North Dakota Nursing Home Medicaid pays for a nursing home once Medicare’s short rehabilitation benefit runs out — but only after the family clears an income test, an asset test and a level-of-care assessment. This North Dakota nursing home medicaid guide gives the 2026 figures, what the spouse at home is allowed to keep, how the five-year look-back works, and where in North Dakota the application actually goes.
Every dollar figure below comes from the state Medicaid agency, CMS or the statute cited, and each resets on its own calendar. Where North Dakota has not published a current figure we say so instead of guessing.
In This North Dakota Nursing Home Medicaid Guide:
North Dakota Nursing Home Medicaid at a Glance (2026)
| Program | North Dakota does not give nursing-home Medicaid a separate brand name. The state agency, North Dakota Health and Human Services, simply calls it ND Medicaid coverage of nursing facility services, and its own pages group it under “Medicaid Long Term Care Services.” Families and facility staff often say “long-term care Medicaid” or “LTC Medicaid,” but on paper it is regular North Dakota Medicaid with a nursing facility level of care determination attached. There is no separate application program to enroll in. |
| 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 |
| Spouse at home may keep (assets) | $32,532 to $162,660 |
| Spouse at home income floor | $2,705 to $4,066.50 per month |
| Look-back period | 60 months |
| Penalty divisor | not published here yet — confirm with Applications are taken by the local Human Service Zone office, the offices that replaced county social services, working under North Dakota Health and Human Services. The published Customer Support Center numbers are (866) 614-6005 and 701-328-1000, with 711 for TTY, and you may request a paper application by mail through that line or through the zone office. Free application help is also published through ND Navigators at 1-800-233-1737. The zone office keeps your case and issues the decision notice. |
| Home equity limit (no spouse at home) | $752,000 (confirm with Applications are taken by the local Human Service Zone office, the offices that replaced county social services, working under North Dakota Health and Human Services. The published Customer Support Center numbers are (866) 614-6005 and 701-328-1000, with 711 for TTY, and you may request a paper application by mail through that line or through the zone office. Free application help is also published through ND Navigators at 1-800-233-1737. The zone office keeps your case and issues the decision notice.) |
| Over the income limit? | Medically-needy spend-down — no Miller trust |
North Dakota Nursing Home Medicaid Income and Asset Limits
Two tests, both applied to the person entering the facility. The income test looks at gross monthly income from every source — Social Security, pensions, IRA withdrawals, annuities, rent. The asset test counts what can be turned into cash: bank accounts, investments, retirement accounts in most states, and any property other than the home.
North Dakota is a medically-needy state. Being over the North Dakota nursing home medicaid income figure does not end the application: the excess is spent down on the cost of care each month, and the nursing home bill itself usually absorbs it. No Miller trust is needed.
North Dakota’s excluded asset policy protects money from the sale of an excluded home when it is set aside to buy another home, but only for a limited window. Irrevocable itemized funeral contracts, pre-need funeral prepayments placed in such a contract, and a burial plot for each family member are excluded, and a burial fund set up at application can reach back to earlier months.
Watch a state quirk: markers, monuments and vaults bought separately from an irrevocable funeral contract are counted. Vehicle and personal-item exclusions: UNVERIFIED.
North Dakota does not appear to run a qualified income trust or Miller trust system. Instead the state uses a medically needy structure the agency calls recipient liability: the amount is based on the difference between the household’s monthly net income and the Medicaid income level, and that share is applied toward the cost of care.
Certain medical costs the person must pay, such as health insurance and Medicare premiums, can reduce that liability if proof is given to the Human Service Zone. Any trust requirement for over-income applicants: UNVERIFIED.
What the Spouse at Home Keeps Under North Dakota Nursing Home Medicaid
Federal spousal impoverishment rules stop North Dakota nursing home medicaid from bankrupting the husband or wife who stays home. The at-home spouse keeps a protected share of the couple’s assets — between $32,532 and $162,660 in 2026 — and is guaranteed a monthly income floor of at least $2,705, rising to $4,066.50 when housing costs are high. The house is fully exempt while the spouse lives in it.
North Dakota follows the federal spousal impoverishment framework, which the state describes as making sure the spouse staying home can live with independence and dignity. Two North Dakota specifics matter. The state publishes an asset assessment process and fact sheet for long-term care couples, and families should ask the Human Service Zone to complete that assessment.
Also, the income allowance for a community spouse who is not on Medicaid can be set higher than the standard figure if a court or a hearing officer orders it.
The asset snapshot is taken on the first day of the continuous stay, not the application date. Families who spend down before asking for a resource assessment often spend money the spouse was entitled to keep.
The Look-Back Rule and Transfer Penalties
North Dakota reviews every transfer made in the 60 months before the application. Money or property given away, or sold for less than it was worth, is added up and divided by the state’s penalty divisor — its average private-pay nursing home cost — to produce a period during which North Dakota nursing home medicaid will not pay.
The divisor in North Dakota is not published here yet — confirm with Applications are taken by the local Human Service Zone office, the offices that replaced county social services, working under North Dakota Health and Human Services. The published Customer Support Center numbers are (866) 614-6005 and 701-328-1000, with 711 for TTY, and you may request a paper application by mail through that line or through the zone office. Free application help is also published through ND Navigators at 1-800-233-1737.
The zone office keeps your case and issues the decision notice..
60 months, federal standard. The IRS annual gift exclusion has no bearing here: a gift that is tax-free can still trigger a Medicaid penalty. Transfers to a spouse, to a disabled child, or of the home to a child who lived there and provided care for two years are the main exceptions.
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How to Apply for North Dakota Nursing Home Medicaid
Where: Applications are taken by the local Human Service Zone office, the offices that replaced county social services, working under North Dakota Health and Human Services. The published Customer Support Center numbers are (866) 614-6005 and 701-328-1000, with 711 for TTY, and you may request a paper application by mail through that line or through the zone office. Free application help is also published through ND Navigators at 1-800-233-1737. The zone office keeps your case and issues the decision notice. — start the application.
North Dakota requires a nursing facility level of care determination, called NFLoC, in addition to the financial decision. The state contracts this out: Maximus performs the level of care determination and reports approvals to the HHS Adult and Aging Services division. The review looks at whether the person genuinely needs the kind of nursing care a facility provides, weighing activities of daily living and instrumental activities of daily living.
Once someone is living in the facility, the facility itself completes the continuing assessments using the Minimum Data Set.
Bring five years of bank statements, deeds, vehicle titles, insurance policies, the Medicare and Social Security cards, and any trust or power of attorney documents. Missing paperwork is the most common reason a North Dakota nursing home medicaid decision is delayed.
While the Application Is Pending
North Dakota allows retroactive eligibility for calendar months before the month the signed application was received, so care already given can sometimes be covered once the case is approved. Because of that, the nursing facility usually admits and bills while the case is pending, and the family pays what the resident can toward the bill in the meantime.
The eligibility worker in the Human Service Zone issues a written decision notice when the case is finished. Typical decision time in weeks: UNVERIFIED.
After approval, nearly all of the resident’s income goes to the facility each month as the patient share, minus a small personal needs allowance, health insurance premiums and the spouse’s allowance.
Denials, Appeals and What Comes After
North Dakota Health and Human Services does not publish a ranked list of the most common denial or delay reasons, so that specific claim is UNVERIFIED. What is documented is the remedy.
An applicant or recipient has the right to request a fair hearing in writing whenever they disagree with an action affecting eligibility or benefit level, and the request may be made by telephone, internet, mail, in person, or other common electronic means. The Human Service Zone completes SFN 162, Request for Hearing; using or signing that form is not required.
One more thing families should know before they file: after the resident’s death, the state may seek repayment from the estate. That process — what it can reach and the exemptions — is covered in our guide to North Dakota Medicaid estate recovery.
A Realistic North Dakota Nursing Home Medicaid Timeline
Week one: the hospital or family calls the Medicaid office for the level-of-care assessment and starts gathering five years of statements. Weeks two to four: the assessment is done and the financial application is filed, usually with the facility’s admissions office helping. Weeks six to twelve: the caseworker verifies accounts and may ask for more documents; answer within the deadline on each request or the clock resets.
Approval, when it comes, is retroactive to the eligibility date, which is why filing early is the single most valuable thing a family can do.
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 nursing home medicaid 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 Nursing Home Medicaid
- Two tests, not one: North Dakota nursing home medicaid checks income and assets separately, and passing one does not excuse the other.
- The spouse is protected: the at-home spouse keeps a share of assets and an income floor under North Dakota nursing home medicaid before anything is spent down.
- The look-back is five years: any gift inside it is divided by the divisor and becomes months without North Dakota nursing home medicaid coverage.
- The home usually does not count: while a spouse lives there, the house is exempt from the North Dakota nursing home medicaid asset test.
- Apply as Medicaid pending: most facilities admit while North Dakota nursing home medicaid is decided and the state pays back to the eligibility date.
- Assessment first: the level-of-care evaluation is what starts the North Dakota nursing home medicaid clock, so request it on day one.
- Retirement accounts often count: IRAs and 401(k)s are countable in most states under North Dakota nursing home medicaid unless in payout status.
- Income trust or spend-down: whether an over-income applicant needs a Miller trust is the first North Dakota nursing home medicaid question to settle.
Official Sources
- North Dakota does not give nursing-home Medicaid a separate brand name. The state agency, North Dakota Health and Human Services, simply calls it ND Medicaid coverage of nursing facility services, and its own pages group it under “Medicaid Long Term Care Services.” Families and facility staff often say “long-term care Medicaid” or “LTC Medicaid,” but on paper it is regular North Dakota Medicaid with a nursing facility level of care determination attached. There is no separate application program to enroll in. — North Dakota Medicaid: https://www.hhs.nd.gov/healthcare/medicaid/eligibility
- Applications are taken by the local Human Service Zone office, the offices that replaced county social services, working under North Dakota Health and Human Services. The published Customer Support Center numbers are (866) 614-6005 and 701-328-1000, with 711 for TTY, and you may request a paper application by mail through that line or through the zone office. Free application help is also published through ND Navigators at 1-800-233-1737. The zone office keeps your case and issues the decision notice.: https://www.hhs.nd.gov/healthcare/medicaid/apply (the form itself, SFN 958, Medicaid Application for the Elderly and Disabled, downloads from https://www.nd.gov/eforms/doc/sfn00958.pdf)
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This North Dakota nursing home medicaid 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.