North Dakota Medicaid for seniors and long-term care

Last verified: June 2026

Long-term care options covered by North Dakota Medicaid

North Dakota Medicaid covers both institutional long-term care and home and community-based alternatives. Per ND HHS, long-term care coverage is for people who "need support for a disability or chronic illness that limits their ability to do daily tasks." This care can be short-term after a hospital stay or long-term for ongoing conditions.

• Skilled nursing facility (nursing home) care
• Basic Care facilities — state-funded residential care for people who need help but don't qualify for nursing home level of care
• Memory care facility coverage
• Home and Community-Based Services (HCBS) waiver — for adults 65+ or ages 18–64 with a physical disability
• Personal care assistance at home
• Housekeeping, meal preparation, and daily living support
• Respite care for family caregivers
• Non-medical transportation (grocery, pharmacy)
• Hospice care

Source: ND HHS Medicaid eligibility page (hhs.nd.gov/healthcare/medicaid/eligibility); ND HHS long-term care program descriptions.

North Dakota Basic Care Assistance Program

North Dakota's Basic Care Assistance Program (BCAP) is a state-funded benefit that fills a gap in Medicaid long-term care. Medicaid covers nursing facility care for people who need a high level of medical assistance. BCAP covers residential care for people who need help with daily tasks but don't meet the nursing facility level of care standard.

BCAP operates separately from federal Medicaid — it uses state funds and has its own eligibility rules. It serves people in licensed basic care facilities (assisted living settings) across North Dakota. Contact ND HHS or your local Human Service Zone office for BCAP eligibility details. Few other states have an equivalent program, making this a meaningful protection for North Dakota seniors who fall between independent living and nursing home care.

Financial eligibility for North Dakota long-term care Medicaid

Source: ND HHS Medicaid eligibility page; federal spousal impoverishment protections (42 U.S.C. § 1396r-5). Exempt assets include the home, one vehicle, household furnishings, irrevocable burial plans. Consult a North Dakota elder law attorney before making asset transfers.

North Dakota Medicaid estate recovery

North Dakota HHS operates an estate recovery program for Medicaid members who received long-term care services at age 55 or older, per the ND Medicaid Estate Recovery page at hhs.nd.gov. The program may seek reimbursement from the member's estate after death. The home is exempt while a surviving spouse or dependent child lives in it. North Dakota enforces the 60-month (5-year) lookback period for asset transfers. Anyone planning to apply for long-term care Medicaid should consult a North Dakota elder law attorney before making asset transfers.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. North Dakota's share of that population is administered through North Dakota Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

North Dakota Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, North Dakota may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether North Dakota uses this approach with North Dakota Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through North Dakota Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact North Dakota Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult North Dakota Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. North Dakota's current CSRA is set by North Dakota Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments