How Special Assistance helps pay for an adult care home in the Triad

What is State/County Special Assistance?

A cash supplement, paid with state and county money, that helps eligible low-income residents of licensed adult care homes and family care homes pay for room, board and care; recipients are also eligible for Medicaid.

Source: NCDHHS Dear County Director letter EFS-SA-04-2025 (2026 Special Assistance rates), effective January 1, 2026. The income test equals the rate plus the $70 allowance.

Special Assistance is not a Medicaid waiver and North Carolina has no Medicaid waiver that pays assisted living rent. Medicaid eligibility that comes with Special Assistance can, however, pay for doctor visits, prescriptions and Medicaid personal care services delivered in the home.

How much does Special Assistance pay in 2026?

The Basic Rate is $1,397 a month for an adult care home or family care home and the Enhanced Rate is $1,792 a month for a special care unit, effective January 1, 2026; the resident keeps a $70 monthly personal needs allowance.

The rate is the most the home receives for an eligible resident, made up of the resident's own countable income plus the Special Assistance payment. A resident with $900 a month of Social Security in a regular adult care home bed, for example, would contribute that income and Special Assistance would make up the difference to the rate, after the personal needs allowance. Rates rise each January with the Social Security cost-of-living adjustment.

Who qualifies for Special Assistance in North Carolina?

Adults 65 or older, or 18 to 64 and disabled, who live in or are moving to a licensed adult care home or family care home, whose countable income falls below the rate plus the personal needs allowance, whose countable resources are within the program's limit, and whose need for that level of care is documented.

The county department of social services decides eligibility, so the details are confirmed at application. Income limits for 2026 are $1,467 a month for the Basic Rate and $1,862 for the Enhanced Rate. Resources follow Medicaid's aged, blind and disabled rules, and a home or car can be excluded under those rules.

Where do Greensboro-area families apply?

At the department of social services in the county where the person lives or will live: Guilford County's offices are at 1203 Maple Street in Greensboro and 325 E. Russell Avenue in High Point (336-641-3000), Randolph County's are in Asheboro, and Rockingham County's are at 411 NC Highway 65 in Wentworth (336-342-1394).

Apply before savings are fully gone if possible, because approval takes time and the home must agree to accept Special Assistance. Bring proof of income, bank statements, identity and the physician's level-of-care form. Ask each home on your list whether it accepts Special Assistance and how many beds it sets aside.

Can Special Assistance help someone stay at home instead?

Yes, in limited numbers: Special Assistance In-Home pays a similar cash supplement to eligible adults who would qualify for adult care home placement but choose to live at home safely with support.

Slots are limited by county, and a case manager helps plan the in-home arrangement. It can be combined with Medicaid personal care services or CAP/DA where the person qualifies. Ask the county DSS adult services unit whether an in-home slot is available.