North Dakota Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In North Dakota, Medicaid is run by the Department of Human Services. This article focuses on North Dakota Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers and ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Jan 12, 2024

North Dakota Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

North Dakota Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

North Dakota Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited North Dakota seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

North Dakota Nursing Home Medicaid beneficiaries are required to give almost all of their income to the state to help cover care expenses. They are allowed to keep a “personal needs allowance” (PNA) of $65/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid recipients.

North Dakota Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – North Dakota Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through North Dakota’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help North Dakota Medicaid recipients who require a Nursing Facility Level of Care remain living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long term care services for North Dakota residents who live in their own home, the home of a loved one, an adult foster care home, an assisted living residence or a residential care home. While North Dakota’s HCBS Waivers will cover some long-term care services in those settings, it will not cover room and board costs, such as mortgage payments, rent, utilities or food expenses.

The HCBS Waiver relevant to North Dakota seniors is the Medicaid Waiver for Home and Community Based Services.

Medicaid Waiver for Home and Community Based Services
North Dakota’s Medicaid Waiver for Home and Community Based Services, which is sometimes simply called the Medicaid Waiver, will provide long-term care benefits to North Dakota Medicaid recipients who live in their own home, the home of a loved one, an adult foster care home, an assisted living residence or a residential care home. While North Dakota’s Medicaid Waiver will cover services and supports in those locations, it will not pay for room and board expenses.

North Dakota Medicaid Waiver benefits include adult day health care, home modifications, housekeeping services, transportation, and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits are made available depending on each individual’s needs and circumstances. Medicaid Waiver recipients can choose from a list of qualified service providers, or they can use the “family personal care” option. This allows a family member who lives with the program participant (including spouses) to be paid by Medicaid to provide care. This family member must enroll as a Qualified Service Provider with the North Dakota Department of Human Services.

Unlike Nursing Home Medicaid, North Dakota’s Medicaid Waiver for Home and Community Based Services is not an entitlement. Instead, it has a limited number of enrollment spots (637 per year as of 2023). Once those spots are full, additional applicants will be placed on a waitlist.

Aged, Blind, and Disabled Medicaid

North Dakota’s Aged, Blind and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited North Dakota residents who are aged (65 and over), blind or disabled. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

The state will conduct an assessment of North Dakota’s ABD Medicaid beneficiaries to determine what type of long-term care services and supports they need and the state will cover. They can receive these benefits through the Medicaid State Plan – Personal Care Services (MSP-PC) program, or the Program of All-Inclusive Care for the Elderly

1. Medicaid State Plan – Personal Care Services
North Dakota ABD Medicaid beneficiaries who need help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and/or the Instrumental Activities of Daily Living (such as housework, laundry, meal preparation and taking medications) to live independently can receive that help and long-term care benefits through the Medicaid State Plan – Personal Care Services (MSP-PC) program.

MSP-PC program participants can live in their own home, the home of a loved one or an assisted living residence. While MSP-PC will pay for some services in those settings, it will not cover room and board costs.

The MSP-PC program will provide personal care assistance with the Activities of Daily Living and the Instrumental Activities of Daily Living. How much assistance depends on the applicant’s level of care requirements – 120 hours per year for Level A, 240 hours per year for Level B and 300 hours per year for Level C.

An MSP-PC applicant is considered Level A if they require help with at least one of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), or if they require assistance with at least three of these Instrumental Activities of Daily Living (housework, laundry, meal preparation, and taking medications). Level B applicants must require a Nursing Facility Level of Care in addition to meeting the Level A criteria. And Level C applicants must require a Nursing Facility Level of Care and need help with all five Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

Like ABD Medicaid itself, North Dakota’s MSP-PC program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

2. Program of All-Inclusive Care for the Elderly (PACE)
North Dakota residents who are age 55 or older and have ABD Medicaid can cover all of their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. North Dakota’s PACE program can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs, and regular health checkups and services to program participants. North Dakota’s PACE program is located in Bismark and called Northland PACE. To learn more about PACE, click here.

Eligibility Criteria For North Dakota Medicaid Long Term Care Programs

To be eligible for North Dakota Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Just For You: The easiest way to find the most current North Dakota Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

North Dakota Nursing Home Medicaid Eligibility Criteria

Financial Requirements
North Dakota residents have to meet an asset limit in order to be financially eligible for nursing home coverage through North Dakota Medicaid. The 2024 asset limit for a single applicant is $3,000, which means they must have $3,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash, and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

For married applicants with both spouses applying in 2024, the asset limit for North Dakota Nursing Home Medicaid is a combined $6,000. For a married applicant with just one spouse applying, the asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance.

There is no set income limit for Nursing Home Medicaid in North Dakota. However, North Dakota Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $65/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy spouses who are not covered by Medicaid.

Plan Ahead: There are alternative pathways to eligibility for North Dakota Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, North Dakota has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through North Dakota Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. The North Dakota Department of Human Services will administer a functional assessment of Nursing Home Medicaid applicants to determine if that level of care is required. The assessment will take into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, and taking medication).

North Dakota Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
North Dakota residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. The 2024 asset limit for a single applicant for HCBS Waivers in North Dakota is $3,000, which means they must have $3,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash, and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in North Dakota for a single applicant is $1,094/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying in 2024, the asset limit for HCBS Waivers in North Dakota is a combined $6,000, and the income limit is a combined $1,479/month. For a married applicant with just one spouse applying, the asset limit is $3,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit for the applicant is $1,094/month and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for North Dakota HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, North Dakota has a Look-Back Period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through North Dakota Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if that level of care is needed, a nurse will conduct a functional assessment of North Dakota HCBS Waiver applicants using the Level of Care Determination tool, which takes into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, and medication management).

North Dakota Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
North Dakota residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. The 2024 asset limit for a single applicant is $3,000, which means they must have $3,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash, and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for North Dakota ABD Medicaid for a single applicant is $1,094/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants in 2024, the asset limit for North Dakota’s ABD Medicaid is a combined $6,000, and the income limit is a combined $1,479/month. This applies to married couples with both spouses applying or with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for North Dakota ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While North Dakota has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Services Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through North Dakota ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How North Dakota Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

North Dakota Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in North Dakota and how you can protect your home from it, click here.

Applying For North Dakota Medicaid Long Term Care Programs

The first step in applying for North Dakota Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for North Dakota Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the North Dakota Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, North Dakota residents can apply for North Dakota Medicaid online. They can also download a Health Care Application for the Elderly and Disabled, complete it and submit it to their county’s Human Service Zone office.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a North Dakota Medicaid Nursing Home

After being approved for nursing home coverage through North Dakota Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. Even though North Dakota Medicaid nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do may not have any available spaces. Finding the right residence can be difficult, especially if you’re looking in a specific geographic area.

North Dakota has roughly 75 nursing homes that accept Medicaid. They are spread throughout the state, with just two noteworthy clusters around the biggest cities. There are 10 nursing homes within 25 miles of Fargo, and 10 more around Bismarck. After that, the choices narrow, even in the larger cities, with three nursing homes in the Minot area and two around Grand Forks.

TOOLS: To find and compare nursing homes, North Dakota residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. And you can find out more information about long term care in North Dakota using this Aging & Disability Resource Link.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence provide transportation? How does it handle dental and vision care? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data shows that nursing homes in North Dakota are well ahead of the pack in some key areas. North Dakota nursing homes averaged 16.7 health deficiencies during a three-year time period from 2019-2022, which was much better than the national average of 25.7. The gap was even wider in favor of North Dakota when it came to fire safety deficiencies: 4.8 vs. 13.5. And North Dakota nursing homes averaged 4.3 nurse staffing hours per resident per day during that three-year time period, while the national average was 3.7.