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 or mail or hand form SFN 958 to your county Human Service Zone office. For help applying, call 1-866-614-6005. North Dakota is a 209(b) state that uses a medically needy spend-down rather than a hard income cap, so no Miller Trust is needed.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 process the applications.1 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

A Qualified Income Trust (Miller Trust) is an income-cap-state tool: federal law lets it open eligibility only in a state that covers nursing facility care through a special income level and not through the medically needy pathway.5 North Dakota applies a medically needy income level to nursing-facility residents, so a Miller Trust is not the route here.1 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.1 ND HHS publishes the aged, blind and disabled monthly income level as $1,197 for one person and $1,623 for two, set at 90% of the federal poverty level and effective April 1, 2026.1

In practice: if your monthly income is over that limit and you have a medical need, you can still get coverage with a "client share," the state's name for spend-down. Your county Human Service Zone works out the share, and your incurred medical expenses count toward it.1

Common qualifying spend-down expenses include:

• Nursing facility 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
• Irrevocable burial plans

The home, vehicle, and household-goods 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): anything not excluded under N.D.A.C. 75-02-02.1-28 or 75-02-02.1-28.1 counts toward the limit, whatever form it takes.1 Typical examples:

• Checking and savings accounts
• Certificates of deposit (CDs)
• Stocks, bonds, and non-retirement investment accounts
• The cash surrender value of life insurance
• Retirement accounts, unless your zone finds an exclusion applies

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 counts back 60 months from the first date you are both receiving skilled nursing, swing-bed, or home and community-based care and have applied, and reviews that period for gifts or below-market transfers.1 A transfer for less than fair market value inside that window creates a penalty period during which Medicaid will not pay for nursing facility care or home- and community-based waiver services; the rest of your Medicaid coverage is not withdrawn. Penalty length is calculated by dividing the total uncompensated value transferred by the state's average monthly private-pay nursing facility cost.3 Not every transfer is penalized: a home whose title passes to a spouse, or to a son or daughter who is under 21, blind, or disabled, is exempt, and when ND HHS imposes a penalty it must tell you of your right to ask for an undue-hardship exception.1

Spousal protections. For married couples, the community spouse is allowed a spousal share equal to half the couple's countable assets as of the start of the first continuous period of institutionalization, but not less than $32,532 and not more than $162,660, under N.D.A.C. 75-02-02.1-24.1 That $162,660 caps the spousal share, not what she can end up keeping: a court order or a fair hearing can raise her allowance above it.1 On the income side, start from this: the community spouse keeps all of her own income, whatever the amount, and no figure here caps it.6 What the figure sets is the level her income is raised to when it falls short, by diverting income from the applicant spouse. North Dakota elects the federal minimum for that level: N.D.A.C. 75-02-02.1-24(1)(e) defines a community spouse's monthly maintenance needs allowance as the lowest amount federal law permits, and the ND Medicaid Policy Manual sets the income level for an ineligible community spouse at $2,705 a month effective July 1, 2026. A higher level applies only when a court or a hearing officer orders one, so plan against $2,705 rather than the higher maximum you may see quoted for other states.1

What Documents You'll Need

Gather these before you start. An incomplete application slows the decision down.

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 (recent statements; 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.7 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. 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.7 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.8 For applications made on or after January 1, 2027, federal law shortens that window to two months before the application month for most applicants. The exact start date inside the window is a state-plan choice, and an approved federal demonstration waiver can shorten the window itself, so ask your Human Service Zone how far back your coverage reaches.8
• If your zone requests more documents, respond before the stated deadline. Missing a document-request deadline can lead to a denial.
• If denied, you have the right to appeal.

For help with your application, call the ND HHS Customer Support Center at 1-866-614-6005.1

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. That is the first deduction, not the only one: amounts for a spouse or family member's maintenance needs, health and long-term-care insurance premiums, incurred medical expenses no one else pays, and guardian or conservator costs up to 5% of countable gross monthly income also come off before the rest goes toward the cost of care, with Medicaid covering the balance.1 The $118 is the figure North Dakota publishes for nursing facility residents, and it is far above the $30 federal personal needs allowance floor.8 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, she keeps her own income in full,6 and the Human Service Zone calculates separately how much of the institutionalized spouse's income may be diverted to her under the monthly maintenance needs allowance 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.9

• The designation has to include the applicant's signature.9
• 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.9
• 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.9

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. For most Medicaid decisions, the request must be filed no later than 30 days from the date the notice of action is mailed, under N.D. Admin. Code 75-01-03-06.4 The same rule gives longer windows in two Medicaid situations: six months when coverage was denied or cut off because the Social Security Administration or the state review team denied or ended disability status (counted from the official SSA notice that disability status was approved or reversed), and 120 days from a managed-care organization's notice of resolution for an enrollee whose Medicaid runs through a managed-care plan.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 general Medicaid window at 30.10 (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 only when the hearing request is filed within the timely-notice period, the gap of at least ten days (five in a suspected-fraud case) between the date the notice is mailed and the date the action takes effect. 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
• You may first ask your county Human Service Zone or ND HHS to correct the decision before you request a hearing, but keep the hearing deadline in view while you do.4

North Dakota's Office of Administrative Hearings schedules the hearing, and a hearing officer presides and issues a recommended decision; the final decision is made by the ND HHS executive director or a designee, and the appeals supervisor mails it to you.4 You can present documents and explain your situation. Having an elder law attorney or legal aid representative with you can help, particularly when the denial involves spend-down calculations or look-back penalties.

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.