North Dakota Medicaid Home Care is the set of Medicaid programs that pay for care in a parent’s own home — or in assisted living — for someone who would otherwise qualify for a nursing home. This North Dakota medicaid home care guide names the program, gives the 2026 financial limits, explains the level-of-care test and the waitlist reality, and shows where the application starts.
The financial figures come from the state Medicaid agency and CMS and reset on their own calendars; where North Dakota has not published a figure we say so.
In This North Dakota Medicaid Home Care Guide:
North Dakota Medicaid Home Care at a Glance (2026)
| Program | North Dakota’s main program is officially called the Medicaid Waiver for Home and Community Based Services, administered by the Adult and Aging Services Division of North Dakota Health and Human Services; caseworkers and families commonly call it the HCBS waiver or the Aged and Disabled waiver. |
| 2026 income limit (single applicant) | No set limit; resident keeps $115/month, the rest goes to the cost of care |
| 2026 asset limit (single applicant) | $3,000 |
| Assisted living covered? | Partly — North Dakota covers services in some assisted living settings; ask Applications for Medicaid long-term care and HCBS waiver services go through the local Human Service Zone office, which is North Dakota’s county-level Health and Human Services office. which residences participate. |
| Waitlist | The HCBS waiver is not an entitlement. |
| PACE available? | YES. |
| Hire your own caregiver? | North Dakota uses a Qualified Service Provider model rather than a formally branded consumer-directed waiver. |
The North Dakota Program Behind North Dakota Medicaid Home Care
Nursing home Medicaid is an entitlement: anyone who qualifies gets it. Home-based care is different. North Dakota delivers it through a waiver or a managed long-term care program with its own name, its own enrollment rules and, in many states, a cap on how many people it serves.
The program North Dakota runs for people 65 and over is North Dakota’s main program is officially called the Medicaid Waiver for Home and Community Based Services, administered by the Adult and Aging Services Division of North Dakota Health and Human Services; caseworkers and families commonly call it the HCBS waiver or the Aged and Disabled waiver..
The HCBS waiver pays for hands-on help rather than housing. Covered services include waiver personal care, extended personal care, family personal care, homemaker, chore, supervision, companionship, adult day care, respite care, home delivered meals, emergency response systems, environmental modification of the home, specialized equipment and supplies, non-medical transportation, community transition services, transitional living, adult residential care, adult foster care and HCBS case management.
Room, board, rent, utilities and groceries are never paid by the waiver, so the family still covers ordinary living costs.
Who Qualifies for North Dakota Medicaid Home Care
Three tests, the same as a nursing home: a medical test, an income test and an asset test. North Dakota uses the nursing-facility level of care as the medical bar, which means the applicant needs hands-on help with daily activities or supervision because of dementia — not merely help with errands.
An applicant must be found to need a skilled nursing facility level of care. A Level of Care Determination form is completed by a nurse, and North Dakota HHS contracts with Maximus to make those skilled nursing facility level of care determinations.
Alongside that, an HCBS case manager employed by Health and Human Services in the regional Human Service Zones completes a functional assessment looking at activities of daily living such as bathing, dressing, eating, toileting and moving around, plus instrumental tasks like cooking, shopping and managing medications.
Financially, the applicant’s own income is measured against the North Dakota medicaid home care limit of No set limit; resident keeps $115/month, the rest goes to the cost of care, and countable assets against $3,000. The spouse who stays home is protected by the same spousal impoverishment rules that apply in a nursing home: up to $162,660 in assets in 2026 and a guaranteed income floor.
Waitlists and Enrollment Caps
The HCBS waiver is not an entitlement. The state’s own waiver documents explain that the number of participant enrollment slots is limited and that a waiting list for program participation forms once those slots are full, so approval is never automatic even for someone who clearly meets the level of care test.
North Dakota does not publish a current statewide wait time for older adults, and recent enrollment status is UNVERIFIED; a family should ask the Aging and Disability Resource LINK or their Human Service Zone what the position is today.
Two facts hold everywhere: applying for the waiver does not stop you from applying for nursing home Medicaid later, and the level-of-care assessment for one is usually accepted for the other.
What North Dakota Medicaid Home Care Pays For
Personal care (bathing, dressing, transfers), homemaker help, adult day programs, respite so the family caregiver can rest, home modifications such as ramps and grab bars, delivered meals, a personal emergency response button, and in many states assisted living services. It does not pay rent, a mortgage or groceries.
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Assisted living: Partly — North Dakota covers services in some assisted living settings; ask Applications for Medicaid long-term care and HCBS waiver services go through the local Human Service Zone office, which is North Dakota’s county-level Health and Human Services office. which residences participate.
PACE: YES. North Dakota Health and Human Services offers the Program of All-Inclusive Care for the Elderly to Medicaid members, and the state describes it as combining Medicare and Medicaid care under one interdisciplinary team so a person can stay at home instead of entering a nursing home.
Can a Family Member Be the Paid Caregiver?
North Dakota uses a Qualified Service Provider model rather than a formally branded consumer-directed waiver. The participant chooses their own provider from the state’s Qualified Service Provider list, and an individual — including certain relatives — may enroll as a Qualified Service Provider and be paid to deliver approved in-home services.
Whether a specific family member such as a spouse or a live-in adult child may be hired depends on the service authorized and is UNVERIFIED here; the Human Service Zone case manager confirms this in each case.
The full picture — who may be paid, how the pay is set and how to enroll — is in our companion guide to North Dakota family caregiver pay.
How to Apply for North Dakota Medicaid Home Care
Where: Applications for Medicaid long-term care and HCBS waiver services go through the local Human Service Zone office, which is North Dakota’s county-level Health and Human Services office. — start here.
Ask for two things on the first call: the functional assessment and a Medicaid financial application. Doing both at once shortens the timeline by weeks. Bring the same five years of financial records a nursing home application needs; the look-back rule applies to waivers too.
What Happens on Assessment Day
The assessment is a visit, usually at the parent’s home, by a nurse or social worker who walks through the day: getting out of bed, bathing, dressing, using the toilet, eating, moving from room to room, taking medication, and whether the person can be left alone safely. Answer for the worst day, not the best one. Families who describe a good morning talk their parent out of North Dakota medicaid home care without meaning to.
Bring the medication list, the diagnoses, recent hospital paperwork and any dementia evaluation. If a doctor has written that the person needs supervision or hands-on help, bring that letter; it is often the single document that tips the level-of-care decision.
The Care Plan That Follows
Approval produces a written care plan: which services, how many hours, and who delivers them. The plan is the budget. Hours outside it are not paid, and hours inside it that go unused are not banked. A plan can be revised when the parent’s condition changes — after a fall, a hospital stay or a new diagnosis — so keep the case manager’s number and call when something changes rather than waiting for the annual review.
Mistakes That Cost Families Months
- Waiting for the crisis. Waiver slots and assessments take weeks; the application should start when the family first notices the parent needs daily help.
- Giving money away first. The five-year look-back applies to the waiver as well as the nursing home, so a gift meant to “get under the limit” creates a penalty period instead.
- Spending the spouse’s protected share. Ask for the resource assessment before paying anything down.
- Assuming Medicare covers it. Medicare pays for short-term skilled care after a hospital stay, never for ongoing daily help. North Dakota Medicaid Home Care is the program that does.
Where to Get Help Free
Two free doors exist in every state: the North Dakota SHIP counselor for the Medicare side and the state’s Aging and Disability Resource Center for the Medicaid side. Neither sells anything. For a North Dakota medicaid home care question involving a house, a spouse at home or a recent gift, a local elder law attorney or legal aid office is the next call.
Key Takeaways: North Dakota Medicaid Home Care
- Same tests as a nursing home: North Dakota medicaid home care requires nursing-facility level of care plus the income and asset tests.
- Not an entitlement: North Dakota medicaid home care runs through a waiver that can have a waitlist, so apply before the crisis.
- The assessment travels: the level-of-care finding for North Dakota medicaid home care is usually accepted for nursing home coverage later.
- Room and board are never covered: North Dakota medicaid home care pays for care services, not rent, even in assisted living.
- Family can be the caregiver: most North Dakota medicaid home care programs let the participant hire and direct a relative.
- The look-back applies: gifts inside five years create a penalty period for North Dakota medicaid home care just as they do for a nursing home.
Official Sources
- North Dakota’s main program is officially called the Medicaid Waiver for Home and Community Based Services, administered by the Adult and Aging Services Division of North Dakota Health and Human Services; caseworkers and families commonly call it the HCBS waiver or the Aged and Disabled waiver.: https://www.hhs.nd.gov/adults-and-aging/homecare is the state’s Home and Community-Based Long Term Care page and the single best official starting point for North Dakota’s home care waiver. Two other official pages are worth keeping open: https://www.hhs.nd.gov/healthcare/medicaid/medicaid-waivers lists the state’s Medicaid waivers, and https://www.hhs.nd.gov/healthcare/medicaid/pace explains PACE. North Dakota also posts its detailed HCBS policy manual, Service Chapter 525-05, on the state website, which is where service definitions and provider rules are spelled out.
- Applications for Medicaid long-term care and HCBS waiver services go through the local Human Service Zone office, which is North Dakota’s county-level Health and Human Services office.
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This North Dakota medicaid home care guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.