As you approach retirement, the likelihood of needing long-term care services for yourself or your spouse increases significantly. Like many seniors, you may find yourself needing to turn to Medicaid for assistance with these expenses; however, the Medicaid eligibility requirements could jeopardize your retirement savings. To help you safeguard your assets and secure Medicaid eligibility, the attorneys at Thompson Law discuss what you need to know about North Dakota Medicaid for seniors.
Will You Require Medicaid Coverage in Your Senior Years?
During retirement, Medicare typically covers healthcare expenses. Yet, Medicare doesn’t extend to long-term care services, which are often necessary. By age 65, there’s about a 70 percent chance you will require some form of long-term care, which can be financially burdensome. In 2023, the national average for long-term care costs exceeded $100,000 for nursing home care and nearly $80,000 for assisted living. North Dakota residents pay, on average, about the same as the national average for nursing home care and a little less for assisted living. Even with private health insurance, covering long-term care costs is improbable, leading over half of all seniors to rely on Medicaid. Qualifying for Medicaid, however, hinges on income and countable resources, posing challenges for seniors who have not incorporated Medicaid planning into their estate plans.
What Benefits Does Medicaid Offer to North Dakota Seniors?
North Dakota Medicaid offers a range of coverage options tailored to the needs of seniors. These include:
- Medical Services: Medicaid covers a wide array of medical services, including doctor visits, hospital stays, preventive care, and diagnostic tests. Seniors can access these services through Medicaid-approved healthcare providers across the state.
- Prescription Drugs: Medicaid helps cover the cost of prescription medications, ensuring seniors can afford vital treatments for chronic conditions and acute illnesses. The program may have a formulary specifying which drugs are covered, so seniors should consult with their healthcare provider or pharmacist to understand their coverage.
- Long-Term Care: Seniors who require assistance with daily activities, such as bathing, dressing, and meal preparation, may qualify for long-term care services through Medicaid. This can include nursing home care, assisted living facilities, and home-based care options.
- Medicaid State Plan Personal Care Services (MSP-PC): An entitlement program, assistance with daily living activities are provided to those who need it. Benefits include aid with personal hygiene, mobility, shopping for essentials, meal preparation, and medication management. While program participants must receive care assistance from a Qualified Service Provider (QSP), one can choose their QSP. Friends, and select relatives, can become a QSP and be hired to provide care.
- Aged and Disabled Waiver: Also called the Medicaid Waiver for Home and Community Based Services, assistance is provided to seniors and adults with disabilities to promote independent living. Available services and supports may include personal care assistance, adult day care, home modifications, emergency response systems, meal delivery, and specialized medical equipment.
- Program of All-Inclusive Care for the Elderly (PACE): The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental and eye care, may be available.
- Money Follows the Person: This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
Meeting Medicaid Qualifications for Seniors in North Dakota
Medicaid, primarily federally funded but state-administered, sets varying eligibility criteria and covered services across states. As a “needs-based” program, all states enforce income and asset limits for applicants. In North Dakota, individual seniors applying for regular Medicaid or for home and community-based services must not exceed $1,130 in monthly income, while married couples applying jointly must stay below $1,533 monthly combined income as of 2024. Individual applicants cannot have countable resources (assets) valued above $3,000 while a married couple applying together cannot exceed $6,000 in countable resources. Exempt assets in North Dakota include personal belongings, such as clothing, household furnishings, an automobile, irrevocable itemized burial contracts, and generally one’s primary home up to an equity limit of $713,000. In North Dakota, IRAs and 401Ks are also exempt if they are in “payout status.”
Exceeding asset limits may require a Medicaid “spend-down” to qualify, as asset transfers within five years of application are subject to scrutiny under Medicaid’s “look-back” rule, potentially resulting in a waiting period for benefits. In addition, while your home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, North Dakota’s Medicaid agency attempts reimbursement of care costs through the Medicaid Estate Recovery Program (MERP). This means that Medicaid may attempt to recover costs from your estate when you pass away.
Understanding North Dakota Medicaid Spousal Impoverishment Rules
Concerns about Medicaid eligibility impacting a spouse’s income and asset access are common. Fortunately, North Dakota Medicaid Spousal Impoverishment Rules safeguard spouses. These rules ensure a Minimum Monthly Maintenance Needs Allowance (MMMNA) for the non-applicant spouse, currently set at $2,550. The Community Spouse Resource Allowance (CSRA) further protects assets, allowing the community spouse to retain up to $154,140 of shared assets in 2024, with a minimum non-applicant share of $30,828.
How Do I Apply for North Dakota Medicaid for Seniors?
You can apply for Medicaid for seniors in North Dakota by navigating to the North Dakota Health and Human Services website, by contacting your local Human Service Zone office, or by calling the Customer Support Center at (866) 614-6005 to request a paper application be mailed to you. If you are concerned about your eligibility for North Dakota Medicaid for seniors, talk to your estate planning attorney about incorporating Medicaid planning into your estate plan. Ideally, Medicaid planning should be incorporated into your estate plan at least five years ahead of the need to qualify for benefits to avoid running afoul of the five-year look-back rule; however, last minute Medicaid planning strategies may still be able to help you if you have a sudden and unexpected need to qualify for Medicaid.
Do You Need Assistance with North Dakota Medicaid Planning for Seniors?
Please view one of our on-demand webinars to receive a free consultation. If you need to incorporate Medicaid planning into your North Dakota estate plan, contact the North Dakota and Minnesota estate planning attorneys at Thompson Law by calling 605-362-9100 to schedule an appointment.
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