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 normally no more than $162,660 unless a fair hearing or court order sets more, plus enough of the other spouse's income to reach $2,705.00 a month, the federal minimum North Dakota uses.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-5.3,2 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 standard allowance runs up to the federal maximum rather than a lower state figure. 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 beginning of the institutionalized spouse's first continuous period of institutionalization (or of home and community-based services), typically the day of admission for a stay expected at the outset to last at least 30 days in a row, even if it ends sooner.2,3

The snapshot date matters because the spousal share, half the total, is fixed as of that date, not as of the Medicaid application. At application the couple's resources are counted again, and whatever is above the community spouse's allowance counts toward the institutionalized spouse.3 Bank and brokerage statements from around the snapshot 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 the federal minimum and maximum resource standards.2

For 2026:

• Minimum resource standard: $32,532 (if half the assets is less than this, the community spouse still keeps $32,532)1
• Maximum resource standard: $162,660 (if half the assets exceeds this, the standard allowance stops at $162,660, unless a fair hearing or court order sets more)1

North Dakota uses the federal maximum rather than electing a lower state figure, so the half-share formula runs all the way to $162,660.2 That is the top of the standard formula, not an absolute limit. North Dakota's rule defines the amount the community spouse may keep as the spousal share plus any amount transferred under a court order or set at a fair hearing. A hearing must be held within 30 days of the request, and it raises the allowance when the assets she keeps would produce too little income to bring her to the $2,705.00 monthly allowance, but only after all of the institutionalized spouse's income that could go to her has been counted first.2,3 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.3 Anything North Dakota's rule does not exclude counts, including:2

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Non-home real estate

Assets that are exempt from the snapshot include the primary home, one vehicle, household goods and personal effects, and irrevocable burial plans.2 How retirement accounts are treated is covered in 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

Some national guides quote the federal maximum here. North Dakota uses the federal minimum:

• 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

A pension or Social Security check in the community spouse's name is not part of the nursing facility bill. The patient liability is figured from the institutionalized spouse's income, and the income allowance below is measured against what the community spouse already receives: it is the amount by which the $2,705.00 allowance exceeds her own monthly income.2,3

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.3

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). Next comes the amount diverted to the community spouse to reach the MMMNA floor, and only then health insurance premiums such as Medicare Part B and the other allowable deductions. 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, $1,205.00 is diverted to the community spouse to close her shortfall, and then the Medicare Part B premium and other allowable deductions are subtracted. What is left 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

Can Shelter Costs Lift a North Dakota Community Spouse Toward $4,066.50?

The federal formula builds the allowance from a floor plus an excess shelter allowance, the part of the community spouse's rent or mortgage, property taxes, homeowners insurance and utilities above a set threshold, up to the $4,066.50 federal cap.3,1 North Dakota's written rules don't describe that step. Its rule defines the community spouse's monthly maintenance needs allowance only as the minimum amount federal law permits, and the ND Medicaid Policy Manual sets the income level for an ineligible community spouse at a flat $2,705 a month, or a higher amount if a court or hearing officer orders one. Neither mentions rent, mortgage, taxes, insurance, utilities or a shelter-cost calculation, and neither says a shelter allowance is added to the $2,705 or ruled out.2

So build the at-home spouse's budget on $2,705.00 a month, and ask your county Human Service Zone whether her housing costs can raise it before counting on anything more. The routes above $2,705 that North Dakota's rules do spell out are a court order, or a fair hearing where either spouse shows she needs more income because of exceptional circumstances resulting in significant financial duress.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.2

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, however modest the rest of their finances, though they may still qualify for other Medicaid benefits, and a reverse mortgage or home equity loan can bring the equity back under the limit.2 That figure sits at the federal minimum; a state may elect up to $1,130,000, and North Dakota has not.4

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.5

North Dakota applies a 60-month lookback on uncompensated asset transfers. Transferring the home within that window can create a penalty period, but a transfer of the home to your spouse, or to a son or daughter under 21 or who is blind or disabled, is exempt, and the institutionalized spouse may transfer assets up to the CSRA to the community spouse without penalty, as soon as practicable after eligibility is determined.2,3 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 motor vehicle, household goods and personal effects, and irrevocable burial plans are all excluded under North Dakota's resource rules.2

• Primary residence (the equity limit does not apply while the community spouse lives there)
• One motor vehicle
• Household goods and personal effects (furniture, clothing, appliances)
• Irrevocable burial plans

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. Either spouse can ask for it at the beginning of the stay, and the state must assess and document the snapshot total and give each spouse a copy with notice of the right to a fair hearing; when the request is not part of an application, federal law lets the state charge a fee covering its reasonable cost. Asking at admission gets the total documented while the statements are freshest.3

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.7,2 For more on income eligibility, see North Dakota Medicaid eligibility and income limits.

Medicaid Planning Strategies to Consider

Because North Dakota's standard allowance runs to 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 $162,660:1

• Converting countable assets to exempt ones: paying down a mortgage on the community spouse's home, making home repairs, buying an irrevocable burial plan, or purchasing the one excluded vehicle.2
• Community-spouse annuities: converting excess assets above the CSRA into an income stream for the community spouse, using an annuity that an elder law attorney structures to the federal Medicaid annuity rules, which test, among other things, whether it is irrevocable, nonassignable, actuarially sound and paid in equal amounts, and whether the State is named as a remainder beneficiary.8
• Fair hearing on the asset allowance: if the assets the community spouse keeps would produce too little income to bring her to $2,705.00 a month, even after all of the institutionalized spouse's available income is counted, a fair hearing can raise her allowance above $162,660.2,1
• Fair hearing or court order on income: 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 $162,660 should consult a North Dakota-licensed elder law attorney before applying.1

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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.