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, 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.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 three channels below, and your county zone is the intake point regardless of which you choose.

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 (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.2

The 60-month look-back. North Dakota reviews the prior 60 months of financial transactions for any gifts or below-market transfers.2 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 for 2026. The community spouse may also receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the institutionalized spouse's income, set within the federal range of $2,705.00 (the floor effective July 1, 2026 through June 30, 2027) to $4,066.50 (the maximum effective January 1, 2026).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.2

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 calendar days for most applicants, or 90 calendar days for applicants who apply on the basis of disability, measured from the date of application.3 These are ceilings, not promises of speed; long-term care applications that require an asset review and a level-of-care assessment often run closer to the limit.

• 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.4 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 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.1 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. Under federal rules, a state must allow at least a reasonable time, not to exceed 90 days from the date the notice of action is mailed, to request that hearing; North Dakota's own deadline is stated on your notice, so act on the date it gives you.5

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. 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.