North Carolina’s state supplement to SSI is called Special Assistance, and it pays low-income seniors and disabled adults toward the cost of room and board in a licensed adult care home. Effective January 1, 2026, the basic monthly rate is $1,397, plus a $70 personal needs allowance the facility cannot touch.1North Carolina Department of Health and Human Services. Special Assistance Change Notice January 2026 The state calculates your check by taking the approved facility rate, adding the personal needs allowance, and subtracting your countable income (including any federal SSI you already receive). The remainder is your Special Assistance payment.
Three types of licensed facilities are covered: adult care homes, family care homes, and group homes for people with disabilities.2North Carolina Department of Health and Human Services. State and County Special Assistance for Adult Care Home Residents Residents placed in a Special Care Unit for Alzheimer’s disease or related dementia receive an enhanced rate, which was $1,743 per month as of January 2025.3North Carolina Department of Health and Human Services. State/County Special Assistance Manual Rev Jan 2025
Who Qualifies
You must be at least 65 years old, or meet the Social Security Administration’s definition of disability, or be blind.2North Carolina Department of Health and Human Services. State and County Special Assistance for Adult Care Home Residents The medical standard is the same one federal SSI uses, so if you already receive SSI on disability grounds, you’ve cleared that hurdle.
You must live in North Carolina in a residential facility approved for Special Assistance, and you must be a U.S. citizen or national or fall into a noncitizen classification recognized by the Department of Homeland Security.4Social Security Administration. Understanding Supplemental Security Income (SSI) Eligibility Requirements An active deportation or removal warrant generally disqualifies you.
The standard program is only for people in a licensed adult care home, family care home, or group home. It doesn’t pay for a private residence, and it doesn’t pay for a nursing home. If you’d rather stay in your own home, there’s a separate in-home version described below.
Income and Resource Limits
Special Assistance uses the federal SSI resource limits: countable assets cannot exceed $2,000 for an individual or $3,000 for a couple.5Social Security Administration. 2026 Cost-of-Living Adjustment (COLA) Fact Sheet Bank accounts, stocks, bonds, and extra vehicles count. Your primary home and one vehicle used for transportation generally don’t. You can also set aside up to $1,500 per person in a designated burial fund or irrevocable burial contract without it counting.6Social Security Administration. SSI Spotlight on Burial Funds
On the income side, eligibility depends on whether your countable income falls below the approved rate plus the personal needs allowance. For a basic adult care home in 2026, that combined threshold is $1,467 per month.1North Carolina Department of Health and Human Services. Special Assistance Change Notice January 2026 Not every dollar of income counts. Most applicants get a $20 general income exclusion, and if you have earned income, the first $65 plus half the remainder is also excluded.7North Carolina Department of Health and Human Services. State-County Special Assistance Adult Care Home/State-County Special Assistance In-Home
The 36-Month Transfer Look-Back
Giving away assets or selling them below fair market value within 36 months before applying can trigger a penalty period during which you’re ineligible. The penalty is calculated by dividing the uncompensated value of the transfer by the maximum monthly SSI benefit plus any applicable state supplement, and the resulting months (rounded, capped at 36) is how long you wait.8Office of the Law Revision Counsel. United States Code Title 42 Section 1382b – Resources Eligibility Transferring a house to a child or draining a bank account right before applying doesn’t make the money invisible. If a transfer creates genuine hardship threatening your health or basic necessities, you can request a hardship waiver, but you’ll need to show you’ve exhausted efforts to recover the transferred assets first.
How the Monthly Payment Is Calculated
The formula is straightforward. Start with the approved facility rate, add the $70 personal needs allowance, and subtract your countable income. Using 2026 figures for a basic adult care home:
- Basic facility rate: $1,397
- Personal needs allowance: $70
- Combined threshold: $1,467
- Countable income after exclusions: $900
- Special Assistance payment: $567
The $70 personal needs allowance is yours to spend on clothing, toiletries, and other small necessities; the facility cannot seize it.9North Carolina Department of Health and Human Services. Special Assistance In-Home Program for Adults If you’re placed in a Special Care Unit for Alzheimer’s or a related dementia, the enhanced rate replaces the basic rate in the same calculation.3North Carolina Department of Health and Human Services. State/County Special Assistance Manual Rev Jan 2025 Couples in a residential facility are treated as two individuals, each with a separate calculation, not as a household.
If You Want to Stay Home Instead
North Carolina runs a Special Assistance In-Home program for adults who would qualify for a residential placement but prefer to remain in their own home. It combines a cash supplement with support services coordinated through the county.10North Carolina Department of Health and Human Services. State-County Special Assistance, In Home The payment is 75% of what you would receive in an adult care home.7North Carolina Department of Health and Human Services. State-County Special Assistance Adult Care Home/State-County Special Assistance In-Home
To qualify, you must first be eligible for Medicaid under the categorically needy standard. A county case manager assesses your functional abilities, your family or community support network, your housing situation, and whether staying home is safe and feasible. It’s worth exploring if you have people around you who can help but still need financial support for daily living.
How to Apply
Applications go through your local county Department of Social Services. You can apply in person, by mail, or through a legal representative.2North Carolina Department of Health and Human Services. State and County Special Assistance for Adult Care Home Residents If you’re not sure which county office to contact, the NC Medicaid Contact Center at 1-888-245-0179 can direct you.
Gather these before you apply:
- Proof of identity and age: birth certificate, passport, or Social Security award letter
- Proof of North Carolina residency: driver’s license, state ID, or utility bills
- Financial records: three months of bank statements, investment information, property deeds, and vehicle titles
- FL-2 medical form: completed by a licensed physician, documenting your diagnosis, functional limitations, nutritional status, and requested level of care
The FL-2 is what holds up most applications. Doctors sometimes take their time completing it, and a vague or incomplete FL-2 will trigger requests for more information. If you’re applying for the enhanced rate in a Special Care Unit, the FL-2 must specifically include a diagnosis of Alzheimer’s disease or another form of dementia.3North Carolina Department of Health and Human Services. State/County Special Assistance Manual Rev Jan 2025
Processing takes up to 45 days for applicants qualifying based on age and up to 60 days for those qualifying through a disability determination.11North Carolina Department of Health and Human Services. Special Assistance In-Home Program Manual Once approved, you’ll get a written notice with your monthly payment amount and start date. Hold onto it. The facility will want a copy, and it’s your reference if a payment dispute comes up later.
After You’re Approved
Approval isn’t permanent. The Social Security Administration periodically reviews your non-medical eligibility (income, resources, living arrangement). Most recipients are reviewed every one to six years, and reporting a change (like moving facilities or new income) can trigger an earlier review.12Social Security Administration. Understanding Supplemental Security Income Redeterminations When redetermination happens, you’ll get a letter asking for an interview by phone, in person, or by mail, and you have 30 days to respond. Ignoring it is one of the fastest ways to lose benefits and end up with an overpayment demand.
On taxes: federal SSI is never subject to federal income tax, and state supplements like Special Assistance follow the same rule.13Internal Revenue Service. Social Security Income You won’t get a 1099 for these payments, and North Carolina doesn’t tax them either.
If You’re Denied
If your application is denied, reduced, or terminated, you can appeal. North Carolina law requires the county to notify you in writing of your appeal rights whenever it takes an adverse action.14North Carolina General Assembly. North Carolina Code 108A-79 – Appeals You have 60 days from the adverse action to file. Miss that deadline and you waive your hearing right, though the county can grant an exception for good cause.
For non-disability cases, the first step is a hearing before the county director or their designee. For disability-related denials, the county forwards your appeal to the state Department of Health and Human Services within five days, and a state hearing officer conducts the hearing in your county. If the local outcome doesn’t go your way, you have 15 days to escalate to the state level, and 30 days after that to petition for judicial review in superior court. You can bring an attorney or represent yourself.15NC OAH. Hearings Division Legal aid organizations in North Carolina handle these cases regularly and may represent you at no cost if you qualify.