Updated September 4, 2026. Quick answer: yes, through State Plan Personal Care Services (PCS) Provided in Congregate Settings (Clinical Coverage Policy No. 3L-1). Medicaid does not pay the facility’s room and board either way; only the care and service component.
What North Carolina covers
| Waiver / state plan option | State Plan Personal Care Services (PCS) Provided in Congregate Settings (Clinical Coverage Policy No. 3L-1) |
|---|---|
| Covers an assisted living setting? | Yes: “resides in: 1. a congregate facility licensed by the State of North Carolina as an Adult Care Home (ACH) as defined in NC G.S. §131D-2.1, a combination home as defined in NC G.S. § 131E-101; or 2. a group home licensed under Chapter 122C of the General Statutes and under 10A NCAC 27G .5601 (b)(2) as a supervised living facility for two or more adults whose primary diagnosis is mental illness, a developmental disability, or substance abuse dependency and is eligible to receive personal care services under the Medicaid State Plan.” |
| Room and board | Never covered by Medicaid, in North Carolina or any state; see below. |
The room-and-board split
Federal law is the floor every state builds on: “The Secretary may by waiver provide that a State plan approved under this subchapter may include as “medical assistance” under such plan payment for part or all of the cost of home or community-based services (other than room and board) approved by the Secretary” (42 U.S.C. §1396n(c)(1), Social Security Act §1915(c)). The words in parentheses do the work: whatever a state’s waiver pays for inside an assisted living community, it is not the rent, the meals, or the room itself. That portion stays the resident’s own to fund, out of income, savings, or a family contribution; the waiver only ever reaches the care and service layer on top of it. North Carolina’s own materials say the same thing directly: “Medicaid shall not cover ANY of the following services under PCS: … m. Room and Board.” (NC Medicaid Clinical Coverage Policy No. 3L-1, State Plan Personal Care Services (PCS) Provided in Congregate Settings, Section 4.2.1.2 (Amended Date: January 1, 2026)).
The waitlist
Not published by the state in the materials reviewed this session.
What you get to keep: the personal needs allowance
$70 a month: “a. Personal Needs Allowance (PNA) (1) $70 for an institutionalized individual, or (2) $140 for a married couple who share a room.” This is the amount of a waiver participant’s own income the state lets them keep for personal spending after the rest goes toward the cost of their care; it varies by state because each state sets its own figure inside the federal floor.
What this doesn’t answer
North Carolina does not run an assisted-living-named HCBS waiver: its disabled/aged waiver, CAP/DA, explicitly cannot be used by anyone living in an Adult Care Home (assisted living’s licensure category here); the pathway that actually reaches Adult Care Homes is the State Plan PCS-in-Congregate-Settings policy (3L-1) confirmed above. Waitlist status is unverified: the most recent CAP/DA enrollment count found is a different, ACH-excluding program and not a waitlist figure for the PCS pathway, so it was not forced into a status. The $70 PNA figure comes from NC’s general LTC budgeting policy (MA-2270, applicable to “institutionalized” Medicaid long-term-care beneficiaries) rather than a PCS-3L-1-specific line item, flagged so it isn’t read as more precise than it is.
Sources
- NC Medicaid Clinical Coverage Policy No. 3L-1: State Plan Personal Care Services (PCS) Provided in Congregate Settings (Amended Jan. 1, 2026)
- NC Medicaid: Community Alternatives Program for Disabled Adults (CAP/DA) program page
- NC DHHS Policy MA-2270: Long Term Care Need and Budgeting
Read September 4, 2026.
Same question, other states: North Dakota · Ohio.
Related: what assisted living actually costs · assisted living vs. staying home vs. a CCRC · why home care has a waitlist and a nursing home doesn’t.
General information drawn from each state’s own Medicaid agency and federal statute, not legal, tax or financial advice. Medicaid is administered state by state; waiver names, coverage decisions, waitlists and allowance amounts change by state budget and legislative action. This page cannot see your own state’s current caseload. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.
Related: North Carolina’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.