North Dakota Medicaid Spousal Impoverishment 2026: CSRA Guide

North Dakota Medicaid spousal impoverishment rules protect the at-home spouse when one partner needs nursing facility care. In 2026 the community spouse keeps half the couple's countable assets, at least $32,532 and at most $162,660, plus a monthly income allowance North Dakota sets at the federal minimum of $2,705.00.1,2

How North Dakota Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility or qualifies for a home- and community-based services (HCBS) waiver, North Dakota applies federal spousal impoverishment protections under 42 USC § 1396r-5. These rules divide into two parts: an asset protection for the at-home spouse and an income protection.

North Dakota is a section 209(b) state. That means it uses its own eligibility standards set in the North Dakota Administrative Code (N.D.A.C. 75-02-02.1) rather than the default federal SSI-linked rules. One practical consequence: the institutionalized spouse qualifies for Medicaid through a medically needy spend-down process, not through a hard income cap.2

The spousal protections follow the federal framework, but the elections North Dakota makes inside that framework are what decide the numbers, and they run in opposite directions. On assets, the state's cap is the federal maximum. On income, N.D.A.C. 75-02-02.1-24(1)(e) defines the community spouse's allowance as the minimum amount federal law permits.2

The spouse entering long-term care is called the institutionalized spouse. The spouse who remains at home is the community spouse.

How the CSRA Works in North Dakota

The Community Spouse Resource Allowance (CSRA) is the portion of the couple's countable assets that the community spouse gets to keep when the institutionalized spouse applies for North Dakota Medicaid long-term care coverage.1

The Snapshot Date

Before North Dakota calculates the CSRA, the program takes a snapshot of the couple's total countable assets. The snapshot date is the first day of a continuous period of institutionalization, typically the date the institutionalized spouse enters a nursing facility for a stay of at least 30 continuous days.

The snapshot date matters because the CSRA is based on that frozen figure, not on the couple's asset position at the time of the actual Medicaid application. Banks and brokerage statements from around that date are the key documentation to gather.

The Half-of-Assets Formula

Once the snapshot is taken, North Dakota applies the federal formula: the community spouse keeps half of the couple's total countable assets at the snapshot date, subject to federal minimum and maximum limits.2

For 2026:

• Minimum CSRA: $32,532 (if half the assets is less than this, the community spouse still keeps $32,532)1
• Maximum CSRA: $162,660 (if half the assets exceeds this, the community spouse keeps $162,660)1

North Dakota caps the CSRA at the federal maximum rather than electing a lower state figure, so the half-share formula runs all the way to $162,660 before it stops.2 It is still a half-share, though: a couple with $60,000 in countable assets protects $32,532, the floor, not $162,660.1

A worked example illustrating the formula:

The figures below are hypothetical and shown only to illustrate how the calculation works. They are not a real case and not a prediction of your own result.

A couple in Bismarck has $120,000 in joint savings and a $60,000 CD. Total: $180,000. Half of that is $90,000, which falls between the $32,532 floor and the $162,660 ceiling, so the community spouse keeps $90,000.1

The institutionalized spouse's share is $90,000. North Dakota limits a one-person unit to $3,000 in countable assets under N.D.A.C. 75-02-02.1-26, higher than the $2,000 federal SSI resource standard. The remaining assets above $3,000 must be spent down before Medicaid eligibility is established.2

What Counts as a Countable Asset?

Both spouses' assets are pooled for the snapshot regardless of whose name is on the account. Countable assets generally include:

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Both spouses' IRAs and 401(k)s
• Cash value of life insurance above the state's exclusion limit
• Non-home real estate

Assets that are exempt from the snapshot include the primary home, one vehicle, household goods and personal effects, and prepaid burial contracts. See the exempt assets section below.

How the North Dakota Medicaid Spousal Impoverishment MMMNA Works

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the income protection for the at-home spouse: the monthly income a community spouse is brought up to when their own income falls short of it.1

This is the figure most often gotten wrong for North Dakota, because national guides present it as a range a state picks from. North Dakota picks the bottom of that range and stays there:

• North Dakota's MMMNA: $2,705.00/month, the federal minimum effective 7/1/2026 through 6/30/2027.2,1
• Above it: only on the order of a court or hearing officer.2
• The federal maximum of $4,066.50/month: a ceiling on what a state may allow, not a figure North Dakota uses.1,2

The Name-on-the-Check Rule

Under federal law (42 USC § 1396r-5(b)(2)), the community spouse keeps all of her own income regardless of amount. A pension or Social Security check in the community spouse's name stays hers in full. Income belonging to the community spouse is hers alone.

Only the institutionalized spouse's income flows toward the nursing facility cost.

Income Diversion

When the community spouse's own income falls below the MMMNA floor, North Dakota allows an income diversion from the institutionalized spouse's income to bring the community spouse up to the floor.

The institutionalized spouse's income is reduced first by North Dakota's nursing care income level, the money the resident keeps for themselves ($118/month effective July 1, 2026, re-set each July 1 and reviewed annually for inflation under House Bill 1485), then by the Medicare Part B premium and other allowable deductions. From the remainder, enough is diverted to the community spouse to reach the MMMNA floor. The net remaining amount is the patient liability, paid to the nursing facility. North Dakota Medicaid covers the facility balance.2

Worked example illustrating income diversion:

The figures below are hypothetical and shown only to illustrate how the calculation works. They are not a real case and not a prediction of your own result.

Suppose the community spouse receives $1,500/month from Social Security. The MMMNA floor is $2,705.00/month, so her shortfall is $1,205.00/month. The institutionalized spouse receives $2,400/month from pension and Social Security. After the $118 the resident keeps, the Medicare Part B premium, and other allowable deductions are subtracted, enough of the remainder is diverted to the community spouse to close her shortfall. What is left after the diversion is the patient liability paid to the nursing facility, and North Dakota Medicaid covers the rest.1,2

In this example, the community spouse moves from $1,500/month up to the $2,705.00/month MMMNA floor.1

Why Excess Shelter Costs Do Not Lift a North Dakota Community Spouse to $4,066.50

In many national explainers, a community spouse with high rent, mortgage, property taxes, homeowners insurance, and utilities can argue her allowance up from the floor toward the $4,066.50 federal maximum. Do not plan on that here. North Dakota's own rule defines the community spouse's monthly maintenance needs allowance as the minimum amount federal law permits, and the ND Medicaid Policy Manual sets the income level for an ineligible community spouse at $2,705 a month, or a higher amount only if a court or hearing officer orders one.2

The practical consequence is a budgeting one, and it is worth being blunt about. A household that plans around $4,066.50 a month is planning on money North Dakota will not release. Build the at-home spouse's budget on $2,705.00, and if that genuinely will not cover her needs, the route to more is a fair hearing or a court order, not a shelter-cost worksheet.2,1

The Home and Home Equity in North Dakota

The primary residence is excluded from the resource count as long as the community spouse lives there. Home equity then works differently from every other asset on this page: excess equity is not counted as a resource, it bars coverage outright.

North Dakota's home-equity limit is $752,000 for anyone applying for Medicaid coverage on or after January 1, 2026, up from $730,000 in 2025.2 An applicant whose equity interest in the home exceeds it is not eligible for skilled nursing, swing-bed, or home and community-based services at all, however modest the rest of their finances.2 That figure sits at the federal minimum; a state may elect up to $1,130,000, and North Dakota has not.3

For the couples this page is about, though, the bar usually does not bite. It does not apply at all where the applicant's spouse, a child under 21, or a blind or disabled child of any age lawfully resides in the home, so a community spouse living in the house takes the equity limit off the table.2 The limit is re-indexed each year under N.D.A.C. 75-02-02.1-28 by the Consumer Price Index for all urban consumers, all items, so confirm the current figure with your county Human Service Zone if the house is worth anywhere near it.2 Looking ahead, a 2025 federal law (the One Big Beautiful Bill Act, Public Law 119-21) caps what a state may elect at a flat $1,000,000 for non-agricultural homes from January 1, 2028, while a home on a lot zoned for agricultural use stays under the indexed rules.3

North Dakota applies a 60-month lookback on uncompensated asset transfers. Transferring the home within that window can create a penalty period. If protecting the home from eventual estate recovery is a concern, consult a North Dakota elder law attorney.2

Assets That Are Exempt

Beyond the home, North Dakota exempts several asset categories from the Medicaid eligibility calculation: the home (subject to the home-equity limit), one vehicle, household goods, and prepaid burial are all excluded under North Dakota's resource rules.2

• Primary residence (equity up to the current annual limit while the community spouse lives there)
• One vehicle used for transportation
• Household goods and personal effects (furniture, clothing, appliances)
• Prepaid irrevocable burial contracts
• Burial plots for the applicant and immediate family

How retirement accounts (IRAs, 401(k)s) held by either spouse are treated is not something to assume either way. Confirm it with North Dakota HHS or a local elder law attorney before you count on an answer.

North Dakota Medicaid Spousal Impoverishment and the Application Process

Who Administers This

North Dakota Medicaid for long-term care is administered by North Dakota Health and Human Services (ND HHS), with eligibility processed through county Human Service Zones. The CSRA and MMMNA are calculated as part of the nursing home Medicaid application.2

How to Request a Resource Assessment

A couple does not need to file a full Medicaid application to request a resource assessment. Requesting it at the time of nursing facility admission preserves the snapshot when documentation is freshest, so ask for it then rather than waiting until you are ready to apply.

The Application Process

North Dakota Medicaid long-term care applications generally follow these steps. For a full walkthrough, see the North Dakota Medicaid how-to-apply guide.

Where to Get Help

North Dakota's 209(b) Spend-Down Model

Because North Dakota is a 209(b) state using its own eligibility standards, the institutionalized spouse qualifies for long-term care Medicaid through a spend-down process: federal rules require a 209(b) state to let applicants deduct incurred medical expenses from income to reach the eligibility level, so excess income is applied toward care costs each month rather than locking the applicant out.2 That is the cliff a Qualified Income Trust, or Miller Trust, exists to get around in income-cap states, and North Dakota does not have it. For more on income eligibility, see North Dakota Medicaid eligibility and income limits.

Medicaid Planning Strategies to Consider

Because North Dakota caps the CSRA at the federal maximum rather than a lower state figure, couples start from a solid baseline. Cases where additional planning may help include situations where countable assets substantially exceed the $162,660 ceiling:1

• Converting countable assets to exempt ones: paying down a mortgage on the community spouse's home, making home repairs, prepaying burial contracts, or purchasing a vehicle.
• Community-spouse annuities: converting excess assets above the CSRA into an income stream for the community spouse, using an irrevocable, actuarially sound annuity that meets Deficit Reduction Act 2005 requirements.
• Fair hearing or court order: North Dakota raises a community spouse's monthly maintenance needs allowance above $2,705.00 only on the order of a court or hearing officer, so that is the route when the allowance leaves the at-home spouse genuinely short.2

For broader planning options, see Medicaid planning strategies.

Couples with significant assets above the CSRA ceiling should consult a North Dakota-licensed elder law attorney before applying.

Learn More

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.