North Dakota Medicaid pays for care at home and in the community for older adults and adults with disabilities mainly 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 is designed for people who would otherwise need nursing-facility care but who can stay in their own home, a family member's home, or a community setting with the right support. 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: ND HHS also runs separate waivers for children and for people with intellectual and developmental disabilities, each with its own eligibility rules.
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 approved as waivers rather than as open-ended entitlements, each one is defined by an agreement between the state and the federal government that spells out who is served, what is covered, and how many people can enroll.
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. The state's other current waivers serve children's hospice, children with medically fragile needs, autism, and people with intellectual and developmental disabilities; if the person you are helping falls into one of those groups, start from ND HHS's Medicaid Waivers page instead. North Dakota's Medicaid Waiver for Home and Community Based Services was renewed effective January 1, 2026 and carries the federal identifier 0273.R06.00.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's main path to Medicaid-funded care at home. It exists to serve people who meet a nursing-facility level of care but who can remain safely in the community when the right services are in place.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
Because it is a single statewide waiver for this population rather than a set of regional programs, the same set of covered services and the same eligibility rules apply across North Dakota. The care coordination piece, which the state calls HCBS care coordination, is built into the waiver: a coordinator helps assess needs, build the care plan, and connect the person with providers.
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, that means their day-to-day needs, help with activities like bathing, dressing, eating, moving around, or managing a condition like dementia, are serious enough that they would qualify for nursing-home placement if the waiver did not exist. A state assessment determines whether this bar is met.
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, which means it sets Medicaid long-term-care eligibility under its own resource standards rather than the single "300 percent of SSI" income cap that a lot of states use.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 Rather than a hard income ceiling, the state 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.
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 two-person figure is the limit for a household where both people are seeking coverage. When only one spouse needs long-term care and the other stays at home, North Dakota instead applies the federal spousal impoverishment rules: the at-home spouse is allowed a spousal share equal to 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 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. The care coordinator and the person, along with their family, build an individual plan that draws on the services that fit that person's needs. If the plan later needs to change because the person's condition changes, the coordinator revises it.
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. (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 Federal rules require the state to let you apply for Medicaid through more than one channel: online, by phone, by mail, or in person at a local office.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 applications, and no more than 90 days when eligibility is being decided 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 on the agency, not a promised turnaround.
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 The staff there can explain the current assessment process and connect you with HCBS care coordination. Enrollment capacity on 1915(c) waivers can change over time, so ask ND HHS about current availability and timelines when you call rather than assuming a slot is open or unavailable. 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 exists precisely so that someone who could qualify for a nursing home can receive support in the community instead.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?
The waiver's covered services include family personal care as one of its personal-care options, along with waiver personal care and extended personal 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 Whether a specific relative can be paid, and under what conditions, depends on the program's provider rules, so ask the HCBS care coordinator or North Dakota Health and Human Services how family personal care works in your situation.
Does North Dakota have a waiting list for the HCBS Waiver?
Enrollment in any 1915(c) waiver is defined by an approved capacity, and that capacity can change from year to year. The sources reviewed for this guide do not spell out a current waiting-list status for North Dakota's waiver, so the most reliable step is to ask ND HHS directly about current availability when you apply.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
My spouse needs the waiver but I do not. Do we have to spend down to $6,000?
No. The $6,000 two-person limit applies when both people are seeking coverage. When only one spouse needs long-term care, North Dakota applies the spousal impoverishment rules: the at-home spouse keeps half the couple's countable assets, with a floor of $32,532 and a ceiling of $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 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 is a section 209(b) state, so it does not use a single income cap for long-term-care Medicaid.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 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. The North Dakota Medicaid income and asset limits guide explains how the spend-down works in more detail.
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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.