North Dakota Medicaid Personal Needs Allowance (2026): $115

In North Dakota, a Medicaid nursing home resident keeps $115 a month as a Personal Needs Allowance, money set aside for personal expenses that never goes to the facility. The figure rose from $100 on July 1, 2025, and it now adjusts each year for inflation.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 Needs Allowance.

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.

In North Dakota, that protected amount is $115 a month for a resident of a nursing facility. 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 The allowance isn't something you apply for separately. Once a resident qualifies for Medicaid long-term care and the state calculates how much of their income goes to the facility, the $115 is simply carved out first and kept for the resident.

One thing worth being clear about: the Personal Needs Allowance 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 a couple when both spouses are in a facility. That floor has been frozen since the Omnibus Budget Reconciliation Act of 1987 made it effective in July 1988, and Congress has never raised it or tied it to inflation.2 States are free to set a higher amount, and most do; in 2026, state nursing-facility allowances commonly run anywhere from the $30 floor up to roughly $200.2

North Dakota's $115 puts it comfortably in the upper part of that range, 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. The state raised the allowance from $100 to $115 effective July 1, 2025 under House Bill 1485, and the same law directs that the amount be reviewed and adjusted each year based on the Consumer Price Index.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 the $115 is protected, where does it actually go? For most residents, the nursing facility holds it in what's usually called a resident trust fund. A facility can't force a resident to let it manage their money, a resident always has the right to handle their own finances, but if the resident asks the facility to hold the funds, federal rules require the facility to act as 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, and the interest belongs to the resident.3
• The facility must keep a full, separate accounting of each resident's funds, with no commingling with the facility's own money.3
• The resident (or the family member managing their affairs) is entitled to a statement every quarter, and can ask to see the record at any time.3
• The facility has to secure all resident funds with a surety bond or equivalent assurance, so the money is protected even if the facility runs into financial trouble.3
• When a resident dies, the facility must turn over the remaining balance and a final accounting within 30 days to whoever is handling the estate.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 $115 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 Personal Needs Allowance is one of the first things subtracted before it's calculated. North Dakota uses a recipient-liability model rather than a strict income cap, and it doesn't require the kind of income trust some other states use.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 Personal Needs Allowance of $115, the money the resident keeps for themselves.1
3. If the resident has a husband or wife still living at home, subtract a monthly maintenance needs allowance for that community spouse. Under the federal spousal-impoverishment rules North Dakota follows, that allowance runs from a floor of $2,705.00 a month (effective July 1, 2026) up to a maximum of $4,066.50 a month, depending on the couple's circumstances.1
4. Subtract certain health-care costs the resident still pays out of pocket, such as a Medicare Part B premium or other medical expenses Medicaid doesn't cover.
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.

Consider a resident with $1,700 a month in Social Security, no spouse at home, and a Medicare Part B premium coming out of that check. Subtract the $115 allowance first, then the Part B premium, and the remainder is what they owe the facility, while the $115 goes into their trust fund 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 the Personal Needs Allowance is supposed to cover everyday care items, soap, laundry, the basics of daily hygiene. It isn't. Federal rules make clear that a whole category of routine items and services is already paid for through the facility's Medicaid per-diem rate, and the facility may not turn around and bill the resident, or the resident's allowance, for them.5

Under 42 CFR 483.10(f)(11), the items the facility must provide as part of a covered stay include:

• Nursing services and personal care, including bathing assistance
• Meals and nutrition services
• An activities program
• Room and bed maintenance
• Routine personal hygiene items and services, such as a comb and brush, bath soap, a razor and shaving cream, a toothbrush and toothpaste, moisturizing lotion, hair and nail hygiene, towels and washcloths, incontinence care and supplies, and basic personal laundry
• Over-the-counter drugs and hair-hygiene supplies

Because these are covered by the daily rate, none of them may be charged against the resident's $115.5,1 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 they're admitted.4 That sounds like a loss, and it's understandably alarming to families the first time they hear it. But the same law is careful about what happens to that $90. It's protected for the veteran: the facility's Medicaid payment can't be reduced by the $90, which means the $90 stays with the veteran rather than flowing to the nursing home.4

So a single, childless veteran on Medicaid nursing-facility care keeps the $90 VA pension in addition to North Dakota's $115 Personal Needs Allowance.4,1 These are two separate rules from two separate programs, the $90 cap comes from federal veterans law, and the $115 allowance comes from North Dakota Medicaid, and they don't cancel each other out. If a caseworker or facility ever suggests the VA money should be deducted from the personal allowance, that's worth questioning.

The math is different for a veteran who has a spouse or a dependent child, or who receives VA benefits other than the basic pension, such as Aid and Attendance. Those situations don't follow the flat $90 cap, so a married veteran should have both a VA-accredited representative and a Medicaid eligibility worker look at the specific circumstances before assuming any figure.4

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.