Short Answer

Yes—under North Carolina Medicaid, you can move your mom into your home and still pursue Medicaid-funded in-home services if she meets financial and medical-need rules. Her primary residence can remain exempt while she lives there or intends to return, but gifting, deed changes, or other transfers during the 5-year lookback can trigger penalties. Plan any spend-downs carefully and understand estate recovery rules after death.

Understanding the Problem

You want to know if, in North Carolina, you can bring your mother with progressive dementia to live in your home and use in-home care without losing Medicaid eligibility. You also want to understand how moving affects her home, whether to use a Lady Bird deed, and how the 5-year lookback and estate recovery work. Here, the key decision is whether Medicaid rules allow in-home services without penalizing her assets or transfers.

Apply the Law

North Carolina Medicaid offers programs that can fund in-home care if the applicant meets medical-need criteria and strict income/resource limits. A home is generally excluded while the applicant lives there or states an intent to return. Transfers for less than fair market value within five years before applying can cause a penalty. After death, the State can seek estate recovery for certain Medicaid benefits paid, subject to claim priority and exemptions.

Key Requirements

• Financial eligibility: Countable assets and income must fall within Medicaid limits; a primary residence may be excluded while the applicant lives there or intends to return.
• Medical necessity: The applicant must meet functional/medical criteria for in-home services.
• Transfer rules (5-year lookback): Gifts or below-market transfers within five years before application can create a coverage penalty.
• Home planning: Selling or deeding the home can affect eligibility; some deeds or transfers can trigger penalties or later recovery.
• Estate recovery: After death, the State may recover certain Medicaid costs from assets available to pay claims in the estate, subject to statutory priority.
• Capacity and approvals: If mom lacks capacity, significant transfers (including deeds or gifts) generally require proper authority (valid POA) or guardianship oversight through the Clerk of Superior Court.

What the Statutes Say

• North Carolina Gen. Stat. § 108A-70.5 (Medicaid Estate Recovery) – permits the State to recover certain Medicaid payments from the estate after death, with exceptions.
• North Carolina Gen. Stat. § 28A-19-6 (Order of claims against estates) – sets the payment priority for estate claims, including Medicaid recovery.
• North Carolina Gen. Stat. § 41-2.1 (Right of survivorship in bank deposits) – explains survivorship accounts and circumstances where a decedent’s contributions may be reached for claims.

Analysis

Apply the Rule to the Facts: Moving your mother into your home can align with Medicaid in-home care as long as she meets medical need and financial limits. Her current home can remain an excluded resource if she lives there or expresses an intent to return; if she clearly will not return, the home may become countable unless handled properly. Paying legitimate expenses (care costs, necessary home expenses) can reduce countable assets; outright gifts during the 5-year lookback risk penalties. Deed changes, including an enhanced life estate (Lady Bird) deed, must be evaluated for both eligibility and later estate recovery effects.

Process & Timing

1. Who files: Applicant or authorized representative. Where: Your county Department of Social Services (DSS) in North Carolina. What: Medicaid application for Aged/Blind/Disabled and assessment for in-home services (e.g., personal care or home- and community-based services). When: Apply as soon as you have current financial records; decisions typically issue within standard DSS processing timeframes.
2. Gather proof of income, assets, home ownership, mortgage statements, and any transfers in the last five years; DSS may request additional verification and a functional assessment.
3. After approval, DSS issues coverage and service authorizations; keep records current and report changes in assets, residence, or care needs.

Exceptions & Pitfalls

• Caregiver child exception: Transferring a home to a child who lived with the parent and provided care that delayed institutionalization for at least two years may avoid a transfer penalty; the details are fact-specific.
• Lady Bird deed risks: While some non-probate transfers may limit direct probate recovery, North Carolina can still reach assets available to pay estate claims, and certain non-probate funds may be pulled back to satisfy claims.
• Intent to return: If mom no longer resides in her home, clearly document any intent to return; otherwise the home may become countable.
• Capacity/authority: If mom cannot consent, do not sign deeds or make gifts without valid POA authority or a court-appointed guardian’s approval from the Clerk of Superior Court.
• Spend-down vs. gifts: Paying legitimate expenses (care costs, necessary home repairs, funeral prearrangements) is generally safer than gifting, which can trigger penalties.

Talk to a Estate Planning Attorney

If you’re weighing in-home Medicaid options while protecting a family home, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at +1-704-555-0100.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.