In North Carolina, the license families see for assisted living is "Adult Care Home", issued by the North Carolina Department of Health and Human Services, Division of Health Service Regulation, Adult Care Licensure Section. A licensed physician, physician assistant or nurse practitioner must complete a medical exam no more than 90 days before admission and every year after, recorded on the North Carolina Medicaid Adult Care Home FL-2 form. The home must give the resident an Adult Care Home Notice of Discharge and a hearing request form at least 30 days ahead, for one of five reasons, such as unpaid bills after a written warning.
Key facts
- The median monthly cost of assisted living in North Carolina was $6,496 in CareScout's 2025 Cost of Care Survey, or $77,955 a year, $296 above the national median of $6,200 a month. (CareScout, 2026)
- NC Medicaid's Personal Care Services (PCS) program can pay for hands-on help with daily activities such as bathing, dressing and eating for eligible people living in a licensed adult care home. (NC Medicaid, 2026)
- New residents must have a two-step TB skin test or one IGRA blood test on admission, or one skin test if they ever had a two-step test or had one in the last 12 months. (NC Office of Administrative Hearings, 2012)
- Staff who give medications, called medication aides, must finish state training, a clinical skills check and a written exam, unless a license already allows them to give medications. (NC Office of Administrative Hearings, 2021)
- For admission to a special care unit for Alzheimer's disease or related disorders, a physician must list a fitting diagnosis on the FL-2 and the home must document a pre-admission screening. (NC Office of Administrative Hearings, 2018)
North Carolina licenses assisted living as adult care homes (seven or more beds) and family care homes (two to six beds) through the Division of Health Service Regulation, which also registers multi-unit assisted housing with services. Facts below are for adult care homes under 10A NCAC 13F; family care homes have their own rules in 10A NCAC 13G.
Rules change and communities can set stricter policies. Before you sign, confirm the details with the community and the North Carolina Department of Health and Human Services, Division of Health Service Regulation, Adult Care Licensure Section. This page is general information, not legal advice.
The rules at a glance
| Medical assessment before move-in | A licensed physician, physician assistant or nurse practitioner must complete a medical exam no more than 90 days before admission and every year after, recorded on the North Carolina Medicaid Adult Care Home FL-2 form. After an unplanned emergency admission, the exam must be done within 72 hours. [3] More on this |
|---|---|
| TB test | New residents must have a two-step TB skin test or one IGRA blood test on admission, or one skin test if they ever had a two-step test or had one in the last 12 months. People coming straight from a North Carolina hospital, nursing home or adult care home with a documented two-step or IGRA test need no retest. [4] More on this |
| Notice before a move-out | The home must give the resident an Adult Care Home Notice of Discharge and a hearing request form at least 30 days ahead, for one of five reasons, such as unpaid bills after a written warning. Notice can be shorter when the home cannot meet needs and must protect the resident's welfare, or when health or safety is in danger. [5] More on this |
| Who may give medications | Staff who give medications, called medication aides, must finish state training, a clinical skills check and a written exam, unless a license already allows them to give medications. Unlicensed staff may give insulin after diabetes training from a registered nurse, pharmacist or prescriber, and may give only subcutaneous (under the skin) injections, not blood thinners such as heparin. [6] More on this |
| Memory care and dementia | For admission to a special care unit for Alzheimer's disease or related disorders, a physician must list a fitting diagnosis on the FL-2 and the home must document a pre-admission screening. Families seeking admission must get the disclosure information required by G.S. 131D-8, and this is recorded in the resident's file. [7] |
| Long-term care ombudsman | North Carolina's Long-Term Care Ombudsman Program helps residents of long-term care facilities, including adult care homes, with their rights and complaints through 16 regional offices in Area Agencies on Aging, with contacts listed on its page. [8] Official page More on this |
| Medicaid help | NC Medicaid's Personal Care Services (PCS) program can pay for hands-on help with daily activities such as bathing, dressing and eating for eligible people living in a licensed adult care home. Eligibility is set by an independent assessment by NC Medicaid or its designee. [9] Official page More on this |
What assisted living costs in North Carolina
The median monthly cost of assisted living in North Carolina was $6,496 in CareScout's 2025 Cost of Care Survey, or $77,955 a year, $296 above the national median of $6,200 a month. [12]
A median is the middle of the rates communities reported, so many charge more or less. Rates differ between regions and by the care a resident needs, so ask each community for its full fee list in writing. More: assisted living costs in every state, a monthly budget and the costs that aren't in the base rate.
How to check a community in North Carolina
Families can search the DHSR facility database by county, city or name to see a home's star rating, state inspection reports (statements of deficiencies) for surveys since November 1, 2014, county corrective action reports, and penalties from the last 36 months. Search North Carolina's records. [2]
The licensing agency: North Carolina Department of Health and Human Services, Division of Health Service Regulation, Adult Care Licensure Section. [1] Our guide on how to read an inspection report explains what to look for.
Put North Carolina's paperwork on a date
Parent Move Plan counts every task back from the move-in day, including the medical assessment and TB screening the community will ask for, so nothing lands in the last week.
Get your first 3 days freeFrequently asked questions
How much does assisted living cost in North Carolina?
The median monthly cost of assisted living in North Carolina was $6,496 in CareScout's 2025 Cost of Care Survey, or $77,955 a year, $296 above the national median of $6,200 a month. A median is the middle of the rates communities reported, so many charge more or less, and rates differ between regions and by the care a resident needs.
What medical assessment does North Carolina require before moving into assisted living?
A licensed physician, physician assistant or nurse practitioner must complete a medical exam no more than 90 days before admission and every year after, recorded on the North Carolina Medicaid Adult Care Home FL-2 form. After an unplanned emergency admission, the exam must be done within 72 hours.
Does North Carolina require a TB test for assisted living?
New residents must have a two-step TB skin test or one IGRA blood test on admission, or one skin test if they ever had a two-step test or had one in the last 12 months. People coming straight from a North Carolina hospital, nursing home or adult care home with a documented two-step or IGRA test need no retest.
How much notice must an assisted living community in North Carolina give before a move-out?
The home must give the resident an Adult Care Home Notice of Discharge and a hearing request form at least 30 days ahead, for one of five reasons, such as unpaid bills after a written warning. Notice can be shorter when the home cannot meet needs and must protect the resident's welfare, or when health or safety is in danger.
Who can give medications in assisted living in North Carolina?
Staff who give medications, called medication aides, must finish state training, a clinical skills check and a written exam, unless a license already allows them to give medications. Unlicensed staff may give insulin after diabetes training from a registered nurse, pharmacist or prescriber, and may give only subcutaneous (under the skin) injections, not blood thinners such as heparin.
Who can help with a complaint about assisted living in North Carolina?
North Carolina's Long-Term Care Ombudsman Program helps residents of long-term care facilities, including adult care homes, with their rights and complaints through 16 regional offices in Area Agencies on Aging, with contacts listed on its page.
Does Medicaid pay for assisted living in North Carolina?
NC Medicaid's Personal Care Services (PCS) program can pay for hands-on help with daily activities such as bathing, dressing and eating for eligible people living in a licensed adult care home. Eligibility is set by an independent assessment by NC Medicaid or its designee.
Sources
- NC Division of Health Service Regulation: Adult Care Licensure Section, General Information (2018) (checked October 22, 2026)
- NC Division of Health Service Regulation: Facility Inspections, Ratings, Penalties and Licensure Actions, Search for a Facility (2026) (checked October 22, 2026)
- NC Office of Administrative Hearings: 10A NCAC 13F .0703, Tuberculosis Test, Medical Examination and Immunizations (2024) (checked October 22, 2026)
- NC Office of Administrative Hearings: 10A NCAC 41A .0205, Control Measures, Tuberculosis (2012) (checked October 22, 2026)
- NC Office of Administrative Hearings: 10A NCAC 13F .0702, Discharge of Residents (2024) (checked October 22, 2026)
- NC Office of Administrative Hearings: 10A NCAC 13F .0403, Qualifications of Medication Staff; .0505, Training on Care of Diabetic Residents; .0903, Licensed Health Professional Support (Subchapter 13F rules, 2021) (checked October 22, 2026)
- NC Office of Administrative Hearings: 10A NCAC 13F .1306, Admission to the Special Care Unit (2018) (checked October 22, 2026)
- NCDHHS Division of Aging: Long-Term Care Ombudsman (2026) (checked October 22, 2026)
- NC Medicaid: Personal Care Services (PCS) (2026) (checked October 22, 2026)
- NC Medicaid: Adult Care Homes (2026) (checked October 22, 2026)
- NC Office of Administrative Hearings: 10A NCAC 13G, Licensing of Family Care Homes (Subchapter 13G rules, 2026) (checked October 22, 2026)
- CareScout: Cost of Care Survey 2025, Ranked Median Costs by State (2026) (checked October 22, 2026)