Medicaid for nursing home and home care in North Dakota

Who qualifies

You must be 65 or older, blind or disabled, live in North Dakota, and be screened as needing long-term care.

How income works

North Dakota has no single income cap for long-term care Medicaid. Instead, it looks at how much of your income must go toward your care:

• In a nursing home, you keep $118 a month for personal needs. After amounts set aside for a spouse or family at home, the rest of your income is your recipient liability, which you pay toward your care. Medicaid pays the rest.
• At home, if your countable income is above the medically needy level, you pay part of your medical costs each month first (your recipient liability). Then Medicaid pays. Ask your zone office how much of your income you would keep.

What counts and what does not

Countable assets include cash, bank accounts, stocks, bonds and other things you could turn into cash.

Your home usually does not count. But for nursing home care or home and community based services, your equity in the home must not be more than $752,000 if you apply in 2026. This limit does not apply if your spouse, a child under 21, or a blind or disabled child of any age lives in the home. Even if you are over it, you may still get other Medicaid benefits.

Giving things away. You cannot give assets away to qualify. A gift to your children may be a disqualifying transfer, which can delay Medicaid coverage for months or years. Extra assets must be spent on your needs.

Health insurance. You can keep private health coverage, such as a Medicare supplement, and still qualify.

What Medicaid pays for

Nursing home care

Medicaid pays the nursing home, a swing bed in a hospital, or the State Hospital, after your recipient liability. It can also cover qualifying medical bills from up to three months before the month you apply. Keep paying your bills while your application is being decided.

Medicaid Waiver for Home and Community Based Services

This waiver is for people 65 and over, and adults 18 to 64 with a physical disability, who need a nursing home level of care but want to stay at home. You must be on Medicaid. Services include:

• personal care, homemaker and chore help
• respite care for family caregivers
• home-delivered meals
• adult foster care and adult residential care
• non-medical rides with an escort, companionship and supervision
• care coordination

Spots are offered by the date you apply. The state says there is no wait list.

Other ways to get care at home

• SPED (Service Payments for the Elderly and Disabled): a state program for in-home help, based on your needs, income and assets. Your home and the first $50,000 of savings do not count. You may pay part on a sliding scale.
• Expanded SPED: for people on Medicaid with income no higher than the SSI payment who need help with tasks like meals, housework and medicines.
• PACE: for people 55 and over who need nursing home care, with sites in Bismarck, Dickinson, Fargo and Minot.

If your spouse stays at home

These rules apply when one spouse needs care expected to last at least 30 days in a row in a nursing home or through the home care waiver, and the other spouse is not on Medicaid.

The spouse needing care may keep up to $3,000 in countable assets. Assets are counted as of the first day of long-term care. You can ask for an assessment of your assets when care begins, even before you apply. The nursing home can ask for one too. Basic care facilities do not count for these spousal rules.

How to apply

1. Call first if you need advice. The Aging and Disability Resource LINK (1-855-462-5465) can explain options and connect you to in-home services.
2. Apply for Medicaid in one of these ways:
   • online at applyforhelp.nd.gov;
   • on paper with the Application for Assistance (SFN 405), returned to your Human Service Zone office or mailed to ND Health and Human Services, 600 E. Boulevard Ave., Dept. 325, Bismarck, ND 58505-0250;
   • by email to [email protected].
3. Have papers ready on income, bank accounts, property, insurance and anything you gave away. Your zone office will tell you what it needs.
4. Get the care assessment. For the waiver, a nursing home level of care must be confirmed.

Questions: Customer Support Center, (866) 614-6005 (TTY 711). Find your zone office at hhs.nd.gov/human-service/zones.

After you apply

• Report changes in income, assets or where you live to your zone office.
• Appeals: If you disagree with a decision, you have 30 days from the date the notice was mailed to ask for a fair hearing. For Medicaid you can ask by phone, in person, in writing or online, and your zone office must help you file. If you already get Medicaid and ask before the change takes effect (notices come at least 10 days ahead), your coverage continues until the hearing decision. If you lose, you may have to pay that back.

Things people miss

• Estate recovery: After death, North Dakota seeks repayment from the estate of members who were 55 or older or lived permanently in a nursing home. Nothing is collected while a spouse, a child under 21, or a blind or disabled child is living. Questions: 701-328-2310 or 1-800-472-2622.
• Basic care is different. A licensed basic care facility is not a nursing home. Ask about the Basic Care Assistance Program instead.
• Ask for the asset assessment early so the spouse at home knows what can be kept.

Free help

• Aging and Disability Resource LINK: 1-855-462-5465 (ND 711 for TTY), [email protected].
• SHIP (free Medicare counseling, ND Insurance Department): (888) 575-6611.
• Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov.

Read more about paying for a nursing home, Medicare and all benefits in North Dakota.

Phone numbers: Free help lines for North Dakota agencies

Check what you may qualify for