North Dakota Medicaid Personal Needs Allowance (2026)

In North Dakota, a Medicaid nursing home resident keeps a protected slice of their monthly income. The rest goes toward the cost of care. North Dakota deducts that protected slice first and publishes it as the nursing care income level: $118 a month, effective July 1, 2026.1 Federal rules call the money a resident keeps a personal needs allowance,2 and North Dakota law requires one and reviews it every year for inflation, but the state publishes no 2026 dollar figure under that name.1

In This Guide

• What Is the North Dakota Medicaid Personal Needs Allowance?
• How the North Dakota Medicaid Personal Needs Allowance Compares to the Federal Floor
• How the Resident Trust Fund Holds the Money
• Patient Liability: Where the Allowance Fits in the Math
• What the Facility Must Provide and Cannot Bill to the Allowance
• If You're a Veteran: the VA Pension Cap
• Frequently Asked Questions
• Learn More

What Is the North Dakota Medicaid Personal Needs Allowance?

When someone moves into a nursing facility and North Dakota Medicaid starts paying for their care, they don't hand the nursing home a rent check the way you might expect. Instead, almost all of their monthly income, Social Security, a pension, an annuity, goes toward the cost of care, and Medicaid covers the rest. The one piece of income the resident is allowed to keep for themselves is the personal allowance this guide is about.

The idea is simple and humane. A person living in a nursing home still needs money that's truly their own, for a haircut, a birthday card, a phone plan, a favorite snack, new clothes, a magazine subscription. Federal law requires every state to protect a small monthly amount for exactly this purpose, so that a resident's entire income doesn't disappear into the cost of care and leave them with nothing to spend on their own life.2

North Dakota protects that money through its post-eligibility rules. Before any of a nursing facility resident's income is applied to the cost of care, the state deducts the nursing care income level first, and what it deducts stays with the resident. That figure is $118 a month, effective July 1, 2026.1 It applies to people whose long-term care is paid by North Dakota Medicaid, which is administered by North Dakota Health and Human Services with eligibility handled through county Human Service Zones.1 You don't apply for it separately. Once a resident qualifies for Medicaid long-term care and the state works out how much of their income goes to the facility, the $118 is carved out first.

There's a naming wrinkle here worth knowing about, because it changes what you should ask for. Most states call this money the Personal Needs Allowance, and North Dakota law uses that name too: House Bill 1485 raised the state's personal needs allowance by $15 a month beginning July 1, 2025 and directs that it be reviewed and adjusted every year for inflation using the Consumer Price Index, and North Dakota HHS gave public notice that it would submit a State Plan Amendment to update the personal needs allowance effective July 1, 2026.1 But the figure the state actually publishes for nursing facility residents is the nursing care income level in the ND Medicaid Policy Manual, and that manual never uses the phrase personal needs allowance. So this guide gives you the figure North Dakota actually publishes, under the name the state gives it, rather than telling you the two labels are one and the same instrument when no state source says so. If the exact wording matters in your situation, ask your county Human Service Zone to confirm the current personal needs allowance figure in writing.

One thing worth being clear about: this protected money is for personal spending, not for medical costs. Medicaid and Medicare already cover the resident's care, and the allowance sits on top of that. It's the money a resident controls, the small margin of independence the program is designed to preserve.

How the North Dakota Medicaid Personal Needs Allowance Compares to the Federal Floor

Every state has to protect at least a federal minimum, and North Dakota chooses to protect more. Under federal law, the Personal Needs Allowance floor is just $30 a month for an institutionalized individual and $60 a month for an institutionalized couple when both spouses are aged, blind, or disabled and their incomes are counted as available to each other. Those amounts haven't changed since the Omnibus Budget Reconciliation Act of 1987 added the floor to federal law, effective for calendar quarters beginning on or after July 1, 1988.2 The law sets an allowance that is "not less (and may be greater) than" that minimum, so states are free to protect a higher amount.2

North Dakota's $118 is nearly four times the federal minimum.1,2 Just as important, North Dakota did something the federal government hasn't: it built in an inflation adjustment. House Bill 1485 raised the state's personal needs allowance by $15 a month effective July 1, 2025, and the same law directs that the amount be reviewed and adjusted each year based on the Consumer Price Index.1 The published nursing care income level runs on the same July 1 cycle, and the current $118 took effect July 1, 2026.1 That matters over time. A frozen $30 buys far less today than it did in 1988, while a figure that tracks inflation holds its value year after year.

Because North Dakota's figure re-indexes around July 1 each year, it's worth confirming the current amount with your county Human Service Zone if you're reading this well after the 2026 adjustment. The mechanism is fixed in state law; the dollar figure moves.

How the Resident Trust Fund Holds the Money

Once North Dakota has protected the $118, where does it actually go?1 It can go into what's usually called a resident trust fund at the nursing facility, but that is the resident's choice. A resident has the right to manage their own financial affairs, and a facility can't require a resident to deposit personal funds with it. If the resident does choose to deposit money with the facility and authorizes it in writing, federal rules require the facility to act as a fiduciary, a careful custodian, rather than just mixing the money into its own accounts.3

Here's what those federal rules, at 42 CFR 483.10(f)(10), require of the facility:

• For a Medicaid resident, any balance above $50 has to sit in an interest-bearing account that's separate from the facility's operating money.3
• The facility must keep a full, separate accounting of each resident's funds, with no commingling with the facility's own money or anyone else's except another resident's.3
• The facility must make the resident's financial record available through a statement every quarter and on request.3
• The facility has to secure all resident funds with a surety bond or another assurance that satisfies federal regulators.3
• For a Medicaid resident, the facility must give notice when the account reaches $200 less than the SSI resource limit for one person, and warn that the resident could lose Medicaid or SSI eligibility if that balance plus their other countable resources reaches the limit.3
• When a resident is discharged, evicted, or dies, the facility must convey the remaining funds and a final accounting within 30 days: to the resident, or after a death to the person or probate court administering the estate, following state law.3

The practical takeaway for families is to treat that quarterly statement as something you actually read, not something that gets filed away unopened. Check it against what you know the resident spent. If a haircut, a set of new clothes, or a phone bill shows up that no one authorized, that's worth a question. And keep the final accounting after a discharge or a death; it's the record of exactly what happened to the resident's money.

Patient Liability: Where the Allowance Fits in the Math

To see why the $118 matters, it helps to understand how North Dakota decides how much of a resident's income goes to the nursing home. That amount is called the resident's patient liability, sometimes the recipient liability or share of cost, and the protected allowance is the very first thing subtracted before it's calculated. North Dakota uses a recipient-liability model rather than a strict income cap.1

The calculation works, in order, roughly like this:

1. Start with the resident's gross monthly income, everything coming in, such as Social Security, a pension, an annuity, or VA benefits.
2. Subtract the nursing care income level of $118, the money the resident keeps for themselves.1
3. If the resident has a husband or wife still living at home, or another family member, subtract the amounts of income provided to them for maintenance needs. For a spouse at home who isn't on Medicaid, North Dakota's income level is the federal minimum, $2,705 a month effective July 1, 2026, or a higher amount if a court or hearing officer orders one, and income counts toward it only to the extent the resident actually makes it available to that spouse.1,5
4. Subtract health-insurance premiums (such as a Medicare Part B premium), long-term-care insurance premiums, documented medical or remedial care expenses that no third party will pay, and the cost of a guardian or conservator, up to 5% of countable gross monthly income.1,2
5. What's left is the patient liability, the amount the resident pays the nursing home each month toward the cost of care. Medicaid pays the rest.1

Consider a resident whose only income is a monthly Social Security check, with no spouse at home and a Medicare Part B premium coming out of that check. Subtract the $118 first, then the Part B premium, and the remainder is what they owe the facility, while the $118 stays with the resident to spend as they choose.1 The allowance doesn't reduce the resident's income on paper, but it does make sure that a fixed, protected slice never reaches the facility.

What the Facility Must Provide and Cannot Bill to the Allowance

A common and costly misunderstanding is that this allowance is supposed to cover everyday care items, soap, laundry, the basics of daily hygiene. It isn't. Federal rules list seven categories of items and services that are included in the facility's Medicare or Medicaid per-diem rate, and during a covered stay the facility must not charge the resident for them.6

Under 42 CFR 483.10(f)(11)(i), those seven categories are:

• Nursing services
• Food and nutrition services
• An activities program
• Room and bed maintenance services
• Routine personal hygiene items and services, including (but not limited to) a comb and brush, bath soap, a razor and shaving cream, a toothbrush, toothpaste and dental floss, deodorant, tissues, moisturizing lotion, over-the-counter drugs, hair and nail hygiene services, bathing assistance, towels and washcloths, incontinence care and supplies, and basic personal laundry
• Medically-related social services
• Hospice services the resident elects, when Medicare's hospice benefit or Medicaid pays for them

More broadly, a facility must not charge a resident's personal funds for any item or service Medicaid or Medicare pays for, apart from applicable deductibles and coinsurance, so none of these may be charged against the resident's $118.6,1

The rule runs the other way too. A facility may charge a resident's funds for items such as a telephone, a TV or personal computer, personal clothing, reading matter, gifts bought for the resident, flowers, social events and entertainment outside the activities program, cosmetic and grooming items beyond what Medicaid covers, a privately hired nurse or aide, or a private room that isn't therapeutically required. But it can do so only if the resident asked for the item, it isn't needed to meet the goals in the resident's care plan, the facility said up front there would be a charge, and Medicare or Medicaid isn't paying for it.6 That's the point of the distinction: the allowance is for the resident's own choices and comforts, a preferred brand of shampoo, a trip out for lunch, a gift for a grandchild, not a way for the facility to shift the cost of basic care onto the resident's pocket money. If you see charges to a resident's trust fund for standard hygiene items or laundry, that's a sign to ask the facility for an explanation and, if needed, raise it with the long-term care ombudsman.

If You're a Veteran: the VA Pension Cap

Veterans and their families run into a rule here that surprises almost everyone, so it's worth explaining slowly. If a veteran receives a VA pension, the needs-based benefit for wartime veterans, and then enters a nursing facility where Medicaid is paying for care, federal law limits how much of that pension the VA will keep paying.

Under 38 U.S.C. 5503(d)(2), a veteran who has neither a spouse nor a child, and who is covered by Medicaid for nursing-facility services, may not be paid more than $90 a month in VA pension for any period after the month of admission to the nursing facility. The same limit applies to a surviving spouse with no child and to a child entitled to a VA survivors pension.4 VA's own regulation, 38 CFR 3.551(i), words the start differently: no more than $90 is paid for any period after the month in which the Medicaid payments begin. When Medicaid is approved months after admission, those two months differ, so confirm with VA which month the reduction starts from rather than working out a back amount yourself.4 Either way, a veteran isn't liable to repay pension VA failed to reduce, unless the veteran willfully concealed information VA needed to make the reduction.4

That sounds like a loss, and it's understandably alarming to families the first time they hear it. The same law also says the payment the nursing facility receives from Medicaid can't be reduced by any of the pension the veteran is permitted to keep.4

The same subsection also limits which facilities it covers, and that is easy to miss. 38 U.S.C. 5503(d)(1)(B) defines nursing facility, for purposes of this rule, to exclude a state home for which the VA makes per diem payments for nursing home care under 38 U.S.C. 1741(a), so a Medicaid-covered veteran living in that kind of state veterans home is outside the $90 cap.4 Which category a facility falls into is a question to settle at admission, not after the first patient-liability notice arrives.

What that law doesn't say is how the $90 sits next to the $118 North Dakota protects. It never mentions a personal needs allowance at all. The $90 cap comes from federal veterans law and the $118 comes from North Dakota Medicaid's income levels, and it is state Medicaid policy, not the federal statute, that decides whether a resident ends up holding both or receives the $90 in place of the state figure. States answer that in opposite directions, so North Dakota's treatment isn't something to assume either way. Ask the county eligibility worker how the pension is being counted, and check the patient-liability figure on the eligibility notice, which is where the answer actually shows up.4,1

The $90 rule is written for a veteran who has neither a spouse nor a child, so a veteran who has a spouse or a dependent child falls outside it.4 A married veteran should have both a VA-accredited representative and a Medicaid eligibility worker look at the specific circumstances before assuming any figure.

Learn More

Find personalized help understanding the North Dakota Medicaid Personal Needs Allowance 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.