North Carolina lawmakers voted unanimously to pass House Bill 485, Adult Care Home Medicaid PCS Coverage, which will expand Medicaid access to over 24,000 low-income seniors to choose assisted living for their long-term care needs. The legislation is pending Governor Josh Stein’s signature, followed by federal approval from the Centers for Medicare & Medicaid Services (CMS).
Medicaid income eligibility for seniors in North Carolina has effectively been frozen for more than 15 years. In 2008, the state placed a cap on income levels for the State-County Special Assistance Program, which helps fund care in assisted living and adult care homes. In 2023, a routine Social Security cost-of-living adjustment (COLA) pushed thousands of seniors just over the income threshold, often by as little as $50 or $100 per month, resulting in many becoming disqualified from assistance and creating a “benefits cliff” for seniors who earned too much to qualify but far too little to afford care out of pocket.
House Bill 485 updates and indexes income eligibility standards, expanding Medicaid access to more than 24,000 seniors who were previously locked out of the system. Before HB 485, North Carolina’s income eligibility caps for the Special Assistance program stood at $1,354.50/month for general assisted living and $1,736.50/month for memory care. The new rate will be indexed at 180% of the federal poverty level for assisted living and 200% of the federal poverty level for those in memory care. These changes are projected to result in savings of $125 million annually for North Carolina and $250 million federally through more efficient resource allocation.
Argentum commends the bill sponsors and bipartisan support from the legislature for passing this legislation, and offers sincere appreciation to the North Carolina Assisted Living Association (NCALA) and ALG Senior, who have championed this cause for years, tirelessly advocating for needed reforms with compelling data, policy insights, and stories through direct outreach to lawmakers and by mobilizing stakeholders.