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

Last updated: April 05, 2021


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.

  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 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, adult foster care, memory care facilities, or 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.

April 1, 2021 – March 31, 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. 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 and / or a monthly spousal income allowance for the non-applicant spouse. $3,000 for applicant & $130,380
for non-applicant
Nursing Home
Medicaid Waivers / Home and Community Based Services $891 / month $3,000 Nursing Home $1,205 / month $6,000 Nursing Home $891 / month for applicant $3,000 for applicant & $130,380
for non-applicant
Nursing Home
Regular Medicaid / Aged Blind and Disabled $891 / month $3,000 None $1,205 / month $6,000 None $1,205 / month $6,000 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. Covid-19 stimulus checks are an exception, as Medicaid does not count them as income. Therefore, they do not impact Medicaid eligibility.

When just one spouse of a married couple is applying for institutional Medicaid or home and community based services via a Medicaid waiver, 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 Regular Medicaid, a couple’s income is considered jointly, regardless of if one, or both, spouses are applying for benefits. This means the income of the non-applicant spouse impacts the income 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 intended to ensure the non-applicant spouse has sufficient funds from which to live, while also effectively lowering the amount the applicant spouse must contribute to their cost of care. This spousal income allowance is not just relevant for non-applicant spouses of nursing home Medicaid applicants, but also for non-applicant spouses of those who are applying for a HCBS Medicaid waiver. The MMMNA is the minimum amount of monthly income to which a non-applicant spouse is entitled. As of 2021, this figure is $2,550 / 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 $2,550 / month. This rule is not relevant for married couples with one spouse applying for regular Medicaid.

*Although many states update their income limits at the beginning of each year, the state of North Dakota increases their income limits annually in April.


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 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. 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, and irrevocable burial trusts. One’s primary home is also exempt, given the Medicaid applicant lives in the home or “intends” to live it in, and his / her home equity interest is under $603,000 (in 2021). (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 exempt regardless of where the applicant spouse lives and his / her home equity interest.

For married couples, in 2021, the community spouse (the non-applicant spouse of a nursing home Medicaid applicant or a HCBS waiver applicant) can retain half of the couple’s joint assets, up to a maximum of $130,380, as shown on the chart above. There is also a minimum asset allowance, which allows the non-applicant spouse to retain 100% of the couple’s joint assets, up to $26,076. In Medicaid terminology, this is called the Community Spouse Resource Allowance (CSRA). As with the MMMNA, this rule does not apply to couples with just one spouse applying for Regular Medicaid.

When considering assets, one should be aware that North Dakota has a Medicaid Look-Back Period, which is 60 months that immediately precedes 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.

 For North Dakota long-term care Medicaid eligibility, an applicant must have a functional need for assistance. This most commonly means one must require a nursing home level of care. Furthermore, additional criteria may need to be met for some program benefits. For example, for home modifications via a HCBS Medicaid Waiver, an inability to safely and independently living at home without modifications might be 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 – One may still be eligible for Medicaid services even if over the income limit if he or she has high medical bills relative to income. “Medical bills” includes health insurance costs, such as Medicare premiums, as well as transportation expenses for medical care, and bills for medical services. The Medically Needy Program is sometimes called a “Spend-Down” Program. Via this program, one’s “excess income,” the income over the Medicaid eligibility limit, is used to pay one’s medical bills. The amount that must be paid may be called a “client share” or “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 reducing countable assets. However, one can “spend down” assets 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.

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 and to protect their home from Medicaid estate recovery.
Read more or connect with a Medicaid planner.


Specific North Dakota Medicaid Programs

1) Medicaid 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. 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, 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.


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 the social service office in their county. Alternatively, persons can contact their local social service office to request an application be mailed to their home. For questions or assistance, seniors can also contact the Department of Human Services at 800-472-2622.

North Dakota Medicaid applicants should be certain that they meet all eligibility requirements (covered in detail above) prior to submitting an application for benefits. For persons over the income and / or asset limit(s), or are unsure where they stand as far as meeting the eligibility requirements, Medicaid planning is strongly recommended. In addition, the application process can be quite 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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