To apply for North Dakota Medicaid, file online at the ND Self Service Portal, visit your county Human Service Zone office, or call 1-800-472-2622. North Dakota is a 209(b) state that uses spend-down rather than a Miller Trust for income above the medically needy limit.
For current program details, visit North Dakota Health and Human Services.
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 choose the channel; the county zone is the intake point regardless.
Online at the ND Self Service Portal
Go to apply.nd.gov to complete your application online. The ND Self Service Portal lets you submit the application, upload supporting documents, and track status after filing. Creating an account is optional but useful if you want to save progress and receive electronic notices.
Have your financial and identity documents ready before you start. The portal is available around the clock. After you submit, your application routes to the Human Service Zone that covers your county.
In Person at Your County Human Service Zone
North Dakota has Human Service Zones covering all 53 counties. These county-level offices are the primary intake point for Medicaid applications. Staff can help you complete the application, identify which documents are needed, and answer questions about the spend-down process.
To find your zone office, visit hhs.nd.gov and use the county directory. Walk-ins are generally accepted, but calling ahead is a good idea if your situation involves nursing facility placement or a complex financial history.
In-person visits are particularly useful when you have a spend-down situation to document, an asset transfer that occurred within the 60-month window, or spousal impoverishment calculations to work through.
By Phone
Call 1-800-472-2622 to reach ND HHS and be connected to the appropriate Human Service Zone. A representative will walk you through the application questions over the phone or direct you to a local zone office.
Not sure if you qualify? Chat with Brevy's care navigator at brevy.com to check your eligibility before you apply.
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.
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. This is set under N.D.A.C. 75-02-02.1-26.
Exempt assets (not counted):
- The primary home (subject to an annual home equity cap set under N.D.A.C. 75-02-02.1-28; confirm the current figure with your Human Service Zone)
- One vehicle
- Household goods and personal property
- Prepaid burial plans
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.
The 60-month look-back. North Dakota reviews the prior 60 months of financial transactions for any gifts or below-market transfers. 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 may retain up to $162,660 in countable assets (minimum $32,532) under the federal Community Spouse Resource Allowance. The community spouse may also receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) of $2,643.75 to $4,066.50 per month from the institutionalized spouse's income.
What Documents You'll Need
Gather these before you start. Incomplete applications are the most common source of delays.
Identity and citizenship:
- Social Security card or statement
- Birth certificate, U.S. passport, or other citizenship documentation
- North Dakota driver's license or state ID
Income:
- Social Security 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.
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.
- If approved, you will receive a Medicaid eligibility notice and card. Coverage may be backdated to the first day of the application month depending on the program.
- 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 1-800-472-2622 for an update.
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 retains a Personal Needs Allowance of $115/month from their income; the remainder goes toward the cost of care, with Medicaid covering the balance. The $115 PNA is higher than the federal default and is adjusted annually for inflation under N.D.A.C. 75-02-02.1-40.
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. A family member, friend, or legal representative can apply for you.
- A close family member with knowledge of the applicant's finances can generally sign the application directly.
- Someone outside the family who is not a legal representative will need a signed authorization form from the applicant.
- A person with legal authority (power of attorney, legal guardian, or court-appointed conservator) can sign and act as the applicant's representative by providing documentation of that authority.
Once authorized, a representative can submit the application, provide documents, communicate with the Human Service Zone, and receive eligibility notices on the applicant's behalf.
If You're Denied: How to Appeal for North Dakota Medicaid
Applicants who are denied Medicaid have the right to a fair hearing. The denial notice will state the reason for denial and the deadline to request a hearing.
To request a hearing:
- Call 1-800-472-2622 and ask to initiate a fair hearing request.
- Submit a written request to your county Human Service Zone office.
- 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.
Legal aid services are available in North Dakota. Contact Legal Services of North Dakota at legalnd.org or call 1-800-634-5263 for free assistance if you qualify.
Questions about your denial? Talk to Brevy's care navigator at brevy.com for guidance on next steps.
Frequently Asked Questions
No. North Dakota is a 209(b) medically needy state. Applicants with income above the medically needy standard qualify through spend-down, that is, by documenting and deducting incurred medical and care expenses. A Miller Trust (Qualified Income Trust) is not part of North Dakota's Medicaid program and is not required.
A single applicant is limited to $3,000 in countable assets. A couple is limited to $6,000. Both figures are higher than the $2,000 federal default most states apply. The home, one vehicle, household goods, and prepaid burial arrangements are exempt from the count, subject to applicable rules.
A Human Service Zone is North Dakota's county-level Medicaid eligibility office. Unlike states where the state agency processes applications directly, North Dakota routes all long-term care Medicaid applications through these county offices. Your zone office conducts the eligibility interview, reviews your documents, and issues the eligibility decision. Applications submitted online at apply.nd.gov still route to your county zone.
North Dakota applies a 60-month (5-year) look-back to any transfers of assets made for less than fair market value. Gifts, below-market sales, and transfers to trusts within that period can trigger a penalty during which Medicaid will not pay for nursing facility services. The look-back applies to nursing facility and HCBS waiver applications.
A nursing facility resident keeps $115 per month from their income as a Personal Needs Allowance. This is higher than the federal floor and is adjusted annually for CPI under N.D.A.C. 75-02-02.1-40. The remainder of income goes toward the cost of care, with Medicaid covering the balance.
Report changes to your county Human Service Zone promptly. North Dakota requires Medicaid recipients to report changes in income, assets, and household composition. A change can affect your spend-down obligation or overall eligibility. Failure to report changes may result in an overpayment and a repayment obligation.
Learn More
- North Dakota Medicaid Eligibility and Income Limits
- Medicaid Planning Strategies
- Medicaid Estate Recovery Explained
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.