How to Apply for North Dakota Medicaid 2026: ND HHS Guide

To apply for North Dakota Medicaid, file online at the ND Self Service Portal, mail or hand form SFN 958 to your county Human Service Zone office, or call 1-866-614-6005. North Dakota is a 209(b) state that uses spend-down rather than a Miller Trust for income above the medically needy limit.1

For current program details, visit North Dakota Health and Human Services.

In This Guide

• Key Takeaways
• How to Apply for North Dakota Medicaid
• How North Dakota's Spend-Down Works (No Miller Trust Needed)
• Before You Apply: Asset Check
• What Documents You'll Need
• What Happens After You File
• Applying as a Nursing Facility Resident
• If You're Denied: How to Appeal
• Where to Get Help Applying
• Frequently Asked Questions
• Learn More

How to Apply for North Dakota Medicaid

North Dakota Health and Human Services (ND HHS) administers Medicaid long-term care eligibility, but county Human Service Zones conduct the actual eligibility interviews and process applications. You pick one of the channels below, and your county zone is the intake point regardless of which you choose. Federal rules require the state to accept an application online, by phone, by mail, in person, or through other common electronic means, so pick whichever channel you can actually manage this week.2

How North Dakota's Spend-Down Works (No Miller Trust Needed)

North Dakota is a 209(b) state operating under a medically needy spend-down model. This is a meaningful difference from income-cap states.1

In an income-cap state, a gross monthly income above a set ceiling bars eligibility unless the applicant establishes a Qualified Income Trust (Miller Trust) to redirect the excess. North Dakota does not require a Miller Trust. Instead, an applicant whose income exceeds the medically needy income standard qualifies by documenting and deducting incurred medical and care costs until net income falls at or below that standard.

In practice: if your monthly income exceeds the medically needy limit, your county Human Service Zone will calculate a monthly spend-down amount. Once you accumulate qualifying medical expenses equal to that amount in a given month, you are eligible for Medicaid coverage for the remainder of that month.

Common qualifying spend-down expenses include:

• Nursing home or assisted living bills
• Prescription drug costs not covered by another payer
• Medicare premiums, deductibles, and copays
• Physician and specialist visits
• Medical equipment and supplies

Keep receipts and billing statements organized by month. Your Human Service Zone will ask for documentation to verify each expense.

If you work with an elder law attorney, ask them to calculate your monthly spend-down obligation before you apply. Getting the figure right the first time avoids delays.

Before You Apply: Asset Check

Your Human Service Zone will review countable assets before approving long-term care Medicaid. North Dakota's asset limits are higher than the federal default: $3,000 for a single applicant and $6,000 for a couple.1 This is set under N.D.A.C. 75-02-02.1-26.

Exempt assets (not counted):

• The primary home
• One vehicle
• Household goods and personal property
• Prepaid burial plans

Those exclusions come from N.D.A.C. 75-02-02.1-28.1

The home equity limit is a different kind of rule, and the direction matters. Equity above the limit does not get added to your countable assets. It bars you from long-term care coverage outright: North Dakota makes an applicant ineligible for skilled nursing, swing-bed, and home- and community-based benefits when their equity interest in the home exceeds $752,000 for anyone applying on or after January 1, 2026 (it was $730,000 in 2025). The limit does not apply at all if a spouse, a child under 21, or a blind or disabled child lawfully lives in the home.1

Countable assets (do count):

• Checking and savings accounts
• Certificates of deposit (CDs)
• Stocks, bonds, and non-retirement investment accounts
• Life insurance with cash surrender value above any exempt threshold
• Most retirement accounts, depending on payout status

If countable assets exceed the limit, you will need to spend them down to the applicable threshold before qualifying. Work with an elder law attorney before transferring any assets. Transfers within the 60-month look-back window can trigger a penalty.3

The 60-month look-back. North Dakota reviews the prior 60 months of financial transactions for any gifts or below-market transfers.3 Transfers that appear to have been made to reduce assets for Medicaid qualification create a penalty period during which Medicaid will not pay for nursing facility services. Penalty length is calculated using the amount transferred and the average monthly private-pay nursing cost in North Dakota.

Spousal protections. For married couples, the community spouse is allowed a spousal share equal to half the couple's countable assets, but never less than $32,532 and never more than $162,660, under N.D.A.C. 75-02-02.1-24.1 On the income side, North Dakota elects the federal minimum: state rule defines the community spouse's monthly maintenance needs allowance as the lowest amount federal law permits, and the ND Medicaid Policy Manual sets it at $2,705 a month effective July 1, 2026. A higher figure applies only when a court or a hearing officer orders one, so plan against $2,705 rather than the $4,066.50 maximum some states allow.1

What Documents You'll Need

Gather these before you start. Incomplete applications are the most common source of delays.

Identity and citizenship:

• Social Security Administration (SSA) card or number
• Birth certificate, U.S. passport, or other citizenship documentation
• North Dakota driver's license or state ID

Income:

• SSA award letter or SSA-1099
• Pension and retirement benefit statements
• Any other monthly income documentation

Assets and financial accounts:

• Bank statements for all accounts (at least the past 3 months; for nursing home or waiver applications, prepare up to 60 months)
• Statements for retirement accounts, CDs, stocks, and bonds
• Life insurance policy documentation (face value and cash surrender value)
• Prepaid burial or funeral contract documentation

Property:

• Property deed and recent tax assessment
• Vehicle registration or title

Medical expenses (for spend-down calculation):

• Medical bills from recent months
• Medicare premium and supplement statements
• Pharmacy receipts

For nursing facility and home- and community-based services (HCBS) waiver applications, prepare five years of bank statements. ND HHS reviews the full 60-month look-back window for these applications.3

How to Apply for North Dakota Medicaid: What Happens After You File

After you submit, your county Human Service Zone reviews the application and may contact you for additional documents or a phone interview.

Federal rules cap how long the state may take to decide. Under 42 CFR 435.912, the eligibility determination may not exceed 45 days for most applicants, or 90 days for applicants who apply on the basis of disability, measured from the date of application.5 Read those as ceilings on the agency rather than a promise about your own case: they are the outside limit the state is held to, not an estimate of how fast your file will move, and long-term care applications that need an asset review and a level-of-care assessment often run closer to the limit than to the first week. The same rule lets the clock slip in unusual circumstances, including when the agency cannot decide because the applicant or an examining physician delays or fails to take a required action.5 That is the practical reason to answer every document request the day it arrives.

• If approved, you will receive a Medicaid eligibility notice and card. Federal law also requires retroactive coverage: once you are found eligible, Medicaid must pay for covered services furnished in or after the third month before the month you applied, if you would have been eligible at that time.6 This three-month window back-stops the wait while your application is processed.
• If your zone requests more documents, respond before the stated deadline. Missing a document request deadline is one of the most common causes of denial.
• If denied, you have the right to appeal.

Check your status at apply.nd.gov if you applied online, or call the ND HHS Customer Support Center at 1-866-614-6005 for an update.1

Applying as a Nursing Facility Resident

If a family member is already in a nursing facility, you can still apply for Medicaid to cover care going forward. Facility social workers often assist with the application and can coordinate with your county Human Service Zone.

Once approved, the resident keeps North Dakota's nursing care income level, $118 a month effective July 1, 2026; the remainder of their income goes toward the cost of care, with Medicaid covering the balance.1 That is the figure North Dakota publishes for nursing facility residents, and it is far above the $30 federal personal needs allowance floor.7 House Bill 1485 raised the state's personal needs allowance by $15 a month from July 1, 2025 and requires an annual inflation review, so expect the number to move each July 1.1

If a community spouse is living at home, the Human Service Zone will calculate how much of the institutionalized spouse's income the community spouse may keep under the MMMNA rules.

Can Someone Else Apply on Your Behalf?

Yes. Federal rules require every state Medicaid agency to let an applicant designate an individual or organization as an authorized representative, at the time of application and at other times.8

• The designation has to include the applicant's signature.8
• A person who already holds authority under state law, such as a power of attorney or a court order establishing legal guardianship, is treated as designated in writing. Bring documentation of that authority.8
• The application itself may also be filed by an adult in the applicant's household or by someone acting responsibly for an applicant who cannot act for themselves.2

Once authorized, a representative may sign the application, complete renewals, receive copies of the applicant's notices and communications, and act for the applicant in all other matters with the agency.8

If You're Denied: How to Appeal for North Dakota Medicaid

Applicants who are denied Medicaid have the right to a fair hearing, and in North Dakota the deadline is short. A request to appeal a Medicaid action must be filed no later than 30 days from the date the notice of action is mailed, under N.D. Admin. Code 75-01-03-06(1).4 The 90-day window you may see quoted elsewhere is the federal ceiling on what a state is allowed to give you, not what North Dakota gives: 42 CFR 431.221(d) caps a state's window at 90 days, and North Dakota set its Medicaid window at 30.9 (The 90-day figure in North Dakota's appeal rule belongs to SNAP food assistance, not Medicaid.)4 Count from the mailing date on the notice, not from the day you opened it.

Filing early matters for a second reason: benefits continue during the appeal when the hearing request is filed within the timely-notice period on the notice, and if you file after that period the human service zone must neither reinstate nor continue aid.4

To request a hearing:

• Call the Appeals Supervisor at the ND HHS Legal Advisory Unit, (701) 328-2311 or toll-free 1-800-472-2622, and file the appeal verbally.4
• Or file in writing by email (dhslau@nd.gov), fax, or mail. Form SFN 162, Request for Hearing, may be used but is not required: your name, your contact information, and the decision or error you are appealing are enough.4
• Submit a written request to your county Human Service Zone office, or ask zone staff in person to document your hearing request.

An independent hearing officer reviews the case. You can present documents and explain your situation. Having an elder law attorney or legal aid representative present is helpful, particularly when the denial involves spend-down calculations or look-back penalties. Free legal aid is available in North Dakota for those who qualify.

Where to Get Help Applying

Learn More

Find personalized help applying for North Dakota Medicaid 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.