Updated September 5, 2026. Quick answer: North Carolina does not test nursing-facility Medicaid income against a statewide percentage of the SSI federal benefit rate. It compares an applicant’s net income against the specific nursing facility’s own Medicaid reimbursement rate or private-pay rate, so the effective ceiling varies by which facility the applicant is in.
What is MA-2270 in North Carolina Medicaid?
MA-2270, Long Term Care Need and Budgeting, is part of North Carolina’s Aged, Blind and Disabled Medicaid Manual. When an applicant’s gross income exceeds the facility’s Medicaid reimbursement rate, it tells caseworkers to contact the facility for its private-pay rate and compare the applicant’s net income to that number.
The test is the facility’s rate, not a state number
North Carolina’s Aged, Blind and Disabled Medicaid Manual (MA-2270, “Long Term Care Need and Budgeting”) instructs caseworkers, when an applicant’s gross income exceeds the facility’s Medicaid reimbursement rate, to contact the specific facility to establish its private-pay rate and compare the applicant’s net income to that number directly.
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How our partner relationships workWhy the same income can pass at one facility and not another
Because the comparison point is the individual facility’s own reimbursement or private rate rather than a fixed statewide dollar figure, two North Carolina applicants with identical income can reach different eligibility outcomes depending on which nursing facility they are applying from, a genuinely different mechanism from the flat percentage-of-FBR cap most states use.
Figures verified against the NC DHHS Medicaid ABD Manual MA-2270 (revised 12/2/24) on September 29, 2026.
| Citation | NC DHHS Medicaid ABD Manual MA-2270, Section V.B (Revised 12/2/24) |
| What it says | “Facility’s Private Rate (DHB-5008, SUPPLEMENT B, Step I., B.) When the a/b’s gross income is greater than the Medicaid reimbursement rate for the facility, determine if net income (after exclusions) is less than the facility’s private rate. Contact the facility to establish the facility’s private rate for 31 days. Compare net income to the facility’s private rate to establish whether financial eligibility exists… If net countable income is less than or equal to the facility’s private rate, the person is financially eligible.” |
This page covers the income eligibility figure itself. How a state handles income above that figure (a Qualified Income Trust, a medically needy spend-down, or something else) is covered on North Carolina’s excess income mechanism page.
Every citation on this page was read directly from the state’s own Medicaid agency, administrative code, or official eligibility manual this session. General information, not legal or financial advice; a figure this specific can change with a budget cycle or a rule amendment, and a county or state caseworker has the final say on any individual application.
Related: use the Medicaid spend-down calculator to estimate how much you would need to spend down to qualify for long-term-care Medicaid in your state.