Medicaid combines federal and state funding to offer health benefits to low-income individuals and families. While many people are aware that Medicaid will cover the cost of nursing home care (for eligible participants), people are often unaware that in North Dakota, Medicaid also has programs that cover home health services, allowing seniors to potentially avoid institutional care. To help ensure that you and your loved ones take advantage of these programs, an attorney at Thompson Law explains Medicaid coverage for home-based long-term care in North Dakota.
North Dakota Medicaid Waiver Programs
North Dakota’s equivalent of the Medicaid waiver program is known as the Aging Services Medicaid Waiver, which includes the North Dakota Choices for Community Living (CCL) program. These programs are designed to support seniors who require a level of care similar to what a nursing home provides, but who prefer to receive care in their home or community setting. Covered services include things such as personal care with activities such as bathing, dressing, and grooming, skilled nursing services such as wound care or medication management, therapy services ordered by a healthcare practitioner, including physical, occupational, or speech therapy, and homemaker services, such as light housekeeping, meal preparation, shopping assistance. To receive any of these services through Medicaid, a formal care plan must be developed and authorized by the relevant Medicaid authorities. That plan will be tailored to the senior’s needs and is subject to ongoing review to ensure care remains appropriate.
Who Is Eligible for Medicaid Covered Home-Based Care in North Dakota?
Although the Medicaid waiver program will potentially cover the cost of home-based care in North Dakota, you must meet both the applicable clinical and financial criteria to qualify. The clinical criteria require an applicant to demonstrate a level of care need equivalent to nursing facility placement. This determination is made through comprehensive assessment, which may include evaluating mobility limitations, cognitive needs, or assistance with daily living tasks.
As of 2025, North Dakota imposes income and asset limits for Medicaid applicants looking to receive long-term services, including home-based waiver services. Single applicants must generally have no more than $3,000 in countable assets; however, married couples where only one spouse is applying may allow the community spouse to retain larger assets to remain financially stable. Income thresholds also apply with individual applicants limited to just over $1,100 a month in income as of 2025, meaning that applicants may need to spend down excess income through permissible expenses to qualify for benefits. Without careful planning, exceeding these thresholds can delay or block access to Medicaid-supported services and may force individuals to deplete savings to qualify.
Family Caregiver Compensation: What Is Allowed in North Dakota
Many families wonder if Medicaid can pay a family member to provide in-home care. North Dakota does permit compensation to designated caregivers under certain circumstances. The CCL waiver supports self-directed care, where eligible seniors choose and supervise their own caregivers within program guidelines. Important rules and restrictions include:
- Spouses and legal guardians often cannot be paid as caregivers due to concerns about conflicts of interest.
- Caregivers must typically complete state-required training or certification, such as gaining Home Care Aide (HCA) or Personal Care attendant credentials.
- Medicaid programs set limits on reimbursable hours and establish standardized payment rates, for example, lower than private caregiver wages
- The care plan must be approved by Medicaid and regularly reviewed to verify ongoing necessity and compliance.
- Family members who meet these requirements can receive compensation while supporting their loved ones in familiar surroundings, an alternative to institutional care that benefits both parties.
Understanding the Medicaid “Look-Back” Period
Asset transfers made within 60 months of applying may be scrutinized and potentially problematic because North Dakota enforces a look-back period, meaning transfers intended to reduce countable assets can delay eligibility. Asset transfers made for less than fair market value during the 60 month look-back period can trigger a waiting period during which an applicant is not eligible for Medicaid benefits. The length of the waiting period is determined by dividing the value of the excess assets by the average monthly cost of long-term care in North Dakota ($9,673 as of 2025) For example, if you transferred a vacation home valued at $200,000 to an adult child just prior to applying for Medicaid, you would incur a 21 month waiting period ($200,000/$9673=20.67). Avoiding the look-back penalty is one of the many reasons to worth with an experienced Medicaid planning attorney if the need for Medicaid eligibility is anticipated in the future.
Steps to Apply for Home-Based Medicaid Benefits in North Dakota
The first step to qualifying for home-based long-term care services in North Dakota is to submit a formal Medicaid application through the North Dakota Department of Health and Human Services. An application can be completed online, via mail, or in person. Be prepared to submit supporting documentation, such as recent bank statements, identification documents, proof of income, property ownership records, and any prior medical evaluations.
Once financial eligibility is verified, a functional assessment will likely be arranged. A social worker or nurse evaluator will visit the applicant’s home to evaluate their condition and determine whether assistance is necessary and, if so, how many hours of service per month are warranted. This assessment includes an in-depth look at the applicant’s physical and mental limitations, medication management, mobility, and ability to live independently. The outcome of this visit heavily influences the level of support the applicant will receive. Therefore, it is crucial for applicants and family members to provide a full and honest picture of the challenges faced on a daily basis. Documentation from treating physicians and records of recent hospitalizations or therapy may support the application.
After the home visit, a formal notice of action will be issued. This notice details whether the applicant has been approved for services, the number of authorized care hours, and when services will begin. If the application is denied, or if the approved hours are insufficient, the applicant has the right to request a hearing. Appeals must be filed promptly and may require the presentation of additional evidence, such as physician testimony or functional capacity evaluations.
If the application is approved, the applicant or their authorized representative may select a caregiver. After that, you will work with case managers or care coordinators to craft an individualized care plan tailored to medical and functional needs.
The Importance of Planning
An elder law or estate planning attorney can help structure your assets, trusts, or gifting strategies to align with Medicaid’s look-back rules while maintaining as much of your financial legacy as possible. Incorporating a Medicaid planning component into your comprehensive estate plan ensures that you (or your loved one) will qualify for the CCL waiver or similar Medicaid programs and allows you sufficient time to set up trusts that protect assets without jeopardizing eligibility.
Do You Have Questions about Home-Based Medicaid Coverage in North Dakota?
Please join us for an upcoming FREE seminar or webinar. If you have questions or concerns about home-based Medicaid coverage in North Dakota, contact a North Dakota Medicaid planning attorney at Thompson Law by calling 605-362-9100 to schedule an appointment.
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