North Dakota Medicaid Income Limits for Long-Term Care in 2026

If you have been searching for the income limit that disqualifies your parent from nursing home Medicaid in North Dakota, you will not find one. That is not because the information is hidden — it is because North Dakota does not have a hard income cap for long-term care Medicaid.

Most states set a strict monthly income ceiling (typically around $2,901 in 2026). Earn one dollar more and you need a Qualified Income Trust — a Miller Trust — just to qualify. North Dakota works differently, and that difference can save your family thousands.

Why North Dakota Has No Income Cap

North Dakota is one of a handful of Section 209(b) states. Instead of the standard federal Supplemental Security Income (SSI) methodology, the state enforces its own eligibility framework that includes a medically needy spend-down program.

In practical terms, this means your parent's pension, Social Security, and retirement income can total $5,000 or $8,000 or more per month — and they can still qualify for Medicaid coverage of their nursing home or home-based care costs. There is no income amount that automatically disqualifies them.

How the Medically Needy Spend-Down Works

Instead of an income cap, North Dakota calculates a monthly patient liability — the amount your parent must pay directly to the nursing facility from their own income. Medicaid covers the rest.

The formula for a single nursing home resident in 2026:

Gross Monthly Income minus $115 Personal Needs Allowance minus Medicare premiums minus any court-ordered support payments equals Patient Liability

For example, if your parent receives $3,000 per month in combined pension and Social Security income and pays $174.70 for Medicare Part B:

$3,000 - $115 - $174.70 = $2,710.30 patient liability

Your parent pays $2,710.30 to the nursing home each month, and Medicaid covers the difference between that amount and the facility's daily rate.

The Medically Needy Income Standard

While there is no income cap, North Dakota does use a Medically Needy Income Standard as part of the eligibility calculation. For the period April 1, 2026 through March 31, 2027:

• Single applicant: $1,197 per month
• Married couple (both applying): $1,623 per month

If your parent's income falls below this standard, their patient liability is zero — Medicaid covers the full cost of care. If income exceeds this standard, the excess becomes patient liability as described above.

Spousal Income Protections

When only one spouse needs nursing home care, the healthy at-home spouse (the community spouse) keeps all of their own income. North Dakota follows the "name-on-the-check" rule — income belongs to whoever receives it.

If the community spouse's independent income falls below the Minimum Monthly Maintenance Needs Allowance (MMMNA) of $2,705 per month (effective July 2026), income can be diverted from the institutionalized spouse to make up the shortfall. The maximum MMMNA with excess shelter costs is $4,066.50.

This means the healthy parent is not forced to survive on a minimal allowance while their spouse's income goes entirely to the nursing home.

No Miller Trust Required

In the roughly 30 states that use hard income caps, families whose parent earns even slightly above the limit must establish a Qualified Income Trust (Miller Trust). This requires an attorney, ongoing bank account management, and strict compliance rules.

North Dakota families can skip this step entirely. The spend-down model handles all income levels without requiring any trust structure, saving both legal fees and ongoing administrative burden.

What Still Counts as Income

The Human Service Zone counts virtually all monthly income when calculating patient liability:

• Social Security benefits (retirement, disability, survivor)
• Pension payments (federal, state, private, military)
• IRA and 401(k) required minimum distributions
• Rental income from non-exempt property
• VA Aid and Attendance benefits (counted as income if coordinating with SPED)
• Interest and dividend income

The Asset Threshold Still Applies

While income does not disqualify your parent, assets do have a hard limit. Countable assets must be at or below $3,000 for a single applicant or $6,000 for a married couple where both apply. The community spouse can retain up to $162,660 under the Community Spouse Resource Allowance.

Understanding the distinction between the no-income-cap rule and the strict asset limit is critical for planning your parent's Medicaid eligibility strategy.

Navigate the Full Spend-Down Process

The North Dakota Medicaid Long-Term Care & Asset Protection Guide walks you through the complete patient liability calculation, spousal income diversion rules, the SPED-to-Medicaid transition, and the asset spend-down strategies that protect your family's savings under North Dakota's 209(b) framework.

See more North Dakota guides →