Quick answer: In North Carolina, a nursing home resident on Medicaid pays a monthly patient liability: gross income minus allowed deductions, such as the personal-needs allowance and any community spouse allowance. Medicaid pays the rest, up to the Medicaid rate.
For an eligible nursing-home resident, North Carolina calculates what's called patient monthly liability by working through a specific sequence of deductions against gross income, under NCDHHS Policy MA-2270. Whatever remains after those deductions goes to the facility, with Medicaid covering the rest up to the state's Medicaid reimbursement rate.
The deductions that reduce a resident's liability can include specified incurred medical expenses, the personal-needs allowance, an allowance for a community spouse or dependent family member when applicable, a return-home allowance in qualifying situations, and other eligible uncovered medical expenses — so the actual amount owed each month is rarely just the facility's full bill.
Sources and official resources
Rules and figures change. Confirm current details with the agency before you act.