State/County Special Assistance In-Home Program North Carolina: Eligibility and How to Apply

What the SAIH Program Provides

Most families know about North Carolina's Special Assistance program for adult care homes — it pays room and board for eligible seniors in licensed facilities. Fewer know about the Special Assistance In-Home (SAIH) variant, which provides a monthly cash supplement to eligible individuals who remain in their own homes or a family member's home instead of moving into a facility.

The concept is straightforward: if a senior meets the clinical and financial criteria for Special Assistance in a facility, the state can pay a portion of that benefit directly to the individual for in-home living expenses. This allows families to keep a parent at home while receiving financial support that offsets care costs.

2026 Eligibility Requirements

SAIH eligibility mirrors the facility-based Special Assistance program with slight variations:

Clinical requirements:

• The senior must be aged 65 or older, or aged 18–64 and determined disabled by the Division of Social Services
• They must meet the clinical criteria for adult care home placement — meaning they need personal care assistance, supervision, or both, at a level that would otherwise require a licensed facility
• An FL-2 form (NC Medicaid 372-124) completed by a physician, NP, or PA certifying the level of care

Financial requirements:

• Countable assets: $2,000 maximum for a single applicant
• Income limits (2026): The basic SAIH rate sets the income threshold at approximately $1,397 per month. The enhanced rate for individuals needing dementia-level SCU care is approximately $1,792 per month
• Assets held solely in the non-applicant spouse's name are completely exempt — this is significantly more favorable than standard Medicaid rules
• The spouse's income is not counted
• The primary home is exempt

The look-back period: SAIH uses a 36-month look-back (three years), not the 60-month period used by standard Medicaid. Transfer penalties are calculated at one month of ineligibility per $2,000 transferred.

How SAIH Differs From Standard Special Assistance

The traditional Special Assistance program pays directly to the facility — the senior pays their income minus a $70 Personal Needs Allowance to the adult care home, and SA covers the gap between that payment and the facility's approved rate.

SAIH works differently:

• The payment goes to the individual (or their representative), not a facility
• The senior uses the funds to cover in-home living expenses and care costs
• The monthly supplement amount is lower than the facility rate, reflecting the lower cost of home-based living
• The senior retains more control over how the money is spent

Who This Program Is For

SAIH makes the most sense for families where:

• A parent with moderate cognitive decline could stay safely at home with caregiver support, but the family needs financial help to make it work
• The parent meets the clinical threshold for facility care but prefers to age at home
• The family is providing hands-on care and needs income offset for reduced work hours or hired help
• The parent's income is low enough to qualify but too high for standard Medicaid coverage without a spend-down

SAIH is mutually exclusive with PACE enrollment — a senior can't receive Special Assistance payments while enrolled in a Program of All-Inclusive Care for the Elderly. If a parent is considering PACE, they must fully disenroll before the SAIH application processing period ends.

How to Apply

Applications go through the local county DSS office (Adult Services or Economic Services division). You'll need:

• Completed FL-2 form certifying level of care
• Bank statements for the past 36 months
• Income verification (Social Security award letter, pension statements)
• Property records
• Identification documents

Processing takes up to 45 days for applicants 65 and older. Submit the application during the calendar month in which you want benefits to start — retroactive coverage is limited.

Changes in income or assets must be reported to DSS within 5 calendar days (tighter than the 10-day window for standard Medicaid). Missing this reporting deadline can result in overpayment recovery or eligibility review.

The North Carolina Dementia & Memory Care Guide covers SAIH alongside the facility-based Special Assistance program, CAP/DA waiver, and PCS — with side-by-side eligibility comparisons and a financial worksheet for determining which program fits your parent's situation.

See more North Carolina guides →