How Medicaid Can Help Pay for Long-Term Care in North Dakota

Q: Do my IRA or 401(k) count as assets for North Dakota Medicaid?

Not if they're in payout status, receiving at least required minimum distributions — these are exempt from North Dakota's asset limit. This is a genuinely favorable treatment compared to some other states.

Q: Why is North Dakota's HCBS Waiver income limit lower than nursing home Medicaid's?

North Dakota is a Section 209(b) state that sets its own eligibility thresholds. The HCBS Waiver uses 90% of the Federal Poverty Level ($1,197/month), while nursing home Medicaid uses the more common 300% federal benefit rate ($2,982/month) — genuinely different limits for different programs.

Published August 28, 2026 How we keep this accurate

This page is North Dakota-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

A favorable rule for retirement savers

IRAs and 401(k)s in payout status — receiving at least required minimum distributions — are exempt from North Dakota's asset limit. This is genuinely favorable compared to states like Wyoming, which count an applicant's own retirement account fully against the asset test.

A waiver that covers more settings than most

North Dakota's HCBS Waiver is the primary program for elderly and disabled residents needing nursing-facility-level care, and it's distinctive in covering home, assisted living, adult foster care, and memory care facilities — broader than most state HCBS waivers, which often exclude memory care facility settings specifically.

One real limit to know about: North Dakota reserves the right to deny waiver enrollment if community-based care would cost more than comparable nursing home care for that specific individual. This isn't automatic denial for everyone, but it's a real factor in the state's approval process.

Two programs, two different income limits

	HCBS Waiver	Nursing Home Medicaid
2026 income limit	$1,197/month (90% FPL)	$2,982/month (300% FBR)
2026 asset limit (single)	$3,000	$3,000
If income exceeds limit	Medically needy spend-down	Medically needy spend-down

Source: North Dakota Health and Human Services (HHS); figures effective April 2026. North Dakota is a Section 209(b) state, meaning it sets its own eligibility thresholds rather than automatically following federal defaults.

These genuinely different limits catch people off guard. Someone whose income fits comfortably under the nursing home limit could still exceed the HCBS Waiver's lower threshold — confirm which program's rules actually apply to your situation before assuming either number is universal.

A higher asset limit than most states, either way

North Dakota's $3,000 asset limit for a single applicant is already higher than the $2,000 federal standard most states use — a real, if modest, cushion on top of the retirement-account exemption above.

A real geographic factor

Rural counties in western North Dakota — the oil patch region — and the far northern prairie have limited local nursing facility options, making home-based care alternatives especially important for residents who want to remain near family rather than relocate for care.

No Miller Trust required — spend-down instead

North Dakota doesn't require a Qualified Income Trust for either program — Medically Needy spend-down is available for excess income above either limit.

How to actually start

Contact the Aging and Disability Resource Center at 1-855-462-5465 or your local Human Service Zone office to begin a Level of Care Determination and financial eligibility review.

If considering memory care, ask specifically whether it's covered through the HCBS Waiver in your situation, since North Dakota's inclusion of this setting is genuinely uncommon nationally.

Common Questions

Do my IRA or 401(k) count as assets for North Dakota Medicaid?

Not if in payout status receiving RMDs — these are exempt, unlike in some other states.

Why is North Dakota's HCBS Waiver income limit lower than nursing home Medicaid's?

North Dakota sets its own thresholds as a 209(b) state — the HCBS Waiver uses 90% FPL, nursing home Medicaid uses 300% FBR.

What settings does North Dakota's HCBS Waiver cover?

Home, assisted living, adult foster care, and memory care facilities — broader than most states.