Elder Care Index

What Medicaid Actually Covers for Senior Care

North Dakota offers several Medicaid programs that can help with the costs of senior care. When thinking about long-term care, you'll primarily encounter Nursing Home Medicaid, the Home and Community Based Services (HCBS) Waiver, and Aged, Blind, and Disabled (ABD) Medicaid.

Nursing Home Medicaid is designed to cover nearly all costs associated with long-term care in a Medicaid-certified nursing home. This means it pays for room and board, personal care assistance with daily activities like bathing and dressing, skilled nursing, doctor visits, prescription medications, and even mental health counseling.

If your loved one prefers to stay at home or in a community setting, the HCBS Waiver, often called the Aged and Disabled Waiver, is key. This program provides services like personal care, adult day health care, home modifications for safety, transportation, homemaker services, and emergency response systems. A unique feature in North Dakota is that certain family members, including spouses, can even be paid to provide care through this waiver if they enroll as a Qualified Service Provider. Unlike Nursing Home Medicaid, the HCBS Waiver generally doesn't cover room and board costs in assisted living or adult foster care settings.

Aged, Blind, and Disabled (ABD) Medicaid primarily offers general healthcare coverage, including doctor visits and prescription drugs, but it can also cover some long-term care services such as personal care assistance. For a comprehensive approach, the Program of All-Inclusive Care for the Elderly (PACE) is available for those aged 55 or older who need a nursing facility level of care but live in the community, coordinating all their medical, social, and long-term care needs.

Do You Qualify?

Navigating Medicaid eligibility can feel like a puzzle, but here’s the real picture for North Dakota in 2026. For a single senior applying for the HCBS Waiver or ABD Medicaid, the monthly income limit is generally $1,174. If both spouses are applying, their combined income limit is $1,587/month. For Nursing Home Medicaid, there isn't a strict income cap, but almost all of your parent's income, beyond a personal needs allowance of $115/month and certain other deductions, will go towards their care costs.

The asset limit for a single applicant across most long-term care Medicaid programs in North Dakota is $3,000 in countable assets. For married couples where both are applying, the combined asset limit is $6,000. If only one spouse needs care, the applicant spouse can have up to $3,000 in assets, while the non-applicant spouse can keep a significantly larger amount, up to $162,660, known as the Community Spouse Resource Allowance. Countable assets include things like bank accounts, stocks, and retirement accounts not in payout status.

If your parent's income or assets are over these limits, there are pathways to still qualify. North Dakota has a "Medically Needy" or "Spend-Down" program. If income is too high, the difference between their income and the Medically Needy Income Limit (which is $1,197/month for an individual as of April 1, 2026) can be "spent down" on medical expenses, like Medicare premiums or medical bills, to become eligible. Assets can also be "spent down" by converting them into non-countable assets, such as making home modifications for accessibility, prepaying for funeral and burial expenses, or paying off debt.

What about common situations? If your parent owns a house, it's generally not counted as an asset if their spouse, a child under 21, or a blind or disabled child lives there. Otherwise, there's a home equity limit of $752,000 in 2026. For pensions, these are typically counted as income. However, IRAs and 401Ks are usually exempt if your parent is already taking their Required Minimum Distributions.

It’s crucial to know about the 60-month (five-year) "look-back" period for Nursing Home Medicaid and HCBS Waivers. Any assets gifted or sold for less than fair market value during this period could trigger a penalty period of ineligibility.

Waitlists & How to Apply

When it comes to waitlists, there's good news and a caveat. Nursing Home Medicaid and ABD Medicaid are considered "entitlement" programs, meaning if your parent meets the eligibility criteria, they are guaranteed to receive benefits without a wait. However, the Aged and Disabled Waiver (HCBS Waiver) is not an entitlement program. It has a limited number of enrollment slots, around 930 beneficiaries per year, so waitlists can exist. Your parent's access to a slot would be based on their application date.

To apply for Medicaid long-term care in North Dakota, you have several options. The easiest way for many is to apply online through the North Dakota Department of Health and Human Services self-service portal at www.applyforhelp.nd.gov. You can also download and mail the "Health Care Application for the Elderly and Disabled" form (SFN 958) to the Customer Support Center, P.O. Box 5562, Bismarck, ND 58506. If you prefer in-person assistance, you can visit a local Human Service Zone office. If you need an application mailed to you, call the Customer Support Center at 1-866-614-6005.

When applying, it's helpful to have documentation ready, such as proof of monthly income (like pay stubs, pension statements, or Social Security benefits), proof of assets (bank statements, certificates of deposit), and identification. Missing paperwork is a common reason for application delays. For free help with the application process, you can reach out to an ND Navigator at 1-800-233-1737.

Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.