North Dakota Medicaid Income Limits 2026: Eligibility

North Dakota Medicaid income limits come in two sets, and the first thing to get right is which set applies to you. If you are under 65 and not disabled, you are measured on the MAGI test: the adult limit is 138% of the federal poverty level, and no assets are counted at all. If you are 65 or older, blind, or disabled, you are measured on the aged, blind, and disabled test, which runs on a 209(b) framework that lets a single applicant keep $3,000 in countable assets, not the $2,000 federal default most states use.1,2,3

That extra room matters, and so does what comes next. If your income runs over the line on the long-term-care side, North Dakota doesn't shut the door. It lets you spend the excess down on care, with no special trust required.

This guide covers both tests for 2026. It starts with North Dakota's MAGI limits by coverage group and the 65th-birthday transition between the two, then works through the long-term-care rules for seniors and people who are blind or disabled: the $3,000 asset limit, how the medically needy spend-down works, what a nursing-facility resident keeps each month, what a spouse who stays home is protected from, and how to apply through your county Human Service Zone.3

Which North Dakota Medicaid income limit applies to you: MAGI or long-term care?

North Dakota runs two different income tests. Which one measures you depends on the door you come through, not on how much you earn.

• The MAGI test covers most people: adults under 65 who are not disabled, parents and caretaker relatives, pregnant women, and children. It uses Modified Adjusted Gross Income, sets each limit as a percentage of the federal poverty level (FPL), and counts no assets at all.2
• The SSI-related aged, blind, and disabled (ABD) test covers people 65 or older and people who are blind or disabled. It is the test behind every other figure in this guide: the $3,000 asset limit, the medically needy spend-down, the $115 Personal Needs Allowance. Federal law expressly excepts this track from the no-asset-test rule, which is why a resource limit exists here and nowhere on the MAGI side.2,3

Most people searching for North Dakota Medicaid income limits are not applying for nursing-facility care. If that is you, the MAGI table below is your answer, and the long-term-care rules in the rest of this guide are not.

North Dakota's 2026 MAGI income limits by coverage group

North Dakota Health and Human Services sets these limits as percentages of FPL, and the levels above took effect April 1, 2026.1 To convert them: in 2026, 100% FPL for one person is $15,960/year, about $1,330/month, in the 48 contiguous states and DC; for two people it is $21,640/year, about $1,803/month.4

No assets are counted on the MAGI side. North Dakota counts no assets for children, families with children, or pregnant women, and applies an asset test only to the aged, blind, and disabled groups.1 That follows federal law, which bars a state from applying any resource test to the MAGI groups.2 So the $3,000 countable-asset limit below has no counterpart here: an adult or parent who qualifies through MAGI can hold savings without it touching their eligibility.

Adults under 65: the Medicaid Expansion group at 138% FPL

North Dakota has adopted the ACA Medicaid expansion.5 Adults ages 19 through 64 qualify through the adult Medicaid Expansion group at 138% FPL.1 For one person in 2026 that works out to roughly $1,835/month, which is 138% of the $15,960/year poverty guideline for one person in the 48 contiguous states and DC (Alaska and Hawaii run on separate, higher guidelines).4,6

That 138% is the effective ceiling, not the statutory one. The Affordable Care Act writes the new adult group at 133% FPL, and a MAGI income disregard of 5 percentage points of FPL sits on top of it, which is where 138% comes from.6 North Dakota's published 138% already folds that disregard in, so it is the number to compare your income against.1

The group has hard edges written into the statute. It covers individuals under 65 years of age, not pregnant, and not entitled to or enrolled in Medicare.6

Turning 65 can end Medicaid eligibility even if your income never changes

Those edges create the trap this guide exists to name. On the 65th birthday, the expansion pathway closes and the same person is assessed on the SSI-related ABD track instead.6 Two things change at once:

• The income yardstick drops. It is no longer 138% FPL, roughly $1,835/month for one person, but the SSI Federal Benefit Rate, which is $994/month for an individual in 2026.7,4
• A resource test appears. The MAGI groups are barred from applying one; the ABD track is expressly excepted from that bar.2 The default standard is the SSI resource limit of $2,000 for an individual.7

So a 64-year-old covered at $1,600/month with modest savings can be over both tests at 65 without a dollar of income changing. Age alone is not the only trigger: the expansion group also excludes anyone entitled to or enrolled in Medicare, so someone under 65 who reaches Medicare through disability leaves the 138% group the same way.6

North Dakota softens the landing more than most states do. Its long-term-care resource limit is $3,000 rather than the $2,000 SSI default, and its medically needy spend-down means income above the standard does not disqualify you outright.3,7 The pathway, the paperwork, and the numbers still change. Confirm which standard applies to your situation with your county Human Service Zone before the birthday, not after.

Parents and caretaker relatives: 41% FPL

North Dakota covers parents and caretaker relatives at 41% FPL.1 For a two-person household, where 100% FPL is about $1,803/month in 2026, that is roughly $740/month.4

This group matters to eldercare readers for one reason: a grandparent raising a grandchild is the household most likely to be looking at it. Whether a particular relative meets North Dakota's definition of a caretaker relative is a determination your county Human Service Zone makes, so ask them rather than assuming.

The number is far lower than the others because of how federal law built the group. Parents and caretaker relatives are federally mandatory, but unlike children (mandatory to 133% FPL) and the new adult group (effectively 138% FPL), the mandatory floor is only the state's old cash-welfare standard: the AFDC income standard the state had in effect before 1996, converted to a MAGI equivalent, which is typically far below the poverty level.8 That floor is a federal minimum and a state may set its own standard above it. North Dakota's 41% sits far below the poverty line, in the range that frozen floor tends to produce.1

The consequence bites hardest in states that never adopted the expansion, where a working parent can be over the income limit at a very low income with no other adult pathway.8 North Dakota is not one of them.5 A parent under 65 whose income runs above 41% FPL is still covered by the expansion group up to 138% FPL.1 The 41% standard binds mainly on someone the expansion group shuts out: a caretaker who is 65 or older, or who is enrolled in Medicare.6

Children and CHIP

North Dakota covers children at 152% FPL from birth through age 5 and at 138% FPL from age 6 through 18, both above the federal mandatory floor of 133% FPL.1,9 Above those levels, the state runs a separate Children's Health Insurance Program (CHIP) covering children birth through age 18 up to 205% FPL.1 Pregnant women qualify at 175% FPL, with the unborn child counted as a family member when household size is figured.1 None of these groups face an asset test.1

Why North Dakota's $3,000 asset limit is different

For most of Medicaid's history, the countable-asset limit for a single aged or disabled applicant has been $2,000, a federal figure unchanged since the 1980s. North Dakota is one of a small number of section 209(b) states that set their own, more generous standard. Under North Dakota Administrative Code 75-02-02.1-26, a single nursing-home or waiver applicant may hold $3,000 in countable assets, and a couple $6,000.3

Two details people get wrong:

The couple figure is $6,000, not double-and-then-some. When only one spouse needs care, the far larger spousal-impoverishment allowance below is what protects the at-home spouse; the $6,000 applies when both members of a couple are applying.3

"Countable" is the word doing the work. North Dakota, like every state, exempts a long list of assets from the count: your home (subject to an equity cap), one vehicle, household goods and personal effects, and prepaid burial arrangements. So the $3,000 applies to things like bank accounts, a second vehicle, and investments, not the roof over your head.3

A note on the home. North Dakota exempts a primary residence subject to a home-equity limit that is set by state rule (N.D.A.C. 75-02-02.1-28) and adjusted each year. Because that figure is indexed and changes, confirm the current number with your county Human Service Zone before assuming the home is fully protected.3

How the North Dakota Medicaid income limits work: spend-down

Here is where being a 209(b) state shapes everything. North Dakota is a medically needy program, so being over the income standard does not disqualify you. If your monthly income is above the medically needy level, the excess becomes a spend-down amount: once you've incurred that much in medical or care costs in a given month, Medicaid covers the rest of that month.3

This is the key reason North Dakota does not require a Qualified Income Trust (also called a Miller Trust). In strict income-cap states, an applicant even one dollar over the limit is locked out unless they route the excess through a special trust. North Dakota has no such cliff. If your income is high, you spend down; you are never simply "too rich" for long-term-care Medicaid here.

How the mechanic works: whatever your monthly income runs above the medically needy income level becomes your spend-down amount for that month. Once you have incurred at least that much in medical or care costs (a prescription, a clinic visit, a share of facility charges), your Medicaid coverage begins for the rest of that month.

For a nursing-facility resident, the income test plays out as recipient liability: the resident contributes their income toward the cost of care, keeping only the protected allowances described next, and Medicaid pays the balance of the bill.

North Dakota nursing home Medicaid: what a resident keeps

When North Dakota Medicaid pays for nursing-facility care, the resident contributes nearly all of their monthly income toward the cost of care. What they keep is the Personal Needs Allowance (PNA), money set aside for the resident's own small expenses like clothing, a haircut, or a phone. North Dakota sets its PNA at $115/month and adjusts it yearly for inflation (N.D.A.C. 75-02-02.1-40), well above the $30 federal floor that some states still use.3,10

The same $3,000 asset limit applies to nursing-home applicants.3 And because North Dakota uses spend-down rather than an income cap, even a resident with substantial monthly income can qualify; they simply contribute more of it toward care. For the national picture on how the PNA is set and calculated, see our explainer on the Medicaid personal needs allowance.

The five-year look-back

North Dakota reviews asset transfers made in the 60 months before a long-term-care application.3,11 Giving away money or property for less than fair market value during that window, such as gifting a grandchild a down payment or signing a house over to a child for a dollar, can trigger a penalty period during which Medicaid won't pay for long-term-care services, even though you're otherwise eligible.

There are legitimate exceptions (transfers between spouses, transfers to a disabled child, certain caregiver-child home transfers) and legitimate planning approaches, but anything done inside the five-year window deserves an elder-law attorney's review first. If long-term care is on the horizon for someone in your family, talk to a professional before moving assets. For the broader toolkit, see our guide to Medicaid planning strategies.

Protecting the spouse who stays home

When one spouse needs long-term care and the other remains in the community, federal spousal-impoverishment rules keep the at-home spouse from being left without enough to live on. North Dakota applies the federal framework for 2026: the community spouse may keep half the couple's countable assets up to the federal maximum, plus a protected share of monthly income.3

So a married couple is in a very different position from a single applicant. The community spouse can hold up to $162,660 in countable assets and keep meaningful monthly income while the other spouse receives Medicaid-funded care.3

After death: estate recovery

Like every state, North Dakota runs a Medicaid estate-recovery program. After a recipient who was 55 or older and received long-term-care services dies, the state may seek repayment from the estate, subject to federal exceptions, such as a surviving spouse or a surviving minor, blind, or disabled child, and an undue-hardship waiver.3,12 For how estate recovery works and where families have room to plan, see our Medicaid estate recovery explainer.

How to apply in North Dakota

North Dakota Medicaid is administered by North Dakota Health and Human Services (ND HHS), but financial eligibility is determined locally by your county Human Service Zone. ND HHS sets policy; your local zone office takes and decides your application. You can apply online, in person, or by phone.3

Long-term-care applicants also go through a level-of-care screening to confirm they need nursing-facility-level services. Apply even if you think you're over the limit. Between the $3,000 asset rule and the medically needy spend-down, many people who assume they're disqualified are not.3

Learn More

Find personalized help working through North Dakota Medicaid eligibility for your family 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.