Understanding who qualifies for Medicaid in North Carolina is crucial for residents who need assistance with healthcare costs. Medicaid is a state and federally-funded program that provides need-based health coverage to individuals and families. Here’s a guide on some of the eligibility criteria for long-term care Medicaid in North Carolina.

Asset Limits

For the Aged, Blind, and Disabled, Medicaid considers the assets you own. Generally, individuals in these categories must have assets below a certain threshold to qualify. Commonly excluded assets include:

  • Primary residence
  • One vehicle
  • Personal belongings
  • Household items

Medical Necessity and Long-Term Care

Medical necessity is crucial for those seeking Medicaid for long-term care services. Applicants must demonstrate a need for the level of care provided in nursing homes or through home and community-based services, and this need must be confirmed by a physician and approved the North Carolina Department of Health and Human Services.


You must be a resident of North Carolina for a minimum of thirty (30) days in order to qualify for North Carolina Medicaid.  

Maintaining Eligibility

Once you qualify for Medicaid, it’s essential to maintain your eligibility by following these crucial steps:

  • Reporting Changes: Notify the Department of Social Services (DSS) of any changes in your circumstances. This includes changes in income, household composition, address, or any other factor that might affect your eligibility. Reporting changes promptly helps prevent any disruption in your Medicaid benefits.
    • Income or Asset Changes: If you experience a change in your monthly income, oryour assets,   it’s vital to inform DSS immediately.
    • Household Composition: Changes such as marriage, divorce, death of a spouse should be reported.
    • Address Updates: Notifying DSS ensures you continue receiving important notices and benefits without interruption if you move to a new address.
  • Benefit Recertification Requests: Complete and submit recertification requests on time to avoid interruptions in coverage. Medicaid eligibility must be reviewed periodically, usually once a year, to confirm that you still meet the requirements.
    • Timely Submission: Keep track of your renewal date and submit your application well before the deadline.
    • Documentation: Ensure that all required documentation is accurate and up-to-date. This may include proof of income, residency, financials,  and other pertinent information.
    • Follow-Up: Check the status of your renewal application and respond promptly to any additional requests for information from DSS.
  • Compliance with Program Rules: To remain eligible, follow all Medicaid program rules and guidelines. This involves understanding and adhering to the program’s requirements and restrictions.
    • Appropriate Use of Benefits: Use Medicaid services and benefits appropriately. Misuse of services, such as providing false information or using benefits for non-covered services, can result in loss of eligibility and legal consequences.
    • Appointment Attendance: Regularly attend medical appointments and follow through with prescribed treatments. Some Medicaid programs may require proof of ongoing medical care to continue eligibility.
    • Communication: Maintain open communication with your healthcare providers and DSS. Inform them of any issues or concerns affecting your ability to comply with Medicaid rules.

We Are Here to Help You Make a Difference

Understanding and navigating Medicaid eligibility in North Carolina can be complex. If you need assistance with Medicaid applications or have questions about eligibility, contact an experienced North Carolina Medicaid lawyer at Salines Mondello Law Firm, PC. We are here to help you understand your options and guide you through the application process. Contact us today at (910) 777-5734 or online to schedule a consultation. Our knowledgeable team is ready to assist you with your Medicaid needs.