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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2270 _______________________________________________________________________ LONG TERM CARE BUDGET NEED AND BUDGETING __ 1

REVISED 06/16/2026 – CHANGE NO. 08-26

I. INTRODUCTION

This section contains instructions for determining income eligibility of individuals in long term care. Long term care is extended care in a hospital or medical facility listed below. Medicaid helps to pay the cost of care for an eligible individual. The applicant/beneficiary (a/b) must also meet all other eligibility requirements including resource limits MA-2230, Financial Resources for resource protection, MA-2231, Community Spouse Resource Protection, and MA-2240 Transfer of Assets.

II. WHEN TO USE LTC BUDGETING

Use LTC budgeting when a person meets all of the criteria below.

A. The a/b must have begun a continuous period of institutionalization (CPI). The definition of CPI is 30 consecutive days in a medical facility or combination of two or more medical facilities. If the individual in one of these facilities is discharged home or to an adult care home during the first 30 days, there is no CPI. The CPI continues if the a/b is discharged from a Medicaid facility but returns within 30 days.

1. The a/b enters a medical facility from a private living arrangement or an adult care home. A medical facility is an institution that primarily provides inpatient medical care (not residential care). A medical facility could be:

a. A Medicare-Medicaid certified nursing facility, ICF-MR, Skilled nursing facility (SNF), or SNF Rehab. (Refer to III. if the facility is not yet certified.)

• A hospice beneficiary is considered long term care if the person is admitted to a hospice inpatient facility or is a patient in a hospital/nursing facility under contract with hospice. If not an inpatient, budget PLA.

b. Skilled nursing care in a general hospital (called a swing bed or inappropriate level of care bed).

c. Psychiatric unit in a state mental hospital (Dix, Broughton, Umstead, and Cherry) when the a/b is:

(1) Age 65 or older, or Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493