Memory Care Medicaid in North Dakota: What's Covered and What's Not

The Coverage Gap That Catches Families Off Guard

Medicaid covers memory care in North Dakota, but not in the way most families expect. The critical distinction: Medicaid funds the care services — personal assistance, nursing oversight, medication management — but does not cover room and board in basic care or assisted living facilities. For skilled nursing facilities, Medicaid covers nearly everything.

This split creates a confusing financial landscape. A parent in a basic care facility with a memory care designation might have their personal care services covered through the Medicaid HCBS waiver while the family remains responsible for the room and board portion. A parent in a skilled nursing facility has virtually all costs covered after paying their monthly income to the facility minus a $115 personal needs allowance.

Understanding which setting Medicaid will fund — and how much the family still owes — determines whether a parent can sustain their placement long-term or faces an involuntary discharge when private funds run out.

North Dakota's 209(b) Medicaid Framework

North Dakota is a "209(b)" state, which means it sets its own Medicaid eligibility criteria rather than automatically following federal SSI standards. For long-term care Medicaid, the key limits are:

• Assets: $3,000 for a single applicant, $6,000 for a married couple both applying
• Income: No hard cap for nursing home Medicaid. Instead, the state uses a "medically needy spend-down" — the applicant's income minus a $115 personal needs allowance, health insurance premiums, and spousal allowances gets paid directly to the nursing facility
• Community HCBS waiver: Income limited to $1,197 per month for a single applicant

The medically needy spend-down replaces the Miller Trust (Qualified Income Trust) system used in most other states. Instead of routing excess income through a trust, families simply document that income above the threshold goes directly toward care costs. This is simpler on paper but requires meticulous record-keeping — every month's medical expenses must be tracked.

What Medicaid Covers in Each Setting

Skilled nursing facilities: Medicaid pays the facility's contracted rate minus the resident's patient liability (their income minus $115 PNA). North Dakota's rate equalization means the Medicaid rate equals the private-pay rate — there's no financial penalty for being a Medicaid resident.

Basic care facilities (with memory care): The HCBS waiver covers personal care services, case management, and some medical services. Room and board is the family's responsibility. The Basic Care Assistance Program (BCAP) provides a state-funded supplement for room and board, but the resident retains only a $153 monthly personal allowance.

Home and community-based care: The HCBS 1915(c) waiver covers adult day care, personal care, homemaker services, respite care, specialized equipment, and 24-hour residential care for individuals who meet Nursing Facility Level of Care criteria but choose to remain in the community.

The Application Process

Medicaid applications for long-term care go through the local Human Service Zone — not a state office. The process involves:

1. Filing form SFN 958 (Health Care Application for the Elderly and Disabled)
2. Providing 60 months of financial statements for the look-back audit
3. A functional assessment by the Maximus assessment contractor to confirm Nursing Facility Level of Care
4. A 45-day review period during which the Human Service Zone audits all financial records

The 60-month look-back is where most applications get complicated. The Human Service Zone audits every financial transaction from the preceding five years for gifts or transfers below fair market value. Any flagged transfer triggers a penalty period calculated using North Dakota's 2026 monthly penalty divisor of $13,450.86.

Before Applying: The SPED Bridge

Families whose parent has between $3,000 and $50,000 in liquid assets should explore SPED (Service Payments for the Elderly and Disabled) before spending down to Medicaid levels. SPED covers many of the same home care services and delays the Medicaid spend-down by months or years. Once assets reach $3,000, the transition to Medicaid or Ex-SPED preserves continuity of care.

The North Dakota Dementia & Memory Care Guide maps out the SPED-to-Medicaid transition sequence with the specific forms, financial thresholds, and Human Service Zone contacts that families need to navigate each step without gaps in coverage.

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