North Dakota Medicaid Definition
In North Dakota, Medicaid is administered by the North Dakota Department of Human Services (DHS) agency.
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are many different eligibility groups, this page is focused strictly on Medicaid eligibility for elderly North Dakota residents who are 65 years of age and older. This page will specifically cover long term care Medicaid, whether that is in one’s home, a nursing home, an adult foster care home, a memory care facility, or an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which North Dakota seniors may be eligible. These programs have slightly different financial and medical eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that North Dakota offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program, meaning anyone who is eligible will receive assistance. It is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Waivers limit the number of program participants. Therefore, wait lists may exist. Services are provided at home, adult day care, in adult foster care, in memory care facilities, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – This is an entitlement program, which means as long as one meets the eligibility requirements, services can be received. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an North Dakota Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in North Dakota. More.
|2019 North Dakota Medicaid Long Term Care Eligibility for Seniors (updated May 29, 2019)|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||No set limit. Applicant is allowed $65 for personal needs and the remaining income goes towards the cost of care.||$3,000||Nursing Home||No set limit. Couple is allowed $130 for personal needs. The remaining income goes towards the cost of care.||$6,000||Nursing Home||No set limit. Applicant is allowed $65 for personal needs and the remaining income goes towards the cost of care.||$3,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$864 / month||$3,000||Nursing Home||$1,170 / month||$6,000||Nursing Home||$864 / month for applicant||$3,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$864 / month||$3,000||None||$1,170/ month||$6,000||None||$864 / month||$3,000 for applicant||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include cash gifts, employment wages, Veteran’s benefits, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. That said, when just one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded and does not impact the eligibility of the applicant spouse. For more information on how Medicaid counts income, click here.
*As the above chart indicates, there is no set income limit for nursing home Medicaid, and a single nursing home Medicaid recipient is able to keep $65 ($130 for a married couple with both spouses as Medicaid recipients) as a personal needs allowance. Program participants are also able to keep enough income to pay for health insurance premiums. In addition, if applicable, there is what is called a Minimum Monthly Maintenance Needs Allowance (MMMNA) that may be deducted from an applicant spouse’s income for their non-applicant spouse.
The MMMNA is the minimum amount of monthly income to which a non-applicant spouse is entitled. As of 2019, this figure is $3,160.50 / month. Said another way, applicant spouses are able to allocate all of their income (or a portion of their income) to their non-applicant spouses to bring their income up to $3,160.50 / month. This rule is intended to ensure the non-applicant spouses have sufficient funds from which to live, while also effectively lowering the amount the applicant spouse must contribute to their cost of care. This rule is relevant for married couples with just one applicant spouse who is applying for nursing home Medicaid or a HCBS Medicaid Waiver.
What Defines “Assets”
Countable (non-exempt) assets include cash and most anything that can easily be converted to cash to be used to pay for the cost of long-term care. Other countable assets include stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $585,000 (in 2019).
For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain half of the couple’s joint assets, up to a maximum of $126,420, as shown on the chart above. That said, if a couple has $25,284 or less in resources, the non-applicant spouse can retain 100% of the couple’s assets. In Medicaid terminology, this is called the Community Spouse Resource Allowance (CSRA). As with the MMMNA, this rule applies to couples with just one spouse who requires a nursing home level of care either in a Medicaid funded nursing home residence or at home via a Medicaid waiver.
When considering assets, one should be aware that North Dakota has a Medicaid Look-Back Period, which is a period of 60 months that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. Please note, this also includes gifts, as well as asset transfers one’s non-applicant spouse may have made. If one is found to be in violation of the look-back period, a penalty period will be established and one will be ineligible for Medicaid for the duration of the penalty period.
Qualifying When Over the Limits
For North Dakota elderly residents (65 and over), who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In a nutshell, one may still be eligible for Medicaid services even if one is over the income limit if he or she has high enough medical bills, which includes health insurance costs, such as Medicare premiums, as well as transportation expenses for medical care, and bills for medical services. The way the Medically Needy Program, also sometimes referred to as a “Spend-Down” Program, works is one’s “excess income,” the income over the Medicaid eligibility limit, is used to pay one’s medical bills. (This may also be referred to as a “client share” or a “recipient liability”). Once one has paid down his or her excess income to the Medicaid eligibility limit, Medicaid will kick in for the remainder of the month. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid.
The Medically Needy Pathway, unfortunately, does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. As mentioned previously, when spending down assets, it’s important that one does not give away assets or sell them under market value. This is because in North Dakota, Medicaid has a “Look-Back” period of 60 months, and if one is found to be in violation, a period of Medicaid ineligibility will result.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, yet they are still unable to afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific North Dakota Medicaid Programs
1) State Plan Personal Care Services (MSP-PC) – an entitlement program, assistance with activities of daily living and instrumental activities of daily living are provided to those who need it. Benefits include aid with personal hygiene, mobility, shopping for essentials, meal preparation, medication management, etc. MSP-PC allows for consumer direction, meaning program participants can hire the care provider of their choice.
2) Aged and Disabled Waiver – also called the Medicaid Waiver for Home and Community Based Services, this program is intended as a nursing home diversion program. Assistance is provided to seniors and disabled adults to promote independent living via the following services: Personal care assistance, adult day care, home modifications, emergency response systems, meal delivery, and specialized medical equipment.