Updated August 27, 2026. Quick answer: North Carolina divides by $11,904 a month, the average monthly private nursing facility rate the state’s manual gives as of January 1, 2025, and then converts the leftover fraction of a month into days by multiplying it by 31. The manual carrying that figure is stamped REVISED 06/30/2026.
What North Carolina publishes
| What the state lists | Figure |
|---|---|
| Private nursing facility rate – the divisor | $11,904 |
| Average private daily rate, used to convert the last month to dollars | $384 |
| What the manual does with the leftover fraction of a month | Multiply the remaining fractional amount by 31 |
| Rounding of the division result | Round the amount to 2 decimals |
| Revision stamp on the manual section carrying the rate | REVISED 06/30/2026 |
| The change notice number | CHANGE NO. 09-26 |
| What the manual says about the rate changing | The current manual states the average monthly private NF rate as of a stated date and applies the rate as of the date of the application, institutionalization or request for CAP or PACE. |
How the penalty period is calculated
- Total the uncompensated value of all transfers in the lookback period, and determine a sanction period on any uncompensated transfers that occurred after the lookback date.
- Divide the total uncompensated value for all transfers by the average monthly private NF rate as of the date of the application, institutionalization or request for CAP or PACE, which the manual gives as $11,904 as of January 1, 2025. The manual says to round the amount to 2 decimals; the resulting whole number is the length of sanction months, and any fractional remainder is additional days.
- Multiply the remaining fractional amount by 31. The result is the additional number of days to be added to the sanction period, and any fractional portion of a day is dropped.
- For cases with a patient monthly liability, convert the number of days in the sanction-ending month to a dollar amount by multiplying those sanction days by $384, the average private daily rate, and add it to the first month’s liability.
- When both spouses are institutionalized, requesting CAP or receiving in-home health services and supplies, the sanction period is divided between the spouses, and the total imposed on both cannot exceed the number of months of the sanction period.
Once you have the figure above, the Medicaid penalty period calculator does the arithmetic. This page is the North Carolina rate record; the calculator is the class parent.
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- The monthly divisor equals the daily rate times 31: $384 multiplied by 31 is $11,904 to the dollar, and the leftover fraction of a month is also converted to days by multiplying by 31. That arithmetic is done here, not by the state.
- This page reports what the currently published manual prints and when that manual was revised: MA-2240 REVISED 06/30/2026, Change No. 09-26, which gives $11,904 as of January 1, 2025.
- The revision is dated 06/30/2026 (Change No. 09-26).
- The daily figure is not a second divisor. It is used only to turn the days in the sanction-ending month into a dollar amount for cases that have a patient monthly liability.
Eligibility is decided by the state agency on the whole file, not by this one number. Nothing here is legal advice, and no one should transfer, retitle or give away property on the strength of a worksheet.
Sources
- North Carolina Medicaid, Aged, Blind and Disabled Medicaid Manual MA-2240, Transfer of Assets, revised 06/30/2026 (the rate and the method)
- North Carolina Medicaid, Aged, Blind and Disabled Medicaid Manual (the manual index)
Each source above was retrieved and read against the state text on August 27, 2026. Every figure on this page was checked against those bytes.
The penalty divisor governs transfers, not eligibility. For the income side, see North Carolina’s Medicaid nursing-home income test, which gives the figure or mechanism and the state regulation it comes from.
Related: North Carolina’s Medicaid home equity limit for a single applicant with no spouse or dependent child at home.
Related: North Carolina’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.