North Dakota Medicaid pays for home and community care for older adults and adults with disabilities through the Medicaid Waiver for Home and Community Based Services.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND Usually called the HCBS Waiver, it serves people who meet a nursing-facility level of care but whose needs can be met at home or in the community.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND If you are helping an aging parent, or an adult relative with a physical or other disability such as a brain injury or dementia, work out whether Medicaid can pay for in-home help, this is the program to start with. It is not North Dakota's only waiver of this kind: adults with intellectual or developmental disabilities, for example, are served under a separate waiver with its own eligibility rules.Centers for Medicare & Medicaid Services. (1915). North Dakota Waiver Factsheet - Medicaid.gov (all ND 1915(c) waivers, active and terminated). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND
In This Guide
- What North Dakota Medicaid HCBS Waivers Are
- The Home and Community Based Services Waiver, in Detail
- Who Qualifies for a North Dakota Medicaid HCBS Waiver
- What the Waiver Covers
- How to Apply and What Enrollment Involves
What North Dakota Medicaid HCBS Waivers Are and the 1915(c) Rule Behind Them
Home- and community-based services, almost always shortened to HCBS, is the umbrella term for the long-term care Medicaid pays for outside of an institution. Instead of covering a nursing-home bed, an HCBS program covers the help a person needs to stay where they live: someone to assist with bathing and dressing, a homemaker for cleaning and meals, adult day care, or a respite worker so a family caregiver can rest.
The legal engine behind almost every program like this is section 1915(c) of the Social Security Act. A 1915(c) HCBS waiver lets a state "waive" the usual rule that Medicaid long-term care happens in a facility, so it can pay for community-based care instead, for people who would otherwise qualify for institutional care. Because these programs are waivers rather than open-ended entitlements, a state can limit each one to specific groups and cap how many people enroll, so each waiver spells out who is served and what is covered.U.S. Government Publishing Office. (n.d.). Electronic Code of Federal Regulations (ecfr.gov) - 42 CFR 440.210, required services for the categorically needy. ecfr.gov. Retrieved Sep 4, 2026, from https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?chapter=IV&subchapter=C&part=440§ion=440.210
North Dakota runs several 1915(c) waivers, each aimed at a different group. The one this guide covers is the waiver for older adults and adults with disabilities, administered by North Dakota Health and Human Services (ND HHS), Medical Services Division. Adults with intellectual or developmental disabilities, for example, are served under the separate Traditional IID/DD Home and Community Based Services Waiver, for people who meet an ICF/IID level of care.Centers for Medicare & Medicaid Services. (1915). North Dakota Waiver Factsheet - Medicaid.gov (all ND 1915(c) waivers, active and terminated). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND If the person you are helping falls into a group this waiver does not serve, start from ND HHS's Medicaid Waivers page instead. North Dakota's Medicaid Waiver for Home and Community Based Services carries the federal identifier 0273.R06.00, and ND HHS lists it as effective January 1, 2026.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND
The Home and Community Based Services Waiver, in Detail
The Medicaid Waiver for Home and Community Based Services is North Dakota Medicaid's home and community-based waiver for older adults and adults with disabilities who meet a nursing-facility level of care. ND HHS describes waivers as giving eligible people options when their needs can be met in their homes and the home and community services are cost neutral compared with institutional care.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND
Two groups of adults fall within the waiver's design. The first is people 65 or older. The second is adults ages 18 to 64 who have a physical or other disability, such as a brain injury or dementia. In both cases the person has to need the kind of hands-on care a nursing facility would otherwise provide.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND
Case management, which the state calls HCBS care coordination, is one of the waiver's covered services.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND The case manager is also the person who meets with the applicant to complete the functional assessment behind the level-of-care decision.ndlegis.gov. (n.d.). North Dakota Administrative Code, Chapter 75-02-02 (Medical Services), section 75-02-02-09 Nursing facility level of care — North Dakota Legislative Branch. Retrieved Oct 4, 2026, from https://ndlegis.gov/information/acdata/pdf/75-02-02.pdf
Who Qualifies for a North Dakota Medicaid HCBS Waiver
Qualifying for the waiver comes down to two separate tests, and a person has to clear both. One is about care needs. The other is about money.
The care-needs (functional) test
The first test is functional: the applicant must meet a nursing-facility level of care.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND In plain terms, their care needs, such as help with toileting, eating, transferring or getting around, have to be serious enough that nursing-facility care is medically necessary under North Dakota's criteria in N.D. Admin. Code 75-02-02-09. For the waiver, a case manager completes a functional assessment on the state's Level of Care Determination form, and Maximus, a contractor, must approve the form to confirm the person meets that level of care.ndlegis.gov. (n.d.). North Dakota Administrative Code, Chapter 75-02-02 (Medical Services), section 75-02-02-09 Nursing facility level of care — North Dakota Legislative Branch. Retrieved Oct 4, 2026, from https://ndlegis.gov/information/acdata/pdf/75-02-02.pdf
The financial test
The second test is financial, and North Dakota handles it differently from many states. North Dakota is a section 209(b) state that sets its own Medicaid resource standards in the North Dakota Administrative Code. Rather than a hard income cap, it applies a medically needy spend-down and a recipient-liability model, so a person whose income is above the basic Medicaid level may still qualify by contributing part of that income toward the cost of their care.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
On the asset side, the limits are concrete. In North Dakota, for the aged, blind, and disabled coverage groups in 2026, a one-person unit is limited to $3,000 in countable assets, and a two-person unit to $6,000, with an additional $25 for each further member of the unit.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND Countable assets do not include everything a person owns; Medicaid excludes certain property, and North Dakota's own rules govern what counts. For the full picture of income and asset rules, see our guide to North Dakota Medicaid income and asset limits.
If the applicant is married, the two-person limit is the wrong number
This is the point where families most often talk themselves out of applying. That $6,000 figure is the asset limit for a two-person Medicaid unit. When only one spouse needs long-term care and the other stays at home, North Dakota instead applies the spousal impoverishment rules: the at-home spouse's standard spousal share is half the couple's countable assets, but not less than $32,532 and not more than $162,660 (N.D.A.C. 75-02-02.1-24).Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf That $162,660 is not an absolute ceiling. The at-home spouse can keep more through a court order or a fair hearing, for example when the protected assets produce too little income to bring the at-home spouse up to the monthly maintenance needs allowance after any income the other spouse can make available is counted.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf ND HHS applies these protections when the person is screened as needing long-term care expected to last at least 30 days in a row and the community spouse is not on Medicaid.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
In other words, a couple does not have to spend down to $6,000 for one of them to get waiver services.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf The at-home spouse's income is protected too. Our guide to North Dakota Medicaid spousal impoverishment rules walks through how the asset snapshot and the income allowance are calculated.
What the Waiver Covers
The waiver's service list is broad, which is what lets it substitute for a nursing home across a range of situations. Covered services include:Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND
- Personal care in several forms, including waiver personal care, extended personal care, and family personal care
- Homemaker and chore services
- Respite care, so a family caregiver can take a break
- Adult day care
- Adult foster care and adult residential care
- Home-delivered meals
- Non-medical transportation
- Companionship and case management (HCBS care coordination)
- Emergency response systems
- Environmental modifications and home alterations
- Community transition services, supported employment, and residential habilitation
- Specialized equipment and supplies
Not every person on the waiver uses every service. Federal rules for 1915(c) waivers require a written person-centered service plan built on an assessment of the person's functional needs, and the plan must be reviewed at least every 12 months, when the person's needs change significantly, or when the person asks.U.S. Government Publishing Office. (n.d.). 42 CFR 441.301 — Contents of request for a waiver (eCFR, current). ecfr.gov. Retrieved Oct 2, 2026, from https://www.ecfr.gov/current/title-42/section-441.301
The waiver also limits what it spends on each person. North Dakota's waiver application caps the cost at the highest monthly rate allowed to a nursing facility within North Dakota Health and Human Services' rate-setting structure, and those rates are published once a year. The state allows a reasonable modification above that cap with prior approval by Program Administration, and every person on the waiver may ask for one.Centers for Medicare & Medicaid Services. (1915). North Dakota Waiver Factsheet - Medicaid.gov (all ND 1915(c) waivers, active and terminated). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND
How to Apply and What Enrollment Involves
Applying for the waiver runs on two tracks that come together: qualifying for Medicaid financially, and being assessed for the waiver itself.
Medicaid eligibility in North Dakota is determined through your local Human Service Zone office, which handles the income, asset, and other financial rules.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf Federal rules require the state to let you apply for Medicaid through more than one channel: online, by phone, by mail, or in person.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Once you apply, federal timeliness standards cap how long the agency may take to decide: no more than 45 days for most applicants, and no more than 90 days for people who apply on the basis of a disability.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 Those are outer limits, not a promised turnaround, and they can be exceeded in unusual circumstances, such as when the applicant or an examining physician delays a required step. The agency must record the reasons for any delay in your case record, and it may not use the time limits as a waiting period or as a reason to deny you.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912
For the waiver side, including the level-of-care assessment and the covered services, contact North Dakota Health and Human Services, Medical Services Division, at 1-800-755-2604 (toll-free) or 701-328-7068.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND Ask about the level-of-care assessment and HCBS care coordination when you call. Because a state can cap enrollment in a waiver, ask ND HHS about current availability and timelines rather than assuming a slot is open or unavailable.U.S. Government Publishing Office. (n.d.). Electronic Code of Federal Regulations (ecfr.gov) - 42 CFR 440.210, required services for the categorically needy. ecfr.gov. Retrieved Sep 4, 2026, from https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?chapter=IV&subchapter=C&part=440§ion=440.210 For a step-by-step walkthrough of the Medicaid application itself, see how to apply for North Dakota Medicaid.
Frequently Asked Questions
Is the HCBS Waiver the same as nursing-home Medicaid?
No. Both serve people who meet a nursing-facility level of care, but the HCBS (home- and community-based services) Waiver pays for care delivered at home or in a community setting, while nursing-home Medicaid pays for care inside a facility. The waiver gives someone who meets that level of care the option of support at home or in the community when their needs can be met there.Centers for Medicare & Medicaid Services. (n.d.). North Dakota Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND If a facility is the better fit, our guide to North Dakota Medicaid and nursing home care covers that path.
Can a family member be paid to provide care through the waiver?
Yes, and the route depends on whether you live together. Through the waiver's Family Personal Care service, the person can choose a spouse or a parent, grandparent, adult child, adult sibling, adult grandchild, adult niece or adult nephew as the paid provider, but payment goes only to legal spouses or family members who reside in the same home, and the relative must enroll as a Qualified Service Provider (QSP).Centers for Medicare & Medicaid Services. (1915). North Dakota Waiver Factsheet - Medicaid.gov (all ND 1915(c) waivers, active and terminated). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND A relative who does not live with the person can be paid under the waiver's Waiver Personal Care service, because relatives and legal guardians qualify by meeting the same provider qualifications as anyone else. A live-in relative cannot provide Waiver Personal Care and must use Family Personal Care instead.North Dakota Health and Human Services. (1915). Application for 1915(c) HCBS Waiver: ND.0273.R06.07 - Jan 01, 2026 (North Dakota consolidated HCBS waiver, Appendix C-1/C-3 and C-2-d/C-2-e) - hhs.nd.gov. hhs.nd.gov. Retrieved Oct 14, 2026, from https://www.hhs.nd.gov/sites/default/files/documents/Adult%20and%20Aging/1915c-hcbs-waiver-2026-exclusion.pdf Our guide to North Dakota Family Personal Care covers its hours and rules, and how to get paid as a family caregiver in North Dakota compares every route.
Does North Dakota have a waiting list for the HCBS Waiver?
A waiver lets a state cap enrollment, which is what produces waiting lists in some states.U.S. Government Publishing Office. (n.d.). Electronic Code of Federal Regulations (ecfr.gov) - 42 CFR 440.210, required services for the categorically needy. ecfr.gov. Retrieved Sep 4, 2026, from https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?chapter=IV&subchapter=C&part=440§ion=440.210 In its January 2026 renewal application, North Dakota told federal regulators it does not have a waiting list for waiver services.Centers for Medicare & Medicaid Services. (1915). North Dakota Waiver Factsheet - Medicaid.gov (all ND 1915(c) waivers, active and terminated). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND Availability can change, so ask ND HHS about current openings when you apply.
My spouse needs the waiver but I do not. Do we have to spend down to $6,000?
No. The $6,000 figure is the asset limit for a two-person Medicaid unit. When only one spouse needs long-term care, North Dakota applies the spousal impoverishment rules: the at-home spouse's standard share is half the couple's countable assets, at least $32,532 and no more than $162,660 (N.D.A.C. 75-02-02.1-24), and a court order or fair hearing can raise it.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf See North Dakota Medicaid spousal impoverishment rules for how the calculation works.
How is income counted if it is above the basic Medicaid limit?
North Dakota does not use a hard income cap for long-term-care Medicaid. Instead it applies a medically needy spend-down and a recipient-liability approach, which can let a person with income above the basic level still qualify by putting part of that income toward the cost of their care. ND HHS sets the aged, blind and disabled income level at $1,197 a month for one person (effective April 1, 2026), and someone over it who has a medical need can still get coverage with a client share.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): SSI resource standard, CSRA minimum/maximum, Minimum Monthly Maintenance Needs Allowance. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf The North Dakota Medicaid income and asset limits guide explains how the spend-down works in more detail.
Learn More
Find personalized help arranging North Dakota Medicaid home care 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.
Still have questions?
Brevy answers from this guide and every other guide here, and can check what you qualify for.