This page provides a plain-English summary of key elder care and estate planning information specific to North Carolina residents. It covers North Carolina Medicaid limits, estate tax rules, advance directive information, and links to important North Carolina agencies and resources.
Information on this page is updated periodically but laws and limits change frequently. Always verify current figures with the relevant agency or a licensed attorney.
North Carolina Medicaid — 2026 Eligibility Limits for Long Term Care
Medicaid in North Carolina is administered by the Division of Health Benefits within the North Carolina Department of Health and Human Services. North Carolina expanded Medicaid in December 2023 covering adults aged 19 to 64 with incomes up to 138 percent of the federal poverty level.
North Carolina nursing home Medicaid — unique income rules North Carolina uses an unusual approach to nursing home Medicaid income eligibility. Rather than setting a hard income cap like most states North Carolina simply requires that virtually all of the resident’s income be applied toward the cost of nursing home care. As a result almost any income level can qualify for North Carolina nursing home Medicaid as long as the resident’s income is less than the cost of their care. This is one of North Carolina’s most important Medicaid advantages for higher-income seniors.
Asset limit — single applicant A single applicant must have $2,000 or less in countable assets in 2026. Exempt assets include the primary residence with equity up to $752,000 if the applicant intends to return home, one vehicle, personal belongings and household furnishings, and irrevocable burial trusts. Note that IRAs are counted as countable assets in North Carolina.
Home and community based care — HCBS Waivers North Carolina offers several HCBS Waiver programs providing home and community based services as an alternative to nursing home placement. The asset limit for HCBS Waivers is $2,000 for a single applicant. The income limit for HCBS Waivers is based on the Federal Poverty Level rather than a straight income cap — consult with an elder law attorney or the county DSS office for current figures.
Married couples — one spouse applying When only one spouse applies for nursing home Medicaid the community spouse — the spouse who remains at home — may retain 50 percent of the couple’s combined countable assets up to a maximum of $162,660. If 50 percent of the couple’s assets is less than $32,532 the community spouse may retain up to $32,532.
Monthly Maintenance Needs Allowance The community spouse is entitled to a minimum monthly income allowance of up to $4,067 per month in 2026 depending on housing costs. If the community spouse’s income falls below the minimum the nursing home spouse may transfer income to bring the community spouse up to the allowance.
Personal needs allowance North Carolina nursing home Medicaid recipients are allowed to keep $70 per month as a personal needs allowance. The remainder of income is applied toward the cost of care.
Look-back period and divestment penalty North Carolina has a 60-month — five year — look-back period for nursing home Medicaid and HCBS Waivers. Asset transfers made within 60 months of applying that were for less than fair market value may result in a penalty period of ineligibility. The 2026 divestment penalty divisor in North Carolina is $11,904 per month — meaning the penalty period is calculated by dividing the disqualifying transfer amount by $11,904.
Estate recovery North Carolina requires Medicaid estate recovery. After a Medicaid recipient dies the state seeks reimbursement from the estate for long term care costs paid. Planning with an elder law attorney can help protect assets from estate recovery.
How to apply for North Carolina Medicaid Applications can be submitted online through NC ePASS at epass.nc.gov, by phone at 1-888-245-0179, or in person at your local county Department of Social Services — DSS — office.
North Carolina Medicaid administering agency North Carolina Division of Health Benefits — medicaid.ncdhhs.gov
North Carolina Estate Tax — 2026
No North Carolina state estate tax North Carolina does not impose a state estate tax or a state inheritance tax. North Carolina repealed both its inheritance tax and its estate tax effective January 1 2013. This makes North Carolina one of the more favorable states for estate planning from a tax perspective.
Federal estate tax North Carolina residents may be subject to the federal estate tax. The federal estate tax exemption is $15,000,000 per person in 2026 following enactment of the One Big Beautiful Bill Act. The exemption is portable between spouses meaning a married couple can protect up to $30,000,000 from federal estate tax with proper planning. The top federal estate tax rate is 40 percent on amounts above the exemption.
No North Carolina inheritance tax North Carolina beneficiaries owe no state inheritance tax on assets received from a North Carolina decedent regardless of the relationship or the size of the inheritance. However if a North Carolina resident inherits property from someone who lived in a state that imposes an inheritance tax — such as Pennsylvania Kentucky or Nebraska — that state’s inheritance tax may apply to the North Carolina heir’s share.
No North Carolina gift tax North Carolina does not impose a state gift tax. Federal gift tax rules apply — the annual gift tax exclusion is $19,000 per recipient in 2026.
Step-up in basis Inherited assets in North Carolina receive a stepped-up tax basis to fair market value at the date of the original owner’s death. This can significantly reduce capital gains taxes when beneficiaries later sell inherited property.
North Carolina income tax rate North Carolina has a flat individual income tax rate of 3.99 percent for tax year 2026 — reduced from 4.25 percent in 2025. Social Security benefits are not taxed in North Carolina. Most other retirement income is subject to the state income tax.
North Carolina Advance Directives
North Carolina law recognizes the following advance directive documents:
North Carolina Health Care Power of Attorney Names a healthcare agent to make medical decisions on your behalf when you are unable to do so. Must be signed and witnessed by two adults who are not the healthcare agent.
North Carolina Advance Directive for a Natural Death — Living Will Documents your wishes regarding life-sustaining treatment when you have a terminal condition end-stage condition or persistent vegetative state. Must be signed and witnessed by two adults.
North Carolina MOST — Medical Orders for Scope of Treatment North Carolina uses a MOST form for seriously ill patients that documents specific medical orders regarding CPR hospitalization and artificial nutrition. Must be completed with and signed by a physician or nurse practitioner.
North Carolina Advance Directive Registry North Carolina maintains a statewide advance directive registry. Residents can register their advance directives through the North Carolina Secretary of State’s office. Registration allows healthcare providers to access your documents in an emergency. Website: sosnc.gov — search Advance Directive Registry
Free North Carolina advance directive forms Free North Carolina-specific advance directive forms are available at caringinfo.org and from the North Carolina Medical Society at ncmedsoc.org.
North Carolina Key Agencies and Resources
North Carolina Division of Health Benefits — DHB Administers North Carolina Medicaid and processes eligibility applications. Website: medicaid.ncdhhs.gov NC ePASS Online Portal: epass.nc.gov Phone: 1-888-245-0179
North Carolina Division of Aging and Adult Services — DAAS Coordinates programs and services for older North Carolinians including home care nutrition programs caregiver support and the North Carolina SHIIP program for free Medicare counseling. Website: ncdhhs.gov/divisions/aging Phone: 1-919-855-3400 NC SHIIP — free Medicare counseling: 1-855-408-1212
North Carolina Area Agencies on Aging North Carolina is served by 17 regional Area Agencies on Aging that coordinate local services for older adults and caregivers. Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov
North Carolina Long Term Care Ombudsman Program Advocates for the rights of residents of nursing homes and adult care homes. Investigates complaints and helps resolve problems free of charge. Website: ncdhhs.gov/divisions/aging/long-term-care-ombudsman Phone: 1-855-227-3640
North Carolina Secretary of State — Advance Directive Registry Maintains the statewide advance directive registry. Website: sosnc.gov Phone: 1-919-814-5400
North Carolina Bar Association Lawyer Referral Service Connects North Carolinians with attorneys including those who specialize in elder law and estate planning. Website: ncbar.gov Phone: 1-800-662-7660
Legal Aid of North Carolina Provides free civil legal services to low income North Carolinians including seniors on issues related to Medicaid benefits housing and elder law. Website: legalaidnc.org Phone: 1-866-219-5262
North Carolina Veterans Resources
North Carolina Division of Veterans Affairs — NCDVA Provides services and benefits to North Carolina veterans and their families including free VA claims assistance and connections to veterans resources. Website: milvets.nc.gov Phone: 1-984-236-4290
North Carolina State Veterans Homes North Carolina operates veterans homes providing long term care to eligible veterans and their spouses. Facilities are located in Black Mountain, Fayetteville, Kinston, and Salisbury. Website: milvets.nc.gov/services/nc-veterans-homes
North Carolina Senior Property Tax Benefits
Homestead Exclusion North Carolina homeowners aged 65 and older or permanently and totally disabled who meet income requirements may qualify for the homestead property tax exclusion. The exclusion reduces the taxable value of the primary residence by the greater of $25,000 or 50 percent of the appraised value. The income limit for 2026 is $37,900 or less in annual income. Apply through your county assessor’s office by June 1.
Circuit Breaker Tax Deferment Program North Carolina allows qualifying homeowners aged 65 and older with income below the limit to defer a portion of their property taxes. The deferred taxes become a lien on the property but are not due until the property is sold transferred or no longer used as the primary residence.
Disabled Veteran Property Tax Exclusion Disabled veterans with a 100 percent permanent and total service-connected disability rating may qualify for a complete exclusion from property taxes on their primary residence.
Finding Elder Law and Estate Planning Attorneys in North Carolina
The following resources can help you find a qualified elder law or estate planning attorney in North Carolina:
- National Academy of Elder Law Attorneys — NAELA — naela.org — searchable directory by location
- North Carolina Bar Association Lawyer Referral Service — ncbar.gov — 1-800-662-7660
- North Carolina Chapter of NAELA — North Carolina has an active NAELA chapter with members throughout the state
- Legal Aid of North Carolina — legalaidnc.org — free legal assistance for income-qualifying seniors
The information on this page is for general informational purposes only and does not constitute legal or financial advice. North Carolina Medicaid rules and other figures change frequently. Always verify current information with the relevant agency or a licensed attorney. Laws vary and individual circumstances differ significantly.
Last updated: March 2026