Greensboro Senior AdvisorBy Greensboro Senior Advisor Care Team · September 24, 2026
Special Assistance tops up a low-income resident's own income to pay a licensed adult care home up to $1,397 a month, or $1,792 in a special care unit, and the resident keeps $70 a month. Apply at the county department of social services, and confirm the home accepts it.
What Special Assistance is
Special Assistance is a cash supplement paid with state and county money to help eligible low-income adults pay for care in a licensed adult care home or family care home. It is not a Medicaid waiver, but recipients are eligible for Medicaid too, which covers medical care and can pay for personal care services in the home.
North Carolina has no Medicaid program that pays assisted living rent, so for a parent with modest income Special Assistance is usually the bridge between private pay and a nursing home.
The 2026 numbers
NCDHHS set these rates effective January 1, 2026, adjusting them by the Social Security cost-of-living change:
| 2026 Special Assistance | Amount |
|---|---|
| Basic Rate (adult care home or family care home) | $1,397 a month |
| Enhanced Rate (special care unit) | $1,792 a month |
| Personal needs allowance | $70 a month |
| Income test, Basic | $1,467 a month |
| Income test, Enhanced | $1,862 a month |
Source: NCDHHS Dear County Director letter EFS-SA-04-2025 (2026 Special Assistance rates). The income test equals the rate plus the $70 allowance.
How the payment works out
The resident's own countable income goes toward the home's charge, the resident keeps the personal needs allowance, and Special Assistance makes up the rest up to the rate. These rough examples ignore deductions the county may apply:
| Monthly countable income | Approximate SA payment (Basic) | Approximate SA payment (Enhanced) |
|---|---|---|
| $800 | $667 | $1,062 |
| $1,000 | $467 | $862 |
| $1,200 | $267 | $662 |
| $1,400 | $67 | $462 |
The county department of social services calculates the actual amount. The examples show why someone with income near the Basic limit may still qualify for the Enhanced Rate in a special care unit.
Applying in Guilford, Randolph or Rockingham County
Apply at the department of social services in the county where your parent lives or will live. Guilford County has offices at 1203 Maple Street in Greensboro and 325 E. Russell Avenue in High Point (336-641-3000). Randolph County's department is in Asheboro, and Rockingham County's is at 411 NC Highway 65 in Wentworth (336-342-1394).
Bring proof of income, bank statements, identification and the physician's level-of-care form (the FL-2). Approval takes time, so start before savings are gone.
Special Assistance and Medicaid together
Because Special Assistance recipients are eligible for Medicaid, their prescriptions, doctor visits and hospital care are covered, and Medicaid personal care services can pay for hands-on help delivered in the adult care home. That combination is how many low-income residents in the Triad afford licensed assisted living.
If a resident later needs a nursing home, Special Assistance ends and nursing home Medicaid takes over, with the resident's income applied to the nursing home bill.
Special Assistance In-Home
North Carolina also offers Special Assistance In-Home for eligible adults who would qualify for an adult care home but can live at home safely with support. Slots are limited by county, and a case manager plans the arrangement.
Ask the adult services unit at your county department of social services whether an in-home slot is available before deciding a move is the only option.
Common reasons applications stall
Applications slow down when documents are missing, when bank statements show transfers that need explanation, or when the level-of-care form is out of date. Gather five years of financial records even if the county asks for less at first, because questions often follow.
Another common problem is timing: a resident moves into a home that does not accept Special Assistance and then applies. Confirm the home's policy before move-in, or the approval may come with nowhere to use it. The caseworker can tell you what is still needed if the file seems stuck.
The question to ask every home
Special Assistance only helps if the home accepts it. Many homes in the three counties do, especially family care homes and some adult care homes, but some charge private payers more than the rate and limit Special Assistance beds.
Ask, in writing, whether your parent could stay if they convert from private pay to Special Assistance, and how many current residents use it. The answer decides whether a move is likely in two years.
Frequently asked questions
Who qualifies for Special Assistance?
Adults 65 or older, or 18 to 64 and disabled, with income below the 2026 limits and resources within the program limit, who need adult care home level of care.
Does Special Assistance pay for nursing homes?
No. It is for licensed adult care homes and family care homes; Medicaid pays nursing home care.
What is Special Assistance In-Home?
A limited program paying a similar supplement to eligible adults who stay at home instead of moving to an adult care home.
Do rates change every year?
Yes, each January, with the Social Security cost-of-living adjustment.
Can Special Assistance be used in a family care home?
Yes. The Basic Rate applies in licensed family care homes as well as adult care homes.
What is the personal needs allowance for?
Clothing, haircuts, toiletries, snacks and other personal items; the money belongs to the resident.
