything done inside the five-year look-back deserves an elder-law attorney's review first. If long-term care is on the horizon for someone in your family, talk to a professional before moving assets. For the broader toolkit, see our guide to Medicaid planning strategies.

Protecting the spouse who stays home

When one spouse needs long-term care and the other remains in the community, federal spousal-impoverishment rules keep the at-home spouse from being left destitute. North Carolina applies the federal framework for 2026:,

Protection 2026 Amount What it does
Community Spouse Resource Allowance (CSRA) Half the couple's countable assets, within a $32,532 minimum and a $162,660 maximum The countable assets set aside for the at-home spouse under the standard formula, separate from the applicant's own $2,000 limit. A fair hearing or a court order can set a higher amount.
Community spouse income allowance Income standard $2,705.00, eff. 7/1/2026, plus shelter costs above $812.00; capped at $4,067.00 The income floor the at-home spouse is allowed, and income can be shifted from the applicant to reach it, up to what the applicant has available. The $4,067.00 cap is North Carolina's ceiling on that allowance (the federal maximum is $4,066.50); a fair hearing can raise the allowance in exceptional circumstances.

So when only one spouse needs care, the $3,000 couple limit isn't the test: the CSRA is set aside first, and what remains is compared to the $2,000 limit for one person. Under the standard formula the community spouse keeps half the couple's countable assets, up to $162,660, plus a monthly income allowance, while the other spouse receives Medicaid-funded care.

After death: estate recovery

Like every state, North Carolina runs a Medicaid estate-recovery program, but it carries a notable age floor. After a recipient who was 55 or older dies, the state may seek repayment from the probate estate for nursing-facility, home-and-community-based, hospital, prescription-drug, or personal-care services. A recipient of any age who was an inpatient in a nursing facility or other medical institution and could not reasonably be expected to return home is also in scope.,

Read the survivor protections carefully, because they are a timing bar, not a permanent release. Federal law allows recovery only after the death of a surviving spouse, and only when there is no surviving child who is under 21 or who is blind or permanently and totally disabled. A surviving spouse postpones the claim for their lifetime; it does not cancel it, and a family that reads the protection as a permanent exemption can be surprised years later. Each state must also have a procedure to waive recovery for undue hardship. For how recovery works and where families have room to plan, see our Medicaid estate recovery explainer.

How to apply in North Carolina

North Carolina Medicaid is administered by the North Carolina Department of Health and Human Services (NCDHHS), and your financial eligibility is determined by your county Department of Social Services (DSS). Coverage is delivered through several plan types, including Standard Plans, Tailored Plans for people with serious behavioral-health needs or intellectual or developmental disabilities, and NC Medicaid Direct. You can apply online through ePASS (the state's benefits portal at epass.nc.gov), in person or by phone at your county DSS, or by mail, email, fax, or drop-off at your local DSS.

A long-term-care applicant also needs a completed FL-2 (the Long-Term Care Services prior approval form, which summarizes the patient's medical requirements) or MR-2, if required, with at least telephone prior approval. Apply even if you think you are over the income limit. Income above the $1,330 MAABD-N limit leads to a deductible, measured from the $242 medically needy level, rather than a denial, and the spousal protections set aside a share of a couple's assets and income for the spouse at home.

North Carolina Medicaid (NCDHHS) Division of Health Benefits. Program rules, Standard Plans, and Tailored Plans. medicaid.ncdhhs.gov
ePASS Apply online or check your Medicaid status through the state benefits portal. epass.nc.gov
Your County Department of Social Services (DSS) Determines financial eligibility. Apply in person, by phone, or by mail, and start a long-term-care application. ncdhhs.gov/localdss

Frequently Asked Questions

What is the monthly income limit for Medicaid in North Carolina?

It depends on which group you are tested in. For an adult ages 19 to 64 who is not on Medicare, the 2026 limit is 138% of the federal poverty level, about $1,835 a month for one person, with no asset test.,, For an aged, blind, or disabled applicant, including a senior seeking long-term care, the state's chart lists a MAABD-N limit of $1,330 a month for one person and a medically needy income level of $242 a month for one person and $317 for a couple. For someone living at home, income at or under $1,330 meets the income test with no deductible; above that, the county uses the income over $242 to compute a deductible you meet with medical costs.

I'm under 65 and not on Medicare. What is the regular NC Medicaid income limit?

About 138% of the federal poverty level. North Carolina's chart effective April 1, 2026 lists $1,769 a month for one person plus a 5% disregard of $66.50, so about $1,835 a month, or roughly $22,000 a year. North Carolina expanded Medicaid effective December 1, 2023 for adults ages 19 to 64, and this pathway applies no asset test at all, so savings and a car do not count. Social Security counts in full toward the income ceiling, including any non-taxable portion. Turning 65 or enrolling in Medicare closes this particular pathway. That does not automatically end MAGI treatment for every group (someone 65 or older tested as a parent or caretaker relative is still assessed under MAGI, with no asset test), but a senior seeking long-term care is assessed on the aged, blind, and disabled track, which does apply a $2,000 asset test, the same figure as the SSI resource limit, against a federal SSI benefit rate of $994 a month for an individual in 2026.

What is the North Carolina Medicaid asset limit in 2026?

$2,000 in countable assets for a single long-term-care applicant, and $3,000 for a couple when both spouses apply. The home (within an equity cap), one vehicle used for transportation, household goods and personal effects, and all burial spaces are exempt from the count. Up to $1,500 of otherwise countable liquid assets for burial expenses can also be excluded for each financially responsible person, but only when resources are over the limit, not when an irrevocable burial arrangement worth $1,500 or more already exists, and not for burial money mixed into an account with other savings.

Can I qualify for North Carolina Medicaid if my income is too high?

Often, yes. For an applicant living at home, income at or under the $1,330 MAABD-N limit ($1,804 for two) meets the income test with no deductible. Above that, the county subtracts the $242 medically needy amount ($317 for two) from your net countable income and uses the excess to compute a Medicaid "deductible" you meet by incurring medical expenses. Higher income makes your deductible larger; it does not disqualify you. For nursing-home cost of care there is one ceiling: the income left after allowed deductions has to be less than the facility's Medicaid rate for 31 days.

Does North Carolina require a Miller Trust (Qualified Income Trust)?

No. North Carolina covers long-term care through a medically needy spend-down rather than a hard income cap, and federal law makes the Qualified Income Trust a route to eligibility only in income-cap states. That is a key difference from those states, where an over-income applicant may need such a trust to qualify.

How much does a nursing-home resident on North Carolina Medicaid keep?

A Personal Needs Allowance of $70/month for an institutionalized individual ($140 for a married couple who share a room), raised from $30 by DHB Change Notice 13-23 with the revised policy effective January 1, 2024. The rest of the resident's monthly income goes toward the cost of care, after allowances for a community spouse and certain health-insurance premiums.

How much can a spouse keep when the other goes into a nursing home?

For 2026, the standard formula protects half the couple's countable assets for the at-home (community) spouse, within a $32,532 minimum and a $162,660 maximum (the Community Spouse Resource Allowance), separate from the applicant's $2,000 limit; a fair hearing or court order can set a higher amount. The community spouse can also receive a monthly income allowance, which North Carolina caps at $4,067.

Will the state take our house through estate recovery?

North Carolina recovers from the probate estate of recipients 55 or older for nursing-facility, home-and-community-based, hospital, prescription-drug, and personal-care services. The survivor protections postpone that claim rather than cancel it: recovery is allowed only after a surviving spouse has died, and only when no surviving child is under 21, blind, or permanently and totally disabled. So a surviving spouse defers recovery for their lifetime, not forever. An undue-hardship waiver procedure is also required.

Learn More

MedicaidMedicaid Income Limits by State: Which Number Applies to YouMedicaid income limits for 2026 depend on your pathway: expansion adults, aged and disabled, or nursing-home care. See the figures and your state's limits. MedicaidNorth Carolina Medicaid: A Guide for Seniors and FamiliesNorth Carolina Medicaid is run by NCDHHS through county DSS offices. Learn 2026 eligibility, the medically needy spend-down, managed care, and how to apply. MedicaidNorth Carolina Medicare Savings ProgramsNorth Carolina Medicare Savings Programs in 2026: QMB, SLMB, and QI income limits, Part B premium savings, Part D Extra Help, and how to apply. MedicaidNC Medicaid Spousal Impoverishment RulesNorth Carolina Medicaid spousal impoverishment in 2026: the $32,532 and $162,660 CSRA standards, the $2,705 MMMNA, the $2,000 limit, and the home. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. MedicaidThe Medicaid Personal Needs Allowance, ExplainedHow the Medicaid Personal Needs Allowance works in 2026: the $30 federal floor, what the states set, and how patient liability is calculated.

Find personalized help working through North Carolina Medicaid eligibility and the spend-down deductible for your family at brevy.com.

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.

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