North Dakota HCBS Medicaid Waiver: North Dakota 2026 Guide

North Dakota’s Home and Community-Based Services (HCBS) Medicaid Waiver helps people who need a nursing facility level of care receive services at home or in a community setting. It is overseen by the Aging Services section of the North Dakota Department of Health and Human Services, and local case management is provided through Human Service Zones.

Here is a plain-language walk-through of the HCBS Waiver: who qualifies in 2026, what help it covers, how a family gets started, whether there is a wait, and how it connects to nursing home coverage. For the full statewide rules on income, assets, spouses and the look-back, see our North Dakota Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What the HCBS Waiver is

The HCBS Waiver is a 1915(c) waiver for older adults and adults with physical disabilities. A case manager completes a functional assessment, explains options, and writes a care plan. Services are delivered by agencies or by qualified service providers, who can be individuals, including some relatives, enrolled with the state. The waiver is one of several programs that North Dakota uses for in-home care; others are state-funded.

In federal terms, the HCBS Waiver is a home and community-based services (HCBS) waiver. That label means North Dakota received approval to bend some usual Medicaid rules, most importantly the link between long-term care and a nursing home bed. Because waivers are optional, each one has its own name, service list and, often, a cap on how many people it serves at once. That is the main difference from regular Medicaid benefits: meeting the rules does not by itself guarantee a slot.

Who qualifies in 2026

North Dakota looks at both how much help a person needs and what they own and earn. In general, to qualify for the HCBS Waiver an applicant must:

• be 65 or older, or 18 to 64 with a physical disability;
• live in North Dakota;
• meet a nursing facility level of care, based on a functional assessment;
• be eligible for North Dakota Medicaid; and
• need waiver services to stay safely at home or in the community.

The money test. the HCBS Waiver uses North Dakota’s long-term care Medicaid financial rules, which are usually the same income and asset limits used for nursing home Medicaid. Countable assets include bank accounts, investments and property other than the home, while the home, one car, personal belongings and certain burial funds are usually not counted. Gifts made in the five years before applying can trigger a penalty that delays waiver services, just as it would delay nursing home coverage.

North Dakota does not use a fixed income cap for nursing home care; people are treated as medically needy, and income above set levels goes toward the cost of care, often as a recipient liability. The single-person asset limit is $3,000.

For reference, these are North Dakota’s key 2026 long-term care Medicaid figures:

Married applicants. When one spouse applies and the other stays at home, spousal impoverishment protections generally apply, so the spouse at home can keep a share of the couple’s assets and may receive part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services the HCBS Waiver can cover

Services are listed in a written plan of care, built from the assessment and the person’s goals. Not everyone gets every service. Depending on need, the HCBS Waiver can include:

• case management
• homemaker and chore services
• adult day care
• adult foster care
• adult residential services, including memory care settings
• respite care
• emergency response systems
• environmental modifications
• home-delivered meals
• non-medical transportation
• companionship
• community transition services
• family personal care, where a family member is paid in limited circumstances
• supported employment and transitional living for some participants

Limits to keep in mind. the HCBS Waiver does not pay for rent, groceries or utilities; in residential settings, room and board is the resident’s responsibility. Family help is usually factored into the plan, and medical coverage runs alongside the waiver as before.

How to apply for the HCBS Waiver

Here is how applying for the HCBS Waiver usually works. Filing the Medicaid application and the waiver request together saves time.

1. Contact the Aging and Disability Resource Link or your local Human Service Zone office to ask for an HCBS assessment.
2. Apply for Medicaid through the state’s benefits portal or the Human Service Zone office, if not already enrolled.
3. A case manager completes the functional assessment and level of care screening.
4. The case manager writes the care plan and helps you choose providers.
5. Services start once approved.

Tips for the paperwork. Keep a folder of copies, and log every call with the date and name. Assessors only see one visit, so describe what a difficult day looks like and have a regular helper in the room. Cognitive problems and fall risk count toward need. If services are denied, the notice lists the deadline to appeal.

Waiting lists and timing

North Dakota’s HCBS waiver has generally been available without a long waiting list, but finding providers in rural areas can delay services.

Because openings can be limited, it usually makes sense to get on any list early, even before needs are urgent. Stopgaps can include state plan home care, adult day centers, PACE where it operates and local aging services. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

the HCBS Waiver and nursing home Medicaid serve the same group of people; the difference is where care is given. Nursing home coverage cannot be capped, but waiver enrollment sometimes is. A participant who later needs a nursing home keeps Medicaid, though more of their income then goes toward care. People leaving a nursing home often get priority for waiver openings, with help from Money Follows the Person.

Tips for families

Begin before the situation is urgent; every step takes longer than families expect. Pull together five years of financial statements and keep a short care log ahead of the assessment. If income is above the limit, a Miller trust or a spend-down may apply, depending on the state. If money has been given to family in the past five years, get advice before applying. If needs change, request a reassessment rather than waiting for the yearly review.

Because the HCBS Waiver combines a care test, a money test and sometimes a wait, a Certified Medicaid Planner familiar with North Dakota can be a real help: checking finances against the 2026 limits, flagging look-back issues and keeping the application on track. Fees vary: roughly $500 to $6,000 for application help, $2,500 to $15,000 or more for full planning, and $150 to $600 an hour for advice.

Related pages

• North Dakota Medicaid guide
• North Dakota Personal Care Services
• HCBS waivers explained
• Applying for a waiver
• Nursing home level of care
• Waiver waiting lists
• The five-year look-back

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.