Basic Care Assistance Program (BCAP) North Dakota: Eligibility and How It Works

BCAP Fills a Gap That Catches Most Families Off Guard

Here's a scenario that plays out across North Dakota every month: a family places their parent in a basic care facility, the parent's savings deplete over time, and the family discovers that standard Medicaid doesn't cover room and board in basic care — only in skilled nursing facilities. Without another funding source, the parent would need to physically move out of the facility they've settled into.

The Basic Care Assistance Program exists to prevent that outcome. BCAP is an income supplement program that pays the difference between what a basic care resident can afford from their own income and the facility's actual rate. It keeps the parent in place when their private funds run out, which matters enormously for someone whose daily routines, social connections, and sense of stability depend on staying in a familiar environment.

How BCAP Works

BCAP functions as a partnership between the resident, the state, and the licensed basic care facility. The financial mechanics are straightforward:

Step 1: The resident contributes all available income. Social Security, pensions, annuity payments, any regular income — all of it goes to the facility except for two protected amounts.

Step 2: The resident keeps a $153 monthly personal needs allowance. This is the amount the state designates for personal expenses — clothing, toiletries, haircuts, magazines, small personal purchases. The facility cannot touch this money; it belongs to the resident. For comparison, nursing home residents on Medicaid retain a $115 monthly personal needs allowance — basic care residents get slightly more because basic care facilities don't typically provide the same level of personal supplies.

Step 3: Health insurance premiums are deducted. Any Medicare premiums, supplemental insurance premiums, or other required health insurance costs are subtracted from the resident's income before the facility contribution is calculated.

Step 4: BCAP pays the remaining balance. After the resident's income (minus the $153 allowance and insurance premiums) is applied to the facility rate, BCAP covers the remaining cost directly to the facility.

The net effect is that the resident's out-of-pocket obligation is their entire income minus $153 per month, and the state covers everything else. The resident doesn't write a check; the funding flows directly from BCAP to the facility.

Who Qualifies

BCAP eligibility has two gates — a functional assessment and a financial screening:

Functional requirements:

• The parent must be assessed as functionally inappropriate for independent living but not so severely impaired that they require skilled nursing care
• Specifically, impairments in at least three of four core IADLs (meal preparation, housework, medication management, laundry) and/or a documented need for environmental supervision
• The parent must be capable of physical self-preservation during emergencies — a basic care licensing requirement that distinguishes basic care from skilled nursing

Financial requirements:

• The parent must qualify for North Dakota Medicaid, which means countable assets cannot exceed $3,000 for an individual or $6,000 for a married couple
• Countable assets include checking and savings accounts, CDs, stocks, and non-primary real estate
• The primary residence is generally exempt if the parent has filed an Intent to Return or if a spouse, minor child, or blind/disabled child lives in the home
• IRAs and 401(k)s are exempt only if they are in active payout status — a critical distinction that trips up many families during the application process

Applying for BCAP

The application process moves through several coordinated steps:

1. Initiate the assessment. Contact the Aging and Disability Resource-LINK (ADRL) at 1-855-462-5465 to request a functional assessment. A case manager from the local Human Service Zone will evaluate the parent's ADL and IADL impairments to determine whether they meet the functional criteria for basic care placement.

2. Apply for Medicaid. The parent must formally apply for and be approved under North Dakota Medicaid financial eligibility. This can be done through the Customer Support Center or the ND HHS online application portal. The Medicaid application requires documentation of all income sources, bank statements, investment accounts, property ownership, insurance policies, and any asset transfers made in the preceding 60 months.

3. Select a participating facility. Not every licensed basic care facility in North Dakota participates in BCAP. Before signing a residency agreement, verify with the facility that they accept BCAP residents and confirm their current BCAP-approved rate. If a parent is already in a facility that doesn't participate, they may need to transfer to a BCAP-eligible facility when private funds run out.

4. The facility coordinates billing. Once BCAP is approved, the facility handles the billing coordination — collecting the resident's income contribution and receiving the BCAP payment for the balance. The family's role shifts from paying the bill to monitoring the personal needs allowance and ensuring the resident's income is being correctly calculated.

The 60-Month Lookback Warning

Because BCAP requires Medicaid financial eligibility, the application triggers a review of all asset transfers the parent made during the 60 months before the application date. Any assets gifted, sold below market value, or transferred to non-spouse family members during that window can result in a penalty period — a stretch of time during which BCAP will not pay benefits.

The penalty period starts on the date of the Medicaid application, not the date of the transfer. This means a family that transferred a parent's savings to a child three years ago and applies for BCAP today will face a penalty period calculated from today — effectively pushing the BCAP start date further into the future while the parent still needs care and has no remaining assets to pay for it.

This is one reason why early financial planning matters. Families who understand the 60-month lookback can structure their parent's finances to avoid inadvertent penalties, and the SPED program — with its $50,000 asset limit and no lookback provision — can bridge the gap between private pay and eventual BCAP/Medicaid eligibility.

Spousal Protections

When one spouse enters a basic care facility and the other remains at home, Medicaid's spousal impoverishment protections apply:

• The community spouse (the one staying home) retains 50% of the couple's combined assets, up to a maximum of $162,660, with a minimum floor of $32,532
• The community spouse is guaranteed a minimum monthly income of $2,705 through the Monthly Maintenance Needs Allowance (MMNA)
• The primary residence is fully exempt from asset counting as long as the community spouse lives there
• Transfers between spouses are exempt from the lookback penalty

These protections are designed to prevent the at-home spouse from being impoverished by the institutional spouse's care costs. But they only apply automatically if the family correctly identifies and claims them during the Medicaid application process.

What BCAP Doesn't Cover

BCAP covers the cost of room, board, and personal care in a licensed basic care facility. It does not cover:

• The cost of a higher level of care in a skilled nursing facility — that's covered by nursing home Medicaid
• Medical services beyond what the basic care license authorizes — the parent's Medicare and any supplemental insurance handle medical costs
• Supplemental services like private companion care, personal phone lines, or premium room upgrades beyond the facility's standard accommodations
• Transportation beyond what the facility provides in its base services

The North Dakota Care Decision Guide covers the complete financial pathway from private pay through SPED to BCAP and Medicaid, including asset inventory worksheets, cost calculators for every care setting, and the specific documentation checklist you'll need for the Medicaid application.

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