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

Last updated: January 03, 2024

 

North Dakota Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While there are many different coverage groups, this page is focused strictly on long-term care Medicaid eligibility for elderly North Dakota residents who are 65 years of age and older. 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 live at home. There are three categories of Medicaid long-term care programs for which North Dakota seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Care is provided only in nursing homes.

2) 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. More on Waivers.

3) Regular Medicaid / Aged, Blind, Disabled – An entitlement; 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.

While Medicaid is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The North Dakota Department of Human Services (DHS) is the administering agency.

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

 

Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying financial and medical eligibility requirements. Further complicating financial eligibility is that the criteria changes annually, varies with marital status, and that North Dakota offers multiple pathways towards eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
North Dakota seniors must have a financial and medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Nearly all of their income must be paid towards nursing home care 2) Assets under $3,000 3) Require a Nursing Home Level of Care.

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 of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in North Dakota. More.

2024 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 & $154,140 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $1,094 / month† $3,000 Nursing Home $1,479 / month† $6,000 Nursing Home $1,094 / month for applicant† $3,000 for applicant & $154,140 for non-applicant Nursing Home
Regular Medicaid / Aged, Blind, Disabled $1,094 / month $3,000 Help with ADLs $1,479 / month $6,000 Help with ADLs $1,479 / month $6,000 Help with ADLs
*All of a beneficiary’s monthly income, minus a Personal Needs Allowance of $100 / month ($200 / 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.

 

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. Examples include cash gifts, employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in ND, VA Aid and Attendance and Housebound benefits, which are above and beyond the Basic VA Pension, do not count as income.

Treatment of Income for a Couple
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 income eligibility of their applicant spouse. The non-applicant spouse, however, may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse to prevent spousal impoverishment.

In 2024, the MMNA in ND is $2,550 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred to them from their 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 MMNA / Spousal Income Allowance.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged, Blind, Disabled; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.

 

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable (non-exempt) assets are calculated towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), 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, irrevocable itemized burial contracts, and generally one’s primary home. In North Dakota, IRAs and 401Ks are also exempt if they are in “payout status”. This means that one is withdrawing their Required Minimum Distribution (RMD).

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. However, Spousal Impoverishment Rules permit the non-applicant spouse of an Institutional Medicaid or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2024, the community spouse (the non-applicant spouse) can retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s portion falls under $30,828, 100% of the assets, up to $30,828, can be retained by the non-applicant spouse. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
North Dakota has a 60-month Medicaid Look-Back Period that immediately precedes one’s Nursing Home Medicaid or Medicaid Waiver application date. During the “look back”, 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. The Look-Back Period does not apply to Regular Medicaid applicants.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

 

North Dakota Medicaid Home Exemption Rules

For the home to be exempt, the Medicaid applicant or their spouse must live in it. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While the 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.

 

Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. 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 (ADLs) is required, but a NFLOC is not necessarily required.

 

Qualifying When Over the Limits

For North Dakota elderly residents (aged 65 and over), who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – Seniors who have income over Medicaid’s income limit may still become income-eligible for Medicaid services if they have high medical bills relative to their income. “Medical bills” include health insurance costs, such as Medicare premiums, as well as transportation expenses for medical care, and bills for medical services. In 2024, the Medically Needy Income Limit (MNIL) in ND is $1,094 / month for an individual and $1,479 / 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 income-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 on non-countable ones to become asset-eligible. This can be done by making 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 this rule was not violated.

 Our Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and/ or “over-asset”, 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 protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.

 

Specific North Dakota Medicaid Programs

In addition to paying for nursing home care, North Dakota Medicaid offers the following programs relevant to the elderly that helps them to live at home and 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. While program participants must receive care assistance from a Qualified Service Provider (QSP), one can choose their QSP. Friends, and select relatives, can become a QSP and be hired to provide care.

2) Aged and Disabled Waiver – Also called the Medicaid Waiver for Home and Community Based Services, assistance is provided to seniors and adults with disabilities 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.

4) Money Follows the Person – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

 

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 form 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. The application process may vary based on the program for which one is applying.

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. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.

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