North Dakota provides long-term care resources to seniors through the North Dakota Department of Human Services (DHS). Aging Services provided by North Dakota DHS include Aging Services; Adult foster care licensing; Dementia care; Aging and Disability Resource LINK; Family Caregiver Support program; Service Payments for the Elderly and Disabled (SPED), and the Expanded-SPED programs; Long-Term Care Ombudsman Program; Older Americans Act services: assistive devices, senior meals, health screenings, elder legal assistance, options counselling, and Senior Companion program; Senior Community Services Employment Program Telecommunications equipment distribution program; and Vulnerable Adult Protective Services (both direct service and contracts). You can contact the DHS for more information on these services by clicking here or by calling N.D. Department of Human Services by phone at 701.328.2310 or 800.472.2622.

The North Dakota DHS also provides home-and-community-based long-term care services paid for by Medicaid for certain populations, including seniors over 65 years old who would need nursing home care but choose to receive services in a community setting (such as assisted living) or in their own home.

Medicaid Waiver Program for Assisted Living and In-Home Care

North Dakota Medicaid Waiver for Home and Community-Based Services (HCBS Waiver)

The Medicaid Waiver for Home and Community Based Services provides service options for a continuum of home and community-based services in the least restrictive environment. The goal is to adequately and appropriately sustain individuals in their own homes and communities and to delay or divert institutional care. In order to successfully meet the mandate, a consumer-centered, affordable delivery system has been established for the delivery of in-home services to the elderly and physically disabled. This system involves a partnership between the local County Social Service Boards, the North Dakota Department of Human Services, informal networks, and consumers/family members.

The North Dakota Department of Human Services, Medical Services Division is the operating agency and administers the Waiver.


Services include Adult Day Care; Adult Family Foster Care; Adult Residential Services; Case Management; Chore Service; Emergency Response System; Environmental Modification; Extended Personal Care / Nurse Education; Family Personal Care; Home-Delivered Meals; Homemaker Services; Non-Medical Transportation; Respite Care; Specialized Equipment; Supported Employment; and Transitional Living Services.


  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: An applicant must meet the Social Security Disability criteria to be financially eligible for the Medicaid waiver or qualify through the “medically needy” pathway. as a 209(b) state, North Dakota can set more restrictive income limits than otherwise would be allowed. For 2022, to be eligible for SSI payments, an individual cannot receive more than $940 a month (or $1,267 for a couple). An individual’s maximum assets are $3,000 (or $6,000 for a couple). If you qualify under the “medically needy” category, the maximum monthly income limit for 2022 is $940. However, under this category, any income that is spent on medical or remedial care services will be disregarded for purposes of Medicaid income limits (known as the “spend-down” provision). The resource limits above are the same. For a non-applicant spouse, the maximum amount of resources allowed without counting towards eligibility is $137,400 for 2022. Furthermore, the non-applicant spouse may maintain a monthly income of up to $2,550 for home maintenance and other monthly expenses, referred to as the Maximum Monthly Maintenance Needs Allowance (MMMNA).

Practical Considerations

There is no Miller Trust allowed in North Dakota, and the spend-down income limit under the “medically needy” category is very low. Unless you spend most of your monthly income on medical needs, it would be hard to qualify unless you meet the lower threshold of $861 monthly for SSI benefits. There is no special income limit; therefore, the ability to qualify for Medicaid is more difficult under the more restrictive standards set by North Dakota.


North Dakota is not a particularly good state for Medicaid long-term care services because of its income requirements and small enrollment cap. The lack of a special income limit as a 209(b) state means that an applicant’s monthly income must be below $1,281 regardless of qualifying through the SSI benefit pathway or through the medically-needy spend-down provision. Suppose you wish to receive Medicaid for long-term care and spend a significant amount of your monthly income on medical services. In that case, a Medicaid Planning specialist may help you qualify for benefits sooner and save you money.

Access all state Medicaid Waiver pages.