How North Dakota Medicaid Covers Assisted Living
In North Dakota, the state's Medicaid program offers financial help for long-term care services, but it does not cover the cost of room and board in typical assisted living facilities. Instead, support for care services is available through two main state programs for eligible seniors: the Home and Community-Based Services (HCBS) Waiver and the Basic Care Assistance Program (BCAP). It's important to understand that North Dakota distinguishes between standard assisted living facilities (ALF) and basic care facilities (BCF), and the rules for eligibility and coverage differ between them.
The Home and Community-Based Services (HCBS) Waiver
The HCBS Waiver, also referred to as the Aged and Disabled Waiver, assists eligible individuals by providing services that enable them to remain in a community setting, like a basic care facility, instead of entering a nursing home. Eligibility for this waiver requires meeting several conditions:
- Being 65 or older, or between 18 and 64 with a Social Security Administration-defined disability.
- Being a resident of North Dakota and a U.S. citizen or qualified noncitizen.
- Meeting Medicaid's financial criteria for income and assets.
- Being assessed as needing a Nursing Facility Level of Care but choosing care in a community setting.
- Residing in a licensed basic care facility.
Covered services under the HCBS Waiver in a basic care facility can include personal care, case management, and residential support. This waiver is not an entitlement, meaning enrollment is limited and there may be a waiting list.
The Basic Care Assistance Program (BCAP)
North Dakota's state-funded Basic Care Assistance Program (BCAP) is designed for eligible seniors residing in licensed basic care facilities. This program helps cover a portion of care costs and works in coordination with Medicaid. Information regarding eligibility criteria for BCAP and details on how BCAP provides financial assistance can be found on {Link: Medicaid Long Term Care https://www.medicaidlongtermcare.org/eligibility/north_dakota/}.
Financial and Functional Eligibility Explained
Qualification for North Dakota Medicaid long-term care programs requires passing both financial and functional assessments to ensure benefits go to those with limited financial resources and a genuine need for care.
Financial Requirements
- Income Limits: As of April 2025, the monthly income limit is \$1,174 for a single applicant and \$1,587 for a married couple. Most income sources are considered.
- Asset Limits: The asset limit is \$3,000 for a single applicant and \$6,000 for a married couple. This includes savings, checking accounts, stocks, and bonds.
- Asset Exemptions: Certain assets are not counted towards the limit, including an applicant's primary home (with an equity limit), one vehicle, personal items, and some retirement accounts in payout status.
- 5-Year Look-Back Period: North Dakota has a 60-month (5-year) look-back period to review asset transfers. Transferring assets below market value to qualify for Medicaid can result in a penalty period.
Functional Requirements Details regarding functional requirements, including the Nursing Facility Level of Care (NFLOC) assessment, evaluation of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), and consideration of cognitive and behavioral conditions, are available on {Link: Medicaid Long Term Care https://www.medicaidlongtermcare.org/eligibility/north_dakota/}.
Comparison of Medicaid Programs for Long-Term Care in ND
A comparison of key North Dakota Medicaid programs that can assist with long-term care costs can be found on {Link: Medicaid Long Term Care https://www.medicaidlongtermcare.org/eligibility/north_dakota/}. This resource details coverage, room and board policies, services covered, eligibility, entitlement status, and facility types for the HCBS Waiver, Basic Care Assistance Program (BCAP), and North Dakota Nursing Home Medicaid.
How to Apply for Assisted Living Medicaid in North Dakota
Applying for Medicaid long-term care programs in North Dakota involves several steps:
- Gather Documents: Collect necessary documents including proof of age, residency, citizenship, income, assets, and disability status.
- Submit an Application: Apply through the North Dakota Department of Health and Human Services (HHS). Options include the online self-service portal, a paper application submitted to a human service zone office, or applying by phone.
- Complete Functional Assessment: For programs like the HCBS Waiver and BCAP, a functional assessment by a social worker is required to determine the level of care needed.
- Explore State Resources: Contact your local human service zone office to discuss your eligibility for the HCBS Waiver or BCAP and get assistance with the application process. Information and office locations are available on the HHS website.
Conclusion
While North Dakota Medicaid doesn't cover room and board in traditional assisted living facilities, it does offer substantial financial help for care services through the HCBS Waiver and the state's Basic Care Assistance Program (BCAP). Eligibility for these programs depends on meeting strict income and asset limits and requiring a specific level of care, similar to nursing home care. Understanding the difference between assisted living facilities and basic care facilities in North Dakota is vital for obtaining appropriate financial aid. For guidance on the application process, families and seniors should reach out to their local North Dakota Human Service Zone office.
