Overview of North Dakota Medicaid State Plan – Personal Care Services
North Dakota’s Medicaid State Plan – Personal Care Services, or MSP-PC, provides state residents who are elderly or disabled with in-home assistance. Intended to promote independent living, program participants receive assistance with completing their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These activities include bathing, dressing, toileting, mobility, light housework, meal preparation, eating, and laundry.
Program participants can live in their own home, that of a loved one, or an assisted living residence. They cannot reside in an adult foster care home and receive MSP-PC Services. However, North Dakota’s Home and Community Based Services Waiver does offer adult foster care services, including personal care assistance.
While many long-term care Medicaid programs allow program participants a self-directed / participant-directed option that enables them to hire, train, and manage their own caregivers, North Dakota’s MSP-PC does not. Instead, program participants receive care assistance from a Qualified Service Provider (QSP). MSP-PC does, however, allow program participants to choose an individual QSP. Friends and relatives, with the exception of a spouse or legal guardian, can become an individual QSP with ND’s Department of Human Services (DHS) and be paid to provide personal care services.
North Dakota Medicaid State Plan – Personal Care Services are available through the state’s Regular Medicaid program. MSP-PC Services are an entitlement. This means meeting the state’s Medicaid eligibility requirements guarantees one will receive this type of assistance; there is never a waiting list for program participation.
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. This means meeting the program’s eligibility requirements guarantees an applicant will receive benefits. HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they are filled, a waitlist for benefits forms. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of Medicaid State Plan – Personal Care Services
There are three levels of personal care services available via MSP-PC, and the maximum amount of assistance a program participant can receive is level-specific. The hours of assistance available per month per level is as follows: Level A (120), Level B (240), and Level C (300). The activities with which assistance can be provided include the following.
– Bathing
– Dressing / Undressing
– Eating
– Essential Shopping
– Laundry
– Light Housekeeping
– Maintaining Continence
– Meal Preparation
– Medication Assistance
– Mobility
– Money Management
– Personal Hygiene / Grooming (i.e., hair, nail, skin, and dental care)
– Telephone Use
– Toileting
– Transferring – i.e., from bed to standing
MSP – PC does not pay for room and board for program participants who reside in an assisted living residence.
Eligibility Requirements for North Dakota Medicaid State Plan – Personal Care Services
Medicaid State Plan – Personal Care Services are for North Dakota residents who require assistance with their daily living activities. The expected need for assistance must be greater than 30 days. Additional eligibility criteria follows and is relevant for seniors.
Financial Criteria: Income, Assets & Home Ownership
Income
Effective 4/1/24 – 3/31/25, the individual applicant income limit is $1,130 / month. For a married applicant, regardless of if one spouse or both are applicants, the income limit is $1,533 / month.
Assets
In 2024, the asset limit is $3,000 for a single applicant. For married couples, it is $6,000, regardless of whether one spouse or both are applicants.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Medicaid in ND considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a blind or disabled child of any age living in the home.
Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
The functional criteria for MSP–PC Services varies based on the coordinating level of personal care. Each of the three levels have their own functional eligibility criteria and are as follows.
Level A:
An applicant must require assistance with a minimum of one of the following Activities of Daily Living (ADLs): bathing, dressing, toileting, continence, transferring, inside mobility, or eating OR require assistance with a minimum of three of the following Instrumental Activities of Daily Living (IADLs): housework, laundry, meal preparation, taking medications.
Level B:
An applicant must require assistance with a minimum of one of the following Activities of Daily Living (ADLs): bathing, dressing, toileting, continence, transferring, inside mobility, or eating OR require assistance with a minimum of three of the following Instrumental Activities of Daily Living (IADLs): housework, laundry, meal preparation, taking medications. Furthermore, the applicant must require a Nursing Facility Level of Care (NFLOC). To determine if a NFLOC is met, a variety of factors are considered. This includes the need for medical care, such as injectable and intravenous medications, decubitus and statis ulcer care, extensive assistance with ADLs, and monitoring and assistance due to deterioration associated with Alzheimer’s disease or a related dementia. A diagnosis of dementia does not mean one will automatically meet the level of care need.
Level C:
An applicant must require assistance with a minimum of five of the following Activities of Daily Living: bathing, dressing, toileting, continence, transferring, inside mobility, or eating. The applicant must also require a Nursing Facility Level of Care. To make a NFLOC determination, a number of factors are considered. This includes the need for medical care, such as injectable and intravenous medications, decubitus and statis ulcer care, extensive assistance with ADLs, and monitoring and assistance due to deterioration associated with Alzheimer’s disease or a related dementia. A dementia diagnosis does not mean the level of care need will automatically be met.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for ND Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
North Dakota has a Medically Needy Pathway to eligibility for Medicaid applicants who have high medical expenses relative to their income. Also known as a Spend-Down Program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit. The amount that must be “spent down” can be thought of as a deductible. Once one’s “deductible” has been met, Medicaid State Plan – Personal Care services will pay for assistance for the remainder of the spend down period.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons may also choose to “spend down” countable assets on ones that are exempt (non-countable). Examples include making home reparations and modifications, purchasing home furnishings, and even taking a vacation. Persons may also turn countable assets into an income stream through a Medicaid-Compliant Annuity. There are many other planning strategies available when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in North Dakota to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for North Dakota Medicaid State Plan – Personal Care Services
Before You Apply
Prior to submitting an application for Medicaid State Plan – Personal Care Services, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Application Process
To be eligible for MSP-PC Services, one must be eligible for ND Medicaid. Persons can apply online or by contacting their local Human Service Zone (previously County Social Services) for a paper application. Furthermore, a Health Care Application for the Elderly and Disabled form can be downloaded from this webpage. For persons who want or require application assistance, ND Navigators are available for free assistance by calling 1-800-233-1737.
Although not intended for a consumer audience, additional information can be found here. Persons can also contact the Aging and Disability Resource Link at 855-462-5465 or their local Human Service Zone.
North Dakota’s Medicaid State Plan – Personal Care Services is administered by the North Dakota Department of Human Services’ Aging Services Division.
Approval Process & Timing
The North Dakota Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.