Medicaid Long-Term Care Guide in North Dakota
Long-term care eligibility, benefits, and how to apply through the North Dakota Department of Human Services (DHS).
What makes North Dakota Medicaid different
Medicaid in North Dakota is jointly funded by the state and federal government but administered by the state under federally set parameters. The DHS is the administering agency. In addition to nursing home care, ND Medicaid pays for services in adult foster care homes, assisted living facilities, and non-medical supports to help frail seniors live at home.
Administered by the North Dakota Department of Human Services (DHS).
Program Types
Institutional / Nursing Home Medicaid
An entitlement; anyone who is eligible will receive assistance. Care is provided in Medicaid-certified nursing homes.
Level of care: Nursing Home
Medicaid Waivers / Home and Community Based Services (HCBS)
Not an entitlement; the number of program participants is limited and waiting lists may exist. Intended to delay nursing home admissions, benefits are provided at home, adult day care, adult foster care, memory care facilities, or assisted living.
Level of care: Nursing Home
Regular Medicaid / Aged, Blind, Disabled
An entitlement; if eligibility requirements are met, benefits can be received. While Regular Medicaid is not Long-Term Care Medicaid, some long-term care services, such as personal care assistance or adult day care, may be available.
Level of care: Help with ADLs
2026 North Dakota Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid*
Medicaid Waivers / Home and Community Based Services†
Regular Medicaid / Aged, Blind, Disabled
*All of a beneficiary's monthly income, minus a Personal Needs Allowance of $115 / month ($230 / month for a married couple with both spouses as Medicaid recipients), Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.
Explore North Dakota Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to North Dakota.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — North Dakota
How the main LTC programs available in North Dakota compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $15–18/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in North Dakota | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
North Dakota Medicaid programs
HCBS
Family Personal Care
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in North Dakota
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in North DakotaHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: DHS · nd.gov/dhs/services/medicalserv
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in North Dakota
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in North Dakota. The process typically takes 45–90 days from application to first paycheck.
Apply in North Dakota: DHS · nd.gov/dhs/services/medicalserv
Medicaid Eligibility Screener — North Dakota
Answer 7 quick questions — we'll check the financial and care requirements for North Dakota and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly any income from any source is counted, including cash gifts, employment wages, alimony, pension payments, SSDI, SSI, IRA withdrawals, and stock dividends.
- Nationally, Holocaust restitution payments are not counted as income.
- In ND, VA Aid and Attendance and Housebound benefits, which are above and beyond the Basic VA Pension, do not count.
- When only one spouse applies for Institutional Medicaid or a Waiver, only the applicant's income is counted.
- The MMNA is $2,644 (eff. 7/1/25 – 6/30/26). If a non-applicant spouse's income is under this amount, income can be transferred from the applicant spouse.
- A non-applicant spouse with income of $2,644 / month or more is not entitled to a MMNA / Spousal Income Allowance.
- For Regular Medicaid, both spouses' income is counted. There is no MMNA for a non-applicant spouse.
- Countable assets include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside.
- In North Dakota, IRAs and 401Ks are exempt if in 'payout status' — meaning one's Required Minimum Distribution (RMD) is being withdrawn.
- Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, irrevocable itemized burial contracts, and generally one's primary home.
- All assets of a married couple are considered jointly owned regardless of the Medicaid program.
- The CSRA allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660 (2026). If the non-applicant's portion is under $32,532, up to $32,532 can be retained.
- There is no CSRA for Regular Medicaid.
- The home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.
- If this is not the case, there is a home equity interest limit of $730,000 (in 2026).
- Home equity is the value of the home minus any outstanding debt. Equity interest is the amount of equity owned by the applicant.
- If neither the applicant nor qualifying family live in the home, the applicant must have Intent to Return.
- There is no home equity interest limit for Regular Medicaid.
- The home is NOT exempt from Medicaid's Estate Recovery Program. After a beneficiary's death, North Dakota's Medicaid agency attempts reimbursement of care costs through the deceased's estate.
- North Dakota has a 60-month Look-Back Period for Nursing Home Medicaid and Medicaid Waiver applications.
- Medicaid checks all asset transfers, including those by a non-applicant spouse, to ensure none were gifted or sold under fair market value.
- Violations result in a Penalty Period of Medicaid ineligibility.
- The Look-Back Period does not apply to Regular Medicaid.
- The U.S. Federal Gift Tax Rule ($19,000 per recipient in 2026) does not extend to Medicaid eligibility — gifting under this rule violates the Look-Back Period.
- MMMNA: $2,644 · CSRA: $162,660 · CSRA Min: $32,532
- When only one spouse applies for Institutional Medicaid or a Waiver, only the applicant's income is counted.
- The MMNA is $2,644 (eff. 7/1/25 – 6/30/26). Income can be transferred from the applicant spouse if the non-applicant's income is below this level.
- A non-applicant spouse with income of $2,644 / month or more is not entitled to a Spousal Income Allowance.
- The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (min $32,532) in 2026.
- For Regular Medicaid, both spouses' income is counted and there is no MMNA or CSRA.
- Medically Needy Pathway — North Dakota has a Spend-Down Program. The MNIL is $1,174 / month for an individual and $1,587 / month for a couple (eff. 4/1/25). The 'client share' or 'recipient liability' is the difference between income and the MNIL. Medical expenses (health insurance costs, Medicare premiums, transportation for medical care, medical service bills) can be used. Once the client share is met, one is Medicaid-eligible for the remainder of the month. The medically needy asset limit is $3,000 (individual) and $6,000 (couple).
- Asset Spend-Down — Spend excess assets on non-countable items such as home modifications (wheelchair ramps, stair lifts), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof the Look-Back Rule was not violated.
- Medicaid Planning — Work with a Medicaid Planning Professional to employ strategies to become eligible and protect your home from Medicaid's Estate Recovery Program.
North Dakota does not use Qualified Income Trusts (Miller Trusts). The Medically Needy / Spend-Down program is available for persons over the income limit. Notably, Nursing Home Medicaid has no set income limit — nearly all income goes towards care costs as a Patient Liability.
North Dakota Medicaid Programs
Medicaid State Plan Personal Care Services (MSP-PC)
An entitlement program providing assistance with daily living activities including personal hygiene, mobility, shopping for essentials, meal preparation, and medication management. Program participants must receive care from a Qualified Service Provider (QSP), but can choose their QSP. Friends and select relatives can become a QSP and be hired to provide care.
Aged and Disabled Waiver
Also called the Medicaid Waiver for Home and Community Based Services. Provides assistance to seniors and adults with disabilities to promote independent living. Services may include personal care assistance, adult day care, home modifications, emergency response systems, meal delivery, and specialized medical equipment.
Program of All-Inclusive Care for the Elderly (PACE)
Combines the benefits of Medicaid, including long-term care, and Medicare into a single program. Additional benefits, such as dental and eye care, may be available.
Money Follows the Person
A federal program that helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
How to Apply
- Apply online at the North Dakota Medicaid portal
- Fill out a Health Care Application for the Elderly and Disabled and submit to a County Human Service Zone office
- Contact a local Human Service Zone office to request a mailed application
- Call the Department of Human Services at 1-866-614-6005 for questions or assistance
Applicants should be certain they meet all eligibility requirements prior to applying. For persons over the income and/or asset limits, or unsure of eligibility, Medicaid Planning is strongly recommended.
More North Dakota Long-Term Care Resources
Take the Next Step for North Dakota Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- North Dakota Department of Human Services (DHS) — North Dakota Medicaid — Official site