North Carolina Medicaid Transfer Penalty Divisor: $10,317 a Month

Updated August 27, 2026. Quick answer: North Carolina divides by $10,317 a month, and then does something no other state page in this series has shown: it converts the leftover fraction of a month into days by multiplying it by 31. The manual carrying that figure is stamped REVISED 12/2/24.

What North Carolina publishes

How the penalty period is calculated

• For transfers on or after November 1, 2007, total the uncompensated value of all transfers in the look-back period, and determine a sanction period on any and all transfers regardless of whether the amount transferred is over or under the private NF rate.
• Divide the total uncompensated value for all transfers by the private NF rate, $10,317. The result is the length of the sanction period. The manual says in terms not to round down to the nearest whole month, and to round the amount to 2 decimals.
• 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 days by $343.90, the average private daily rate, and add it to the first month’s liability.
• Transfers made before November 1, 2007 are totalled separately and follow a different rule: if the total uncompensated value of those transfers is less than the private NF rate, there is no sanction at all, and the result is rounded down to the lowest whole number of months.
• 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.

What this page does not settle

• The manual uses two different month lengths in the same calculation. The monthly divisor and the daily rate are exactly thirty days apart – $343.90 multiplied by 30 is $10,317.00 to the cent – but the leftover fraction of a month is converted to days by multiplying by 31. That arithmetic is done here, not by the state, and it is shown because it is the check that proves the two published figures are one rate expressed two ways.
• This page reports what the currently published manual prints and when that manual was revised. The manual itself says the private NF rate is subject to change and that DHB will issue changes in the rate, so a rate issued after the 12/2/24 revision would not appear in this document. No claim is made here about whether such a change exists.
• The revision is dated 12/2/24 and its Change Notice lists exactly two things it changed: the home equity amount in Section I, and Section XII, the private nursing facility rate. The home equity ceiling it carries reads $730,000.
• The date a transfer happened, not the date of the application, decides which of the two rules applies, and the pre-November-2007 rule is the more forgiving one: under it a total below the rate produces no sanction at all, while under the current rule any amount produces one.
• 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 12/2/24 (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.