When a parent or spouse in North Dakota needs nursing-home care, North Dakota Medicaid can pay for it once countable assets are at or below $3,000 for one person. A spouse at home may keep a share of the couple's assets: at least $32,532 and at most $162,660 from January 2026. Gifts made in the 60 months before applying can delay coverage.
Most people facing a nursing-home admission in North Dakota come to this question suddenly. A fall, a hospital discharge or a diagnosis means a husband, wife, mother or father cannot safely live at home anymore. The family is looking at monthly bills it never planned for and wondering what the savings, the house and the spouse still at home will look like a year from now. This page sets out how North Dakota's own Medicaid policy manual treats those questions, and where the answer turns on facts or on rules that change.
What North Dakota Medicaid Covers for Long-Term Care
North Dakota Health and Human Services publishes the state's Non-ACA Medicaid Policy Manual. That manual sets the financial rules for what it calls "nursing care services." The home-equity section says these services include home and community-based services, called HCBS. HCBS is long-term care delivered at home or in the community instead of in a nursing facility.
For a family, that matters because the choice between a facility and care at home does not usually change the financial picture much. The manual applies many of the same rules in both settings. Spousal protections, for example, apply to an "institutionalized spouse," meaning a spouse in a facility, and also to an "HCBS spouse." The names of the specific HCBS programs, who can enroll and whether openings exist depend on North Dakota's current rules.
Federal law sets the framework every state must follow, and each state runs its own program. This page covers Medicaid for long-term care in North Dakota only. It does not cover Medicare, private long-term-care insurance or veterans' benefits.
North Dakota Medicaid Eligibility: Who Qualifies for Long-Term Care Coverage
North Dakota looks at three things about money: what a person owns, the home, and monthly income. Each is measured separately, and an applicant has to fit within all three.
Assets. The Asset Limits section (revised July 1, 2025) limits the combined equity value of all property that is not excluded:
- $3,000 for a one-person unit
- $6,000 for a two-person unit
- $25 more for each additional member
Property is valued at current fair market value. The manual leaves no room for flexibility here: "there is no provision for the Asset Limit to be exceeded." One practical point works in an applicant's favor, though. Eligibility can exist in a month if countable assets are within the limit for at least one day of that month.
The home. The home-equity section applies to anyone who applies on or after January 1, 2026. That person cannot get coverage of nursing care services, including HCBS, if their home equity is more than $752,000. The 2025 figure was $730,000. This limit does not apply if any of these people lives in the home:
- a spouse
- a son or daughter under 21
- a son or daughter of any age who is blind or disabled
Income. The Income Levels section, effective April 1, 2026, sets a "nursing care income level" of $118 per month. That level applies to residents receiving nursing care in nursing facilities, the state hospital and certain other facilities.
Put simply, the manual treats income levels as the amount of income set aside for a person's own maintenance needs. For a nursing-facility resident, $118 a month is what is reserved for that resident's personal needs. Social Security, a pension and other monthly income are measured against that amount. The manual section relied on here does not walk through how the rest of the resident's income goes toward the cost of care, often called the patient's share or patient pay, or which deductions come first. Those details depend on North Dakota's current rules. When a spouse remains at home, separate income levels for that spouse come into play, as the spousal section below describes.
Income above a limit. Families sometimes hear that certain states cap income for nursing-home Medicaid and require an applicant with higher income to use a qualified income trust, often called a Miller trust, to route income into the program. The North Dakota manual sections relied on in this page do not address whether North Dakota works that way. Whether an income cap or a qualified income trust has any role in a North Dakota application depends on the state's current rules.
Level of care. How North Dakota assesses medical or functional need for nursing-facility care also depends on its current rules.
Countable and Exempt Assets in North Dakota Medicaid
A countable asset is property Medicaid adds up against the limit. An exempt asset, which the manual calls "excluded," is one it does not count. For most families, the first question is the house.
The Excluded Assets section excludes the home occupied by the Medicaid unit, including a trailer home used as living quarters. The exclusion covers the land under the home up to 160 contiguous acres in rural areas, or two acres within a city's boundaries.
The exclusion depends on the home still being "occupied," and the manual defines that word narrowly:
- A rented-out home is not occupied. A home is not occupied if the right to live there was given up through a rental or lease, whether written or not. - A home left for long-term care may not count as occupied. If the person is in long-term care or the state hospital, the home is not occupied unless one of two things is true: - a spouse, a son or daughter under 21, or a blind or disabled son or daughter is at home, or - a physician certifies that the person is likely to return home within six months. - The physician's statement has strict requirements. It must give the admission date and the date of the statement, say the person is reasonably expected to return within six months, and be signed by the physician. Saying someone "may" or "wants to" return is not enough.
In practice, this means a family that rents out a parent's house after admission, or relies on a doctor's note that is too tentative, may find the house counted after all.
Other asset types. The Excluded Assets section lists further exclusions beyond the home. Retirement accounts, life-insurance cash value, vehicles and burial arrangements are the asset types families most often ask about. Each either appears on the state's excluded list, and so does not count, or it does not, and its current fair market value counts toward the $3,000 or $6,000 limit. Which group a given account, policy or vehicle falls into, and under what conditions, depends on North Dakota's current rules and on the specific asset. Federal law separately treats certain annuities bought with retirement-account funds in a particular way, as the planning-tools section explains.
Spend-down means bringing countable assets down to the limit, for example by paying debts or buying things the rules exclude. Whether a particular purchase helps depends on how North Dakota classifies it. Spending at fair market value is different from giving property away, which the next section covers.
The Look-Back Period and Transfer Penalties in North Dakota
Many families have helped children or grandchildren over the years, and this is where those gifts can matter. North Dakota's Disqualifying Transfer Provisions apply when the person or their spouse gives away assets or income for less than fair market value on or after the look-back date. Such a transfer makes the person ineligible for nursing care services for a time.
The look-back period is the window of past transfers the agency examines. For transfers made on or after February 8, 2006, it reaches back 60 months. The 60 months are counted from the date the person is both receiving nursing care services and has applied. This matches the federal rule in 42 U.S.C. § 1396p(c)(1)(B)(i).
North Dakota adds three points:
- Once a person's look-back date is set, it stays that person's look-back date permanently.
- Each spouse sets their own look-back date.
- A parent's transfers of the parent's own assets do not affect a child's coverage, and a child's transfers of the child's own assets do not affect the parent's.
A penalty period is the stretch of months with no long-term-care coverage that a transfer causes. Under 42 U.S.C. § 1396p(c)(1)(E)(i), the number of months equals the uncompensated value transferred, divided by the average monthly private-pay cost of nursing-facility care in the state. The state may instead use the average in the community where the person lives. North Dakota's current divisor depends on its current rules.
Under 42 U.S.C. § 1396p(c)(1)(D)(ii), the penalty starts on the later of two dates: the month of the transfer, or the date the person is eligible and would otherwise be receiving institutional-level care. The effect is that the penalty clock does not run while the person is still healthy at home. A gift made four years before applying is penalized the same way as one made last month.
Federal law lists exceptions. They include transferring the home to the person's spouse, under 42 U.S.C. § 1396p(c)(2)(A)(i). Federal law also imposes no transfer penalty on transfers to a spouse. The crisis planning checklist walks through these timing questions.
Spousal Protections: What a Community Spouse in North Dakota Can Keep
A community spouse is the husband or wife who stays at home while the other spouse enters a facility or receives HCBS. For that spouse, the real question is whether there will be enough left to keep the household running.
Assets the community spouse keeps. The Community Spouse Asset Allowance section (revised January 1, 2026) works like this:
- The agency adds up all countable assets either spouse owns, individually or jointly. It values them as of the start of the first continuous period of institutionalization or HCBS.
- Half of that total is the "spousal share."
- The community spouse's allowance equals the spousal share, but not less than $32,532 and not more than $162,660, effective January 2026. The January 2025 figures were $31,584 and $157,792.
The allowance can be increased by a court order or through a fair hearing. The federal framework for this is in 42 U.S.C. § 1396r-5(c) and (f).
Once the spouse in care is found eligible, the allowance no longer applies to the community spouse. However, the community spouse's assets remain subject to the transfer rules. Giving them away for less than fair market value can make the spouse in care ineligible.
Income the community spouse keeps. The Income Levels section sets the income level for an ineligible community spouse at $2,705, or more if a court or hearing officer orders it. Each ineligible family member in a spousal impoverishment case has an income level of $902, effective July 2026.
Spousal refusal. Whether North Dakota allows spousal refusal depends on its current rules.