Medicare-Medicaid Pay-Down of Assets
State law and regulations impose income and asset limits on persons applying for Medicaid.
The income limit for the institutional Medicaid program and certain home and community-based waiver programs is determined by the North Carolina Medicaid – Division of Health Benefits. To qualify for Medicaid through SSI the income limit for 2025 for an aged, blind or disabled individual cannot exceed $1,305 per month or $1,763 for a couple. Resources are limited to $2,000 for an individual and $3,000 for a couple.
When an individual, legal representative, or financially responsible spouse transfers any real property, personal property or any other assets, including assets counted or excluded in determining Medicaid eligibility, for less than current market value, a transfer of assets sanction may be imposed. If a sanction is imposed the individual is ineligible for certain Medicaid covered services. The services that can be sanctioned are: Institutional services which are provided to individuals who are in a nursing facility (NF), intermediate care facility for the mentally retarded (ICF-MR), swing bed or inappropriate level of care bed, Community Alternatives Program (CAP), or the Program of All-Inclusive Care for the Elderly (PACE). Additionally, certain non-institutional services may be sanctioned. These are in-home health services and supplies after the individual has been sanctioned for institutional services.
The lookback date is the earliest point in time on or after which all transfers of assets are reviewed for an a/b requesting or receiving institutional services. For applications on or after November 1, 2007, the look back period is 5 years for all transfers.
North Carolina Medicaid – Division of Health Benefits SSI Eligibility Limits
North Carolina Aged, Blind, and Disabled Medicaid Manual – MA-2240 (Transfer of Assets)
Medicaid for Workers with Disabilities