How North Carolina's Special Assistance program helps pay room and board in a licensed adult care or family care home, and what the SA, SA/SCU, and SAIH tracks actually cover.
By Charlotte Senior Advisor Care Team — Benefits & Costs Team · February 3, 2026
State/County Special Assistance (SA) is North Carolina's main public path to help low-income older adults with the cost of a licensed adult care or family care home. It is a state and county CASH supplement — not Medicaid — administered through the county Department of Social Services (DSS) that helps eligible seniors (65 or older, or disabled) pay the room-and-board portion of living in a licensed Adult Care Home or Family Care Home. One important detail families ask about constantly: SA recipients are automatically Medicaid-eligible, so the two are linked, but SA itself is a separate cash program with its own application through the county DSS.
There are three tracks worth knowing. Standard SA supports room and board in an adult care or family care home. SA/SCU is the track for residents living in a memory-care Special Care Unit, reflecting the higher cost of dementia care. And Special Assistance In-Home (SAIH) helps eligible seniors who want to stay in their own home rather than move to a facility. The maximum monthly rates are set annually by the North Carolina General Assembly — for 2026, roughly $1,397 a month for the Basic rate and $1,792 for the Enhanced rate — so the exact figures shift year to year and are worth confirming with your county DSS.
Because SA is tied to Medicaid eligibility, a resident approved for Special Assistance also gains Medicaid coverage for their medical care — but SA is what helps with the room-and-board bill in the adult care or family care home, and Medicaid does not directly pay that rent. Families in Mecklenburg, Cabarrus, Gaston, Union, and Iredell counties apply through their own county DSS, which handles both the SA cash supplement and the linked Medicaid determination. The Centralina Area Agency on Aging can also provide free benefits counseling to help a family understand which programs they qualify for.
Special Assistance is distinct from NC Medicaid's Community Alternatives Program for Disabled Adults (CAP/DA), which is the home- and community-based waiver that funds in-home personal care as an alternative to a nursing home. A family keeping a parent at home might use SAIH or CAP/DA; a family moving a parent into a licensed adult care home might use standard SA or SA/SCU. A benefits counselor at your county DSS or the Centralina Area Agency on Aging can help sequence Special Assistance, CAP/DA, VA benefits, and any private resources so nothing is left on the table.
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