North Dakota Medicaid for Seniors & Long-Term Care

Updated August 2026

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.

$3,000

Individual asset limit

BCAP

State-funded Basic Care Assistance Program

60 months

Asset transfer lookback period

North Dakota's Basic Care Assistance Program (BCAP) fills the gap between independent living and nursing home care

BCAP is a state-funded benefit, separate from federal Medicaid, that covers residential care in licensed basic care (assisted living) facilities for people who need help with daily tasks but don't meet the nursing facility level of care standard that Medicaid requires. It uses state funds and has its own eligibility rules. Few other states have an equivalent program, making this a meaningful protection for North Dakota seniors. Contact ND HHS or your local Human Service Zone office for BCAP eligibility details.

Long-term care options covered by North Dakota Medicaid

Long-term care Medicaid in North Dakota is administered through ND HHS and requires a nursing facility level-of-care assessment. Apply through your local Human Service Zone office or call 1-800-755-2604. Use the LTC application checklist at hhs.nd.gov before submitting — it lists required documentation.

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

Financial eligibility for North Dakota long-term care Medicaid

The individual asset limit for North Dakota long-term care Medicaid is $3,000, and the couple asset limit is $6,000. Exempt assets include the home, one vehicle, household furnishings, and irrevocable burial plans.

Individual asset limit: $3,000
Couple asset limit: $6,000
Community spouse minimum resource protection (CSRA): approximately $32,532 (2026 federal floor)
Community spouse maximum resource protection (CSRA): approximately $162,660 (2026 federal cap)
Community spouse income allowance: North Dakota sets this at the federal minimum, about $2,705/month as of July 2026, rather than the higher amount some states allow
Asset lookback period: 60 months (5 years)

North Dakota is one of a small number of "209(b) states," meaning it does not use a flat income cap for long-term care Medicaid the way most states do. Instead, an applicant whose income is above the state's aged, blind, and disabled income level can still qualify by spending down their excess income on incurred medical and care costs — paying a monthly "client share" — rather than being required to use a Miller Trust (qualified income trust) to get under a hard ceiling.

North Dakota enforces a 60-month (5-year) asset transfer lookback period. Consult a North Dakota elder law attorney before making asset transfers.

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 is about $115/month in North Dakota, well above the $30/month federal minimum. Medicaid covers the gap. Because North Dakota is a 209(b) spend-down state rather than an income-cap state, most residents with income above the state's income level qualify by incurring medical and care costs to spend down to that level, rather than by using a Miller Trust.

Spousal protections and estate recovery

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income, the minimum monthly maintenance needs allowance (MMMNA). The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility.

North Dakota HHS operates an estate recovery program for Medicaid members who received long-term care services at age 55 or older. 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 described above. Anyone planning to apply for long-term care Medicaid should consult a North Dakota elder law attorney before making asset transfers.

What long-term care Medicaid typically covers

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact North Dakota Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

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