North Dakota Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: March 28, 2022


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. Specifically, long term care Medicaid is covered. In addition to care services in nursing homes, adult foster care homes, and assisted living facilities, ND Medicaid pays for non-medical services and supports to help frail seniors remain living at home.

  The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.


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 varying financial and medical eligibility requirements, as well as benefits. Further complicating eligibility is 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; Anyone who is eligible will receive assistance. Care is provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – These are not entitlement programs; Waivers limit the number of program participants and wait 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. More on Waivers.

3) Regular Medicaid / Aged, Blind, Disabled – This is an entitlement program; If eligibility requirements are met, benefits can be received. Various long-term care services, such as personal care assistance or adult day care, may be available.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a North Dakota Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in North Dakota. More.

2022 North Dakota Medicaid Long Term Care Eligibility for Seniors
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* $3,000 Nursing Home No set limit* $6,000 Nursing Home No set limit* $3,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $940 / month (eff. 4/1/22 – 3/31/23)† $3,000 Nursing Home $1,267 / month (eff. 4/1/22 – 3/31/23)† $6,000 Nursing Home $940 / month (eff. 4/1/22 – 3/31/23)† $3,000 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Aged, Blind, Disabled $940 / month (eff. 4/1/22 – 3/31/23) $3,000 Help with ADLs $1,267 / month (eff. 4/1/22 – 3/31/23) $6,000 Help with ADLs $1,267 / month (eff. 4/1/22 – 3/31/23) $6,000 Help with ADLs
*All of a beneficiary’s monthly income, minus a personal needs allowance of $65.00 / month ($130 / month for a married couple with both spouses as Medicaid recipients), Medicare premiums, and potentially an income allowance for a non-applicant spouse, must be paid to the nursing home.

†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.


What Defines “Income”

Any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include cash gifts, employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Veteran’s benefits, with the exception of VA Aid and Attendance and Homebound benefits, also count as income. Holocaust restitution payments and Covid-19 stimulus checks are not considered income and do not impact Medicaid eligibility.

When just one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse does not impact the eligibility of the applicant spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse to prevent spousal impoverishment. In 2022, the MMMNA in ND is $2,550 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred from the applicant spouse to the non-applicant spouse to bring their income up to this level. A non-applicant spouse who already has a monthly income of $2,550 or more is not entitled to a MMMNA / spousal income allowance. Furthermore, if the non-applicant spouse has income over $2,550 / month, they will be asked to contribute towards their spouse’s long-term care costs.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged, Blind, Disabled; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. For more information on how Medicaid counts income, click here.


What Defines “Assets”

Countable (non-exempt) assets include cash and most anything that can easily be converted to cash to pay for long-term care. This includes stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. Medicaid also considers many asset to be exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, and irrevocable burial trusts. One’s primary home is also exempt, given the Medicaid applicant lives in the home or has intent to return, and in 2022, their home equity interest is not more than $636,000. Equity interest is the amount of the home’s value owned by the applicant. If a non-applicant spouse lives in the home, it is automatically exempt.

 While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s estate recovery program. Following a long-term care Medicaid beneficiary’s death, North Dakota’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, spousal impoverishment rules permit the non-applicant spouse of an Institutional Medicaid or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couple’s assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets falls under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant spouse.

North Dakota has a 60-month Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this period, Medicaid checks to ensure no assets were gifted or sold under fair market value. This includes gifts and asset transfers one’s non-applicant spouse may have made. If the look-back period has been violated, it is assumed it was done to meet Medicaid’s asset limit, and a penalty period of Medicaid ineligibility will be established.

 Non-Financial Eligibility Requirements – For North Dakota long-term care Medicaid eligibility, an applicant must have a functional need for assistance. For Institutional Medicaid and Medicaid Waivers, a nursing home level of care (NFLOC) is required. Furthermore, additional criteria may need to be met for some program benefits. For example, for a Waiver to cover the cost of home modifications, an inability to safely live at home without modifications may be necessary. For long-term care services via the Regular Medicaid program, a functional need with the activities of daily living is required, but a NFLOC is not necessarily required.


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 – Seniors who have income over Medicaid’s income limit may still be eligible for Medicaid services if they have high medical bills relative to their income. “Medical bills” includes health insurance costs, such as Medicare premiums, as well as transportation expenses for medical care, and bills for medical services. In 2022, the medically needy income limit (MNIL) in ND is $940 / month for an individual and $1,267 / month for a couple. Also called a “Spend-Down” Program, the amount that must be “spent down” on medical bills is called a “client share” or “recipient liability”. This amount is the difference between one’s monthly income and the MNIL. Once one has paid their client share for the month, they will be Medicaid-eligible for the remainder of the month. The medically needy asset limit is $3,000 for an individual and $6,000 for a couple.

2) Asset Spend Down – Persons who have countable assets over ND’s asset limit can “spend down” assets and become asset eligible. This can be done by spending excess assets on non-countable ones, such as home modifications (i.e., the addition of wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, yet they still can’t afford their cost of long-term care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible as well as to protect their home from Medicaid estate recovery. Read more or connect with a Medicaid planner.


Specific North Dakota Medicaid Programs

Like all states, North Dakota Medicaid pays for nursing home care for state residents who are medically and financially eligible for such care. ND Medicaid also offers Medicaid programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.

1) Medicaid State Plan Personal Care Services (MSP-PC) – An entitlement program, assistance with daily living activities are provided to those who need it. Benefits include aid with personal hygiene, mobility, shopping for essentials, meal preparation, and medication management. MSP-PC allows for consumer direction. This means program participants can hire the care provider of their choice, including select relatives.

2) Aged and Disabled Waiver – Also called the Medicaid Waiver for Home and Community Based Services, assistance is provided to seniors and disabled adults to promote independent living. Available services and supports may include personal care assistance, adult day care, home modifications, emergency response systems, meal delivery, and specialized medical equipment.

3) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental and eye care, may be available.


How to Apply for North Dakota Medicaid

North Dakota seniors can apply for Medicaid online or fill out a Health Care Application for the Elderly and Disabled and submit it to their county human service zone office (previously called county social service office). Alternatively, persons can contact their local human service zone office to request an application be mailed to their home. For questions or assistance, the Department of Human Services can be reached at 800-472-2622.

North Dakota Medicaid applicants should be certain that they meet all eligibility requirements prior to submitting an application for benefits. For persons over the income and / or asset limit(s), or are unsure if they meet eligibility requirements, Medicaid planning is strongly recommended. Furthermore, the application process can be complicated and specific documentation must be submitted along with the Medicaid application. For additional information about the application process for long-term care Medicaid, click here.


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