North Dakota sets no Medicaid long-term-care income cap you can fail, and that one fact changes the arithmetic for a family working out how to pay for senior care in North Dakota. North Dakota is a 209(b) state that runs a medically needy program, so Medicaid income eligibility there works by spend-down rather than a flat cutoff, and a person over the income limit who has a medical need can still be covered, with a client share. If a nursing home price just arrived in a hospital corridor, take a breath. The main ways to pay for senior care in North Dakota are the family's own income and savings, Medicare's short-term skilled nursing coverage, North Dakota Medicaid, North Dakota's state-funded Service Payments for the Elderly and Disabled (SPED) program and its Basic Care Assistance Program, VA benefits and any long-term care insurance, and most families stack several of them., North Dakota also licenses basic care separately from assisted living, and basic care has its own assistance program.

In This Guide

Start With What Care Will Cost

Every option below gets measured against one number: what a year of care in your parent's setting will cost, set against your family's savings and income. Our guide to the cost of senior care in North Dakota carries the current median for each setting. Write that figure down before you read on; it turns the programs below from a list into a plan.

If the plan is assisted living, see how to pay for assisted living in North Dakota. If a nursing home is already on the table, our guide to North Dakota nursing homes walks through choosing one.

Paying for Senior Care in North Dakota From Your Own Money

Almost every family starts here, with Social Security, a pension, savings and sometimes the house. That is normal, and it is not a sign anyone planned badly.

The state income tax treats retirees gently. North Dakota lets every individual deduct the federally taxable part of their Social Security benefits from state taxable income, with no income limit, because Senate Bill 2351, passed in the Legislature's November 2021 Special Session, removed the old $50,000 threshold ($100,000 married filing jointly) for tax years 2021 and after. Retirement income other than Social Security remains subject to North Dakota individual income tax.

North Dakota also has a large first income tax bracket at a zero rate: on the 2025 table, the newest the North Dakota Office of State Tax Commissioner has published, it covers taxable income up to $48,475 filing single or $80,975 married filing jointly, and the state adjusts bracket levels for inflation each year. Detail: how North Dakota taxes retirement income.

Property Tax Credits That Stack

North Dakota lets an older homeowner hold two property tax credits at the same time, and both have spring deadlines.

North Dakota's Homestead Property Tax Credit is for a homeowner who is 65 or older, or who has a permanent and total disability, with no age requirement on the disability route. A Homestead credit applicant must live at the property and must not have income over $70,000 for the calendar year before the assessment date, counting the income of a spouse and any dependents. With income of $0 to $40,000, the North Dakota Homestead credit cuts taxable value by 100 percent, up to $9,000 in taxable value and $200,000 of true and full value; with income of $40,001 to $70,000, it cuts taxable value by 50 percent, up to $4,500 in taxable value and $100,000 of true and full value. Homestead credit applications go to the local assessor or county director of tax equalization and are due before March 31 of the year the property is assessed.

The separate North Dakota Primary Residence Credit is worth up to $1,600 against a homeowner's property tax, with no age restrictions and no income limits, one credit per household, applied for online at tax.nd.gov/prc between January 1 and April 1. A homeowner approved for the Homestead or Disabled Veteran's Property Tax Credit who still has a balance due can receive the Primary Residence Credit against the property taxes that remain.

If the homeowner is a disabled veteran, North Dakota's Disabled Veteran's Property Tax Credit adds a third layer. A veteran discharged under honorable conditions or retired from the U.S. Armed Forces, with a service-connected disability rating of 50 percent or more, can qualify, and the Disabled Veteran's Property Tax Credit applies the veteran's VA disability rating percentage against the first $9,000 of the homestead's taxable valuation. The veteran's income and assets do not affect eligibility for the Disabled Veteran's Property Tax Credit. A surviving spouse can also qualify for North Dakota's disabled veteran credit, and a surviving spouse receiving VA dependency and indemnity compensation receives a 100 percent credit. Filing detail: North Dakota senior property tax relief and the North Dakota disabled veteran property tax exemption.

Borrowing Against the House

Every route to borrowing against the house is secured by the home and reduces the equity the owner or the heirs would otherwise keep, and a home equity loan or line of credit usually carries monthly payments. The federally insured Home Equity Conversion Mortgage (HECM) is open to homeowners 62 and older through an FHA-approved lender, needs no monthly mortgage payments, and adds interest and fees to the loan balance each month, so the balance grows and the equity shrinks. The HECM rule that matters most for care: if the borrower is away for more than 12 consecutive months in a healthcare facility such as a nursing home or assisted living facility and no co-borrower lives in the home, anyone else living there must move out unless they can repay the loan or qualify as an Eligible Non-Borrowing Spouse. That is why a HECM fits care delivered at home, or a couple where one spouse stays in the house, far better than one person's permanent move into a facility. More: home equity options for senior care.

Not sure which of these your family qualifies for? Chat with Brevy's care navigator at brevy.com.

What Medicare Pays For, and What It Won't

Medicare, in North Dakota as everywhere, does not cover custodial care, the non-medical help with bathing, dressing and using the bathroom, when that is the only care a person needs, which is why Medicare does not pay for a long-term stay in a nursing home or an assisted living facility.

What Medicare Part A does cover is real, and short. Medicare Part A pays for skilled nursing facility care on a short-term, post-acute basis, up to 100 days per benefit period, and it generally requires a qualifying inpatient hospital stay of at least three consecutive days first. Time under observation or in the emergency room before admission does not count toward Medicare's three-day qualifying hospital stay, even overnight. The three-day rule has exits. A patient whose doctor participates in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver may not need the three-day stay, and a Medicare Advantage plan may also waive the three-day minimum. Re-entering the same or another skilled nursing facility within 30 days of leaving one needs no new three-day qualifying hospital stay. A Medicare patient admitted as an inpatient whose hospital changes their status to outpatient observation can ask for a fast appeal while still in the hospital.

In 2026 a Medicare Part A skilled nursing facility stay costs $0 a day for days 1 through 20 after the $1,736 deductible, which is not owed again if you already paid it for hospital care in the same benefit period; $217 a day for days 21 through 100; and after day 100, Medicare pays nothing. Day 101 is a cliff, not a step. See also Medicare plans and coverage in North Dakota.

How to Pay for Senior Care in North Dakota With Medicaid

When private money runs low, Medicaid is what pays. North Dakota Medicaid covers long-term care, including nursing facility care and home and community-based services, for eligible older adults and people with disabilities.

Instead of an income cap that denies you outright, North Dakota Medicaid sets an aged, blind and disabled monthly income level of $1,197 for a household of one and $1,623 for two, effective April 1, 2026, at 90 percent of the federal poverty level, and a person over that level who has a medical need can still be covered, with a client share. If a relative has told you your father's Social Security is too high, hand them that sentence. The client share is the other side of the bargain, and our guide to the North Dakota Medicaid personal needs allowance covers what a nursing-facility resident keeps.

On assets, North Dakota Medicaid allows $3,000 in countable assets for a single person and $6,000 for a couple, with $25 added for each additional person in the household, which sits above the federal SSI resource standard of $2,000 for an individual and $3,000 for a couple. The home, one car, furnishings, irrevocable burial plans and other personal items don't count toward the North Dakota Medicaid asset limit. Full detail: North Dakota Medicaid income and asset limits.

Home equity has its own federal ceiling. Under federal Medicaid law, an applicant whose home equity exceeds the 2026 minimum of $752,000 is not eligible for long-term care assistance, and a state may substitute a higher figure up to $1,130,000. The federal Medicaid equity limit does not apply at all while a spouse, or a child under 21 or a child who is blind or permanently and totally disabled, lawfully lives in the home. More on how the state treats the home: our guide to North Dakota Medicaid and nursing home care.

Our guide on how to apply for North Dakota Medicaid walks through the forms and offices. If a decision goes against you, read North Dakota Medicaid appeals and fair hearings the day the notice arrives.

The Five-Year Look-Back

Federal Medicaid law, which North Dakota applies, puts assets disposed of for less than fair market value on or after February 8, 2006 under a 60-month look-back. The 60 months run backward from the Medicaid application, not from the gift. A transfer inside the window triggers a penalty period during which Medicaid will not pay for long-term care, calculated by dividing the total uncompensated value by the state's average monthly private-pay cost of nursing-facility care, and it begins on the later of the transfer date or the date the person is otherwise eligible and receiving institutional-level care. The Medicaid transfer penalty is not a denial of all Medicaid coverage: it blocks nursing facility services and home and community-based waiver services for the penalty months.

Not every transfer is penalized. Under federal Medicaid law, a home can pass without penalty to a spouse; to a child under 21 or a child who is blind or permanently and totally disabled; or to a son or daughter who lived there at least two years before the institutionalization and provided care that let the parent stay home rather than in a facility. A state may also excuse the penalty on an undue-hardship showing. With your parent's care and your family's savings both on the table, an hour with an elder-law attorney before moving any money is cheap.

What Happens to the House

Whether the house is really a payment source depends on what the state can claim afterward. Federal Medicaid law requires North Dakota to seek recovery from the estate of a person who was 55 or older when they received nursing facility services, home and community-based services, and related hospital and prescription drug services. Federal law also sets the timing: Medicaid estate recovery may be made only after the death of a surviving spouse, and only when there is no surviving child who is under 21 or blind or permanently and totally disabled. Every state Medicaid agency must also have procedures to waive recovery where it would work an undue hardship. How the state runs its own claim is in our guide to North Dakota Medicaid estate recovery.

Staying Home, Assisted Living, or Basic Care

If your parent would rather stay put, understand the home-care route before anyone signs a facility contract. North Dakota Medicaid covers home and community-based services as part of its long-term care benefit, and the services, level-of-care test and how to enroll are in our guide to North Dakota Medicaid HCBS waivers.

The state-funded Service Payments for the Elderly and Disabled (SPED) program, run by North Dakota Health and Human Services, can pay for personal care in assisted living. To get the SPED assisted living daily rate, the person must live in a licensed assisted living facility, need daily personal care averaging at least one hour a day, and not be eligible for personal care under the Medicaid State Plan, Waiver Personal Care, Family Personal Care or Family Home Care. The SPED daily rate does not cover room and board.

SPED has its own asset test. A SPED applicant's resources cannot exceed $50,000 in liquid assets plus the value of any residence other than the primary one, and state law does not count the primary home or the first $50,000 of liquid assets for SPED. SPED is cost-shared on a sliding fee scale based on family size and income, adjusted each July 1, and under the SPED policy manual section revised July 1, 2026, the maximum under North Dakota's SPED and Expanded SPED programs is $4,873 per person per month for all services, excluding adult foster care.

North Dakota program Setting What it pays toward Key condition
Medicaid home and community-based services At home and in the community Services under North Dakota Medicaid's long-term care benefit Qualify for North Dakota Medicaid
SPED personal care Licensed assisted living facility Daily personal care, not room and board At least one hour of care a day on average; $50,000 liquid asset limit
Basic Care Assistance Program Licensed basic care facility A portion of the cost of care Qualify for North Dakota Medicaid and have a functional assessment

North Dakota licenses assisted living facilities under Century Code chapter 50-32 and basic care facilities separately under chapter 23-09.3. A basic care facility provides room and board to five or more unrelated people who, because of impaired capacity for independent living, need health, social or personal care services but do not need regular 24-hour medical or nursing services. North Dakota basic care facilities are licensed by the state but are not certified by the Centers for Medicare and Medicaid Services to take part in Medicare or Medicaid.

What helps instead is North Dakota's Basic Care Assistance Program, which helps qualifying residents of a licensed basic care facility pay a portion of their cost for care. The Basic Care Assistance Program has four conditions: the person must be a North Dakota resident, be 65 or older or 18 or older and blind or disabled, apply and qualify for North Dakota Medicaid, and have a functional assessment of how they handle activities of daily living. Start the Medicaid application early, because the Basic Care Assistance Program cannot help until Medicaid says yes. Under North Dakota Century Code 50-24.5-04, the cost of basic care services for a resident whose facility rate includes room and board is limited to that facility's rate, plus the personal needs allowance, less the resident's total income. Compare the settings in our guide to assisted living in North Dakota.

If a family member is doing the caregiving, see how to get paid as a family caregiver in North Dakota and caregiver programs in North Dakota.

If One Spouse Stays Home

Federal spousal-impoverishment rules exist so the at-home spouse is not left with nothing. When one spouse needs care, those federal rules let the at-home spouse in North Dakota keep a community spouse resource allowance, and the maximum resource standard effective January 1, 2026 is $162,660. The state's computation, the at-home spouse's income allowance and how to ask for more at a hearing are in our guide to North Dakota Medicaid spousal impoverishment rules.

If Your Parent Served in the Military

If your husband, wife or parent served, VA benefits may belong in the plan too, and the rules and current rates are in our guide to VA Aid and Attendance in North Dakota.

Is your parent a veteran, or a veteran's surviving spouse? Chat with Brevy's care navigator at brevy.com to see which benefits might apply.

Long-Term Care Insurance

If your family member bought a long-term care insurance policy, find it and read the benefit triggers, the daily maximum and the elimination period. Per-diem benefits from a tax-qualified long-term care insurance policy are excluded from federal income only up to the greater of an indexed amount, $430 a day for 2026, or the costs actually incurred for care, so the cap binds only when a policy pays more per day than the care costs. Tax-qualified long-term care insurance premiums count as a federal medical expense only up to age-banded limits, and through the itemized medical-expense deduction they reduce tax only for the part of medical expenses above 7.5 percent of adjusted gross income. A self-employed person with a net profit has a second route: under IRS Publication 502, qualified long-term care insurance premiums may be deductible as an adjustment to income on Form 1040 or 1040-SR, without itemizing, subject to the publication's conditions.

On the Medicaid side, a long-term care insurance partnership can shelter assets, but a partnership is a state option rather than a national entitlement, existing only where the state has an approved Medicaid state plan amendment providing for the disregard. Ask North Dakota Medicaid in writing whether a policy you are offered is a partnership policy before you buy it on that basis. More: long-term care insurance.

Paying for elder care in North Dakota usually means stacking several of these. If your parent is on Medicare with a modest income, check North Dakota Medicare Savings Programs to see whether your parent qualifies.

Frequently Asked Questions

What is the income limit for North Dakota Medicaid long-term care in 2026?

North Dakota Medicaid's aged, blind and disabled monthly income level, effective April 1, 2026, is $1,197 a month for one person and $1,623 for two, but it works as a spend-down threshold rather than a cutoff: an applicant above that level with a medical need can still be covered, with a client share. The asset side of the test is in How to Pay for Senior Care in North Dakota With Medicaid.

Does Medicare pay for a nursing home in North Dakota?

Medicare does not pay for a long-term stay in a North Dakota nursing home, because Medicare does not cover custodial care when it is the only care a person needs. Medicare Part A's short-term skilled nursing coverage, and the daily costs that come with it in 2026, are in What Medicare Pays For, and What It Won't.

Will Medicaid pay for a basic care facility in North Dakota?

Not directly, because North Dakota basic care facilities are not certified to take part in Medicare or Medicaid. The Basic Care Assistance Program helps qualifying residents pay a portion of their cost instead, and it requires qualifying for North Dakota Medicaid.

Can North Dakota SPED and Medicaid both pay for my parent's personal care in assisted living?

Not for the same personal care. SPED personal care is only for someone not eligible for personal care under the Medicaid State Plan, Waiver Personal Care, Family Personal Care or Family Home Care.

How much can my mother keep if my father goes into a nursing home in North Dakota?

Under federal spousal-impoverishment rules, the at-home spouse in North Dakota can keep a community spouse resource allowance, with a maximum resource standard of $162,660 effective January 1, 2026. The actual share depends on how the state measures the couple's assets, which our North Dakota spousal impoverishment guide walks through.

Learn More

Care TypesCost of Senior Care in North DakotaWhat senior care costs in North Dakota in 2026: assisted living about $56,745 a year, a nursing home about $138,335. See every setting and how to pay. MedicaidNorth Dakota Medicaid Income and Asset LimitsNorth Dakota Medicaid income limits for 2026: the 138% FPL MAGI limits, the $3,000 asset rule, and the 209(b) spend-down. See which test applies to you. MedicaidNorth Dakota Medicaid Spousal Impoverishment RulesNorth Dakota Medicaid spousal impoverishment rules for 2026: CSRA, MMMNA, exempt assets, and the 209(b) spend-down when one spouse needs nursing facility care. Care TypesHow to Pay for Assisted Living in North DakotaHow to pay for assisted living in North Dakota: SPED pays personal care, not room and board, with a $50,000 asset limit, plus basic care and Medicaid rules. VA BenefitsVA Aid and Attendance in North DakotaVA Aid and Attendance in North Dakota for 2026: who qualifies, pension maximums up to $34,488 a year (about $2,874 a month), how to apply, and free local help. FinancialNorth Dakota Senior Property Tax ReliefHow North Dakota seniors 65+ cut property taxes with the Homestead Credit's two income tiers, plus the $1,600 Primary Residence Credit. March 31 deadline.

Find personalized help paying for senior care 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.

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Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.