North Dakota

What Is Medicaid Long-Term Care in North Dakota?

Medicaid is a healthcare program designed to help low-income individuals of all ages. For seniors 65 years and older in North Dakota, Medicaid provides long-term care, including services in nursing homes, adult foster care homes, and assisted living facilities. ND Medicaid also supports non-medical services to help seniors live at home. There are three main categories of Medicaid long-term care programs for which seniors in North Dakota may qualify.

What Are the Types of Medicaid Long-Term Care Programs?

1. Institutional / Nursing Home Medicaid

   This program is an entitlement. Eligible individuals will receive care in nursing homes.

2. Medicaid Waivers / Home and Community-Based Services (HCBS)

   This program is not an entitlement; the number of participants is limited, and waiting lists may exist. Its goal is to delay nursing home admission and provides benefits at home, in adult day care, foster care, or assisted living.

3. Regular Medicaid / Aged, Blind, Disabled

   This is an entitlement. Eligible individuals receive assistance for long-term care, such as personal care assistance or adult day care.

While Medicaid is funded by both the federal and state governments, the state administers it under federal guidelines. The North Dakota Department of Human Services (DHS) manages Medicaid.

What Are the Income and Asset Limits for Medicaid Eligibility?

Eligibility for the different Medicaid programs in North Dakota varies by income and assets. The criteria also change annually and depend on marital status. North Dakota provides multiple pathways to eligibility.

What Is the Simplified Eligibility for a Single Nursing Home Applicant in 2025?

A single applicant for Nursing Home Medicaid in North Dakota must meet the following conditions:

1. Income: Almost all income must go toward nursing home care.
2. Assets: Must have assets under $3,000.
3. Level of Care: Requires a Nursing Home Level of Care.

The table below outlines the eligibility details for different types of Medicaid programs in North Dakota:

2025 North Dakota Medicaid Long-Term Care Eligibility for Seniors

Note: All of a beneficiary’s monthly income (minus personal allowances and expenses) must be paid to the nursing home.

How Is Income Defined and Treated for Medicaid?

What Is Countable vs. Non-Countable Income?

Income from any source is counted toward Medicaid’s income limits. This includes employment wages, alimony, pensions, Social Security benefits, and others. Some income, like Holocaust restitution and certain VA benefits, is not counted.

How Is Income Treated for a Couple?

When one spouse applies for Medicaid, only the applicant’s income is considered. The non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance (MMNA) to avoid financial hardship. In 2025, the MMNA is $2,644/month. If a non-applicant spouse already receives this amount, they are not entitled to additional support.

What Are the Asset Definitions and Exceptions for Medicaid?

What Are Countable vs. Non-Countable Assets?

Countable assets include cash, stocks, real estate, and other financial resources. Non-countable assets include personal items, household furnishings, and a primary home. In North Dakota, certain retirement accounts are exempt if in payout status.

How Are Assets Treated for a Couple?

For married couples, all assets are considered jointly owned. However, the non-applicant spouse can retain a portion of the couple’s assets, with a maximum of $157,920 in 2025. Regular Medicaid does not have a similar allowance.

What Is Medicaid’s Look-Back Rule?

North Dakota has a 60-month Look-Back Period before applying for Nursing Home Medicaid or Medicaid Waivers. During this period, Medicaid checks for any assets transferred below market value. Violating this rule results in a Penalty Period.

What Are the Home Exemption Rules for Medicaid?

In most cases, a home is exempt from Medicaid’s asset limits if the applicant or spouse lives in it. However, there is a $730,000 home equity interest limit. The home is not exempt from Medicaid’s Estate Recovery Program, meaning it may be used to repay Medicaid after the beneficiary’s death.

What Are the Medical and Functional Need Requirements for Medicaid?

To qualify for Medicaid long-term care, applicants must have a Nursing Home Level of Care (NFLOC) or meet specific functional needs for services like personal care assistance. For Regular Medicaid, applicants only need to demonstrate a need for assistance with daily living activities.

How Can Seniors Qualify for Medicaid If They Exceed the Limits?

What Is the Medically Needy Pathway?

Seniors whose income exceeds the Medicaid limit may still qualify if they have high medical expenses. The Medically Needy Income Limit (MNIL) for 2025 is $1,174/month for individuals and $1,587/month for couples.

What Is the Asset Spend-Down Option?

Seniors with assets over the Medicaid limit can “spend down” excess assets by paying for non-countable items, such as home modifications or funeral expenses. It is important to avoid selling assets below fair market value within the 60-month Look-Back Period.

What Is Medicaid Planning?

Medicaid Planning involves working with a professional to help seniors qualify for Medicaid while preserving assets. This can include strategies to protect the home from Medicaid’s Estate Recovery Program.

What Specific Programs Does North Dakota Medicaid Offer?

1. Medicaid State Plan Personal Care Services (MSP-PC)

   Provides help with daily living activities like personal hygiene and medication management. Participants can choose their Qualified Service Provider (QSP).

2. Aged and Disabled Waiver

   Offers support to seniors and adults with disabilities for independent living, including personal care, meal delivery, and home modifications.

3. Program of All-Inclusive Care for the Elderly (PACE)

   Combines Medicaid and Medicare benefits into a single program, offering additional services like dental and eye care.

4. Money Follows the Person

   Helps eligible individuals transition from institutional care back to their homes or communities.

How Can One Apply for North Dakota Medicaid?

Seniors in North Dakota can apply for Medicaid online or through a Health Care Application for the Elderly and Disabled form. Assistance is available by calling the Department of Human Services at 800-472-2622. It is recommended to check eligibility before applying, and Medicaid Planning is strongly advised for those unsure about their eligibility.