Long-term care in nursing homes, assisted living facilities, or an individual’s own home, is the largest portion of North Carolina’s Medicaid budget. It is also the fastest growing portion of that budget. As the state’s population ages, it will drive even more demand for these services. Medicaid was not meant to be inheritance insurance for baby boomers, but current policy in North Carolina allows it to be exactly this. Encouraging more people to rely on private payment options, such as reverse mortgages or long-term care insurance, will mean lower state costs for care and better results for individuals. This paper examines the state of long-term care in North Carolina, current abuses of the system, and private payment options.

Long-Term Care Financing in North Carolina: Good Intentions, Ambitious Efforts, Unintended Consequences