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, and North Dakota applies the full federal CSRA range.

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. No Miller Trust is required.

The spousal protections, however, follow the federal framework. The community spouse's asset and income protections are set under the same federal rules that apply in most other states.

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.

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.

For 2026:

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

North Dakota applies the federal maximum, meaning North Dakota couples receive the maximum protection the law allows.

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.

The institutionalized spouse's share is $90,000. North Dakota allows a single applicant up to $3,000 in countable assets (note: this is North Dakota's own standard under N.D.A.C. 75-02-02.1-26, which is higher than the $2,000 federal default). The remaining assets above $3,000 must be spent down before Medicaid eligibility is established.

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 $1,500 face value
• 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. It sets a floor and ceiling on how much monthly income the community spouse may keep.

For 2026, North Dakota applies:

• Floor (minimum MMMNA): $2,643.75/month (effective 7/1/2025 through 6/30/2026)
• Ceiling (maximum MMMNA): $4,066.50/month (effective 1/1/2026 through 12/31/2026)

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. If she receives a pension of $3,200/month, she keeps every dollar. 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 by the Personal Needs Allowance ($115/month in North Dakota, per N.D.A.C. 75-02-02.1-40), Medicare Part B premiums, and other 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.

Worked example #1 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.

The community spouse receives $1,500/month from Social Security. The MMMNA floor is $2,643.75/month. Her shortfall is $1,143.75/month. The institutionalized spouse receives $2,400/month from pension and Social Security. After the $115 PNA and a $185 Medicare Part B premium, $2,100 is available. Of that, $1,143.75 is diverted to the community spouse. The remaining $956.25 goes to the nursing facility as patient liability. North Dakota Medicaid covers the rest.

The community spouse moves from $1,500/month to $2,643.75/month.

Reaching the MMMNA Ceiling

The community spouse can reach the $4,066.50 ceiling if she has excess shelter costs above the federal shelter standard ($793.13/month for 2026). Actual rent, mortgage, property taxes, homeowners insurance, and utilities exceeding $793.13/month raise the allowable income toward the ceiling.

The Home and Home Equity in North Dakota

The primary residence is exempt from Medicaid eligibility calculations as long as the community spouse lives there. The home's equity does not count as a resource.

North Dakota's home equity cap is set annually by state rule under N.D.A.C. 75-02-02.1-28 and adjusted each year. Because the figure is indexed rather than fixed, applicants should confirm the current limit with their county Human Service Zone before relying on any number.

North Dakota applies a 60-month lookback on 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.

Assets That Are Exempt

Beyond the home, other asset categories are excluded from the Medicaid eligibility calculation:

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

Retirement accounts (IRAs, 401(k)s) held by either spouse are typically countable. Confirm current treatment with North Dakota HHS or a local elder law attorney.

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.

How to Request a Resource Assessment

A couple does not need to file a full Medicaid application to request a resource assessment. Requesting the assessment at the time of nursing facility admission preserves the snapshot when documentation is freshest. Apply online through the North Dakota Self Service Portal, at a county Human Service Zone office, or by phone at 1-800-472-2622.

Long-term care facilities are required by federal law to inform residents and their spouses of the right to request this assessment.

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.

1. Gather documentation: bank and brokerage statements at the snapshot date, property records, insurance policies, income statements.
2. Apply online at apply.nd.gov, at a county Human Service Zone, or by phone at 1-800-472-2622.
3. Request a resource assessment early to lock in the snapshot date.
4. ND HHS calculates the CSRA and MMMNA and notifies both spouses.
5. Both spouses have the right to appeal any CSRA or MMMNA determination.

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. Excess income is applied toward incurred medical and care costs each month until Medicaid eligibility is established. No Qualified Income Trust (Miller Trust) is required. This is an important difference from income-cap states, where a trust must be set up before Medicaid will pay. For more on income eligibility, see North Dakota Medicaid eligibility and income limits.

Medicaid Planning Strategies to Consider

North Dakota's federal-maximum CSRA gives couples a solid baseline. Cases where additional planning may help include situations where countable assets substantially exceed the $162,660 CSRA ceiling:

• 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: if the CSRA does not generate enough income to reach the MMMNA, a fair hearing can result in an increased resource allowance.

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

• North Dakota Medicaid Eligibility and Income Limits
• How to Apply for North Dakota Medicaid
• Medicaid Planning Strategies

Find personalized help understanding North Dakota Medicaid spousal impoverishment rules 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.