Nursing Homes in North Dakota: Cost & Medicaid (2026)

A semi-private nursing-home room in North Dakota runs about $138,335 a year, which is above the national median and far more than most families can pay out of pocket for long.1 For most long-term residents, what makes a stay affordable is North Dakota Medicaid, which pays for nursing-facility care once a person meets the level-of-care and financial rules.

This guide covers how North Dakota oversees its nursing homes, what a stay costs, who pays for it (Medicare's limited skilled benefit versus Medicaid for long-term care), and how to check a facility's record before you choose one.

In This Guide

• Key Takeaways
• How North Dakota Oversees Nursing Homes
• What a Nursing Home Costs in North Dakota
• Who Pays: Medicare vs. Medicaid
• How to Vet a Facility
• Frequently Asked Questions

How North Dakota Oversees Nursing Homes

A nursing home, often called a skilled nursing facility, provides 24-hour licensed nursing care, help with daily activities like bathing and dressing, and rehabilitation services such as physical, occupational, and speech therapy. That round-the-clock nursing is the line separating it from assisted living, which is built for people who need help with daily tasks but not constant skilled care. Before you weigh cost or payment, it helps to know who watches over these facilities in North Dakota, because that oversight is what gives you a record to check.

Two layers of regulation apply, and they work together. At the state level, nursing facilities are licensed and inspected by the North Dakota HHS Health Facilities Unit.2 A facility that takes part in Medicare or Medicaid is also federally certified, and the same unit serves as the state survey agency that runs those certification inspections on behalf of CMS. Their findings feed the federal Five-Star Quality Rating System published on Medicare Care Compare, which scores each facility from one to five stars on health inspections, staffing, and quality measures.2

There's also a free advocate you should know about before you need one. The North Dakota Long-Term Care Ombudsman, housed within the HHS Aging Services Division, advocates for residents of nursing homes, basic care facilities, and assisted living settings, and helps residents and families resolve concerns at no cost.2 The program advocates and resolves complaints but does not license or inspect, so it's a different kind of help than the state survey process. An ombudsman who regularly visits facilities in your area can tell you things a brochure never will.

What a Nursing Home Costs in North Dakota

Nursing-home care is among the priciest long-term care in North Dakota, and the numbers are large enough that paying privately for years is out of reach for most families. According to the CareScout (Genworth) Cost of Care Survey, the 2025 statewide medians were about $138,335 a year (roughly $11,528 a month) for a semi-private room and about $147,642 a year (roughly $12,304 a month) for a private room.1 These are medians from an industry survey, not government rates and not maximums. The figure at any one facility can land higher or lower depending on location, room type, and how much care a resident needs.

What stands out about North Dakota is how sharply nursing-home costs jumped in the latest survey. Facility care that used to sit below the national line now runs above it: the semi-private median of about $138,335 sits above the national figure of about $114,975, and the private room of about $147,642 runs above the national $129,575. Assisted living moved the other way, falling to about $56,745 a year in North Dakota, well below the national $74,400. So the gap between a nursing home and assisted living is now especially wide here, and that gap is what pushes most long-term nursing-home residents onto Medicaid.1

A semi-private nursing-home room in North Dakota now costs well over twice what assisted living does.1 That gap is the reason families look hard at whether assisted living or in-home care can meet the need before moving to a nursing home, and it's the reason most long-term nursing-home residents in the state end up relying on Medicaid rather than paying privately for years.

Who Pays: Medicare vs. Medicaid

People often assume Medicare covers a nursing home. It does, but only in a narrow way, and confusing the two programs is one of the most expensive mistakes a family can make. Here's how they divide the work.

Medicare covers short rehab, not a long stay. Medicare Part A covers skilled nursing facility care only on a short-term basis after a hospital stay. To qualify, a person generally needs a qualifying inpatient hospital stay of at least three consecutive days, then enters a Medicare-certified facility for skilled care related to that stay. Medicare then covers up to 100 days per benefit period: days 1 through 20 in full, and days 21 through 100 with a daily coinsurance, after which coverage ends.3 The coinsurance amount changes each year, so confirm the current figure on Medicare's own coverage page before you count on a number. Medicare does not pay for long-term custodial care, the ongoing help with daily living that someone needs when skilled rehab is finished.3 That is the care most families worry about affording, and it's where Medicaid takes over.

Medicaid covers long-term nursing-facility care. North Dakota Medicaid, administered by HHS, pays for nursing-home care for people who meet a nursing-facility level of care and the financial rules.4 Qualifying turns on two findings on separate tracks: a level-of-care assessment on the medical side and the income and asset rules on the money side.

North Dakota's income rules are where it differs from most states, so it's worth slowing down here. Most states use a flat special income limit for long-term-care Medicaid, set at 300% of the SSI federal benefit rate. North Dakota does not. It's a 209(b) state, which means it follows a medically needy, share-of-cost approach instead.4 In practice, an applicant whose income runs above the standard isn't automatically disqualified the way they would be under a hard cap. They can still qualify by spending the excess down on their care, and once enrolled, a nursing-home resident contributes most of their monthly income toward the cost of care while keeping a small personal needs allowance for incidentals. The countable-asset limit is generally $3,000 for a single applicant and $6,000 for a couple, higher than the $2,000 most states use.4

A married couple is not held to the single-person numbers. When one spouse enters a nursing home and the other stays in the community, federal spousal-impoverishment rules let North Dakota protect a community spouse resource allowance, up to $162,660 in 2026, so the at-home spouse is not left without savings.4 Two more rules shape long-term-care eligibility. North Dakota applies a five-year, or 60-month, look-back to assets transferred for less than fair value, which can trigger a penalty period of ineligibility.4 And as federal law requires, the state recovers from the estates of people who received long-term-care Medicaid at age 55 or older.4 Because these rules are detailed and the share-of-cost math depends on your own income and expenses, it's worth getting professional advice before assuming any outcome.

How to Vet a Facility

Quality varies widely from one nursing home to the next, and North Dakota gives you several free tools to check a place before you commit. Use more than one, because each shows you something the others don't.

Start with the federal scorecard. On Medicare Care Compare, CMS rates every Medicare- and Medicaid-certified nursing home from one to five stars, combining an Overall rating with separate ratings for health inspections, staffing, and quality measures.2 Read the component ratings, not just the headline star count, because a strong Overall can hide a weak staffing or inspection score. The staffing numbers deserve a close look on their own, since how many nurses and aides a facility keeps per resident shapes day-to-day care more than almost anything else.

Then go to the source of those ratings. When you tour a facility, ask to see its most recent state survey results from the North Dakota HHS Health Facilities Unit, and watch for a pattern of repeat deficiencies rather than reacting to a single old citation.2 Finally, call the North Dakota Long-Term Care Ombudsman before you sign anything. An advocate who visits facilities in your area regularly can give you an honest, on-the-ground read on a specific place that no rating captures.2

Learn More

Find personalized help comparing nursing homes in North Dakota at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.