North Dakota Medicaid Eligibility: Income Limits, Asset Rules & How to Apply

North Dakota Medicaid is administered by the North Dakota Department of Health and Human Services (HHS) and funded by federal and state dollars, providing health coverage to low-income North Dakotans including children, pregnant women, parents, seniors, and people with disabilities.

North Dakota is the least populous state in this series — fewer than 800,000 residents — and its Medicaid program reflects the character of a small, rural, agricultural and energy-producing state. The state expanded Medicaid under the ACA in 2014 with relatively little political controversy compared to many states in this series, reflecting North Dakota’s pragmatic approach to federal programs even within a strongly Republican political environment.

North Dakota is the fourteenth no-QIT state in this series — joining the list of states that use a medically needy pathway with a $967/month income standard rather than a Qualified Income Trust for long-term care income management. North Dakota’s long-term care asset limit is $3,000 for a single applicant — 50% above the $2,000 national standard — with the same $3,000/$6,000 limits applying to Regular Medicaid (ABD) as well. The pre-paid funeral contract exemption is $10,000 — matching Iowa and among the higher caps in the series.

North Dakota’s defining economic features — wheat and soybean farming in the Red River Valley and the Missouri Slope, and the Bakken oil formation in the western part of the state — create specific Medicaid planning complexities around farmland transfers and mineral rights that are central to long-term care planning for rural North Dakotans.

Tribal Medicaid is also particularly important here — North Dakota has five federally recognized tribal nations with significant reservation populations, and Indian Health Service facilities and tribal health programs serve communities across the state’s western and north-central regions.

This guide covers every major North Dakota Medicaid program, 2026 income and asset limits, the 60-month look-back rule, and how to apply through ND Apply. For a quick eligibility check, use our Medicaid Eligibility Calculator before applying.

North Dakota Medicaid Programs

Institutional / Nursing Home Medicaid

An entitlement program with no waiting list — everyone who qualifies is guaranteed coverage. It funds care in nursing facilities, hospitals, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).

Applicants must demonstrate a Nursing Facility Level of Care (NFLOC). North Dakota’s nursing home industry is concentrated in Fargo, Bismarck, Grand Forks, and Minot — the state’s four largest cities. Rural counties in western North Dakota (the oil patch region) and the far northern prairie have limited local nursing facility options, making home-based care alternatives especially important for residents who want to age in place near family.

Expanded Service Waiver — Home and Community Based Services

North Dakota’s primary HCBS waiver for seniors and disabled individuals is the Expanded Service Waiver, covering in-home personal care, adult day services, delivered meals, home modifications, and other community-based supports.

The Expanded Service Waiver is a non-entitlement program with limited slots and waiting lists. In a state as small as North Dakota, home care workforce shortages are particularly acute — many rural communities have limited access to home health aides and personal care workers, especially in the western oil patch communities where the workforce has historically been drawn to higher-paying energy sector jobs.

Apply as early as possible. While waiting, many North Dakotans also qualify for food assistance — see our North Dakota SNAP benefits page.

Regular Medicaid (Aged, Blind, and Disabled)

Covers elderly, blind, or disabled North Dakotans with lower income and assets, without requiring nursing-level medical need. No look-back period applies.

North Dakota uses a medically needy spend-down pathway — if income exceeds $967/month, qualifying medical expenses can be deducted to reach the eligibility threshold. SSI recipients are categorically eligible.

For seniors on Social Security who also need food assistance, see our guide on whether seniors on Social Security can get food stamps.

Children’s Medicaid and CHIP

North Dakota covers children up to age 19 at income limits up to 209% FPL ($2,791/month for a single-person household). No asset test applies.

Families who qualify may also be eligible for WIC nutrition support — see North Dakota WIC income guidelines or use our WIC Eligibility Calculator.

Medicaid for Pregnant Women

Pregnant women qualify at income limits up to 194% FPL ($2,596/month for a single-person household), with coverage extending 12 months postpartum. No asset test applies. North Dakota’s rural healthcare landscape — with limited obstetric providers in many rural counties — makes Medicaid-covered prenatal care particularly important for ensuring access to care during pregnancy.

ACA Medicaid Expansion (2014)

North Dakota expanded Medicaid under the ACA in 2014, covering adults aged 19–64 without dependent children earning up to 138% FPL ($1,799/month for a single person) with no asset test.

North Dakota’s oil and gas workforce in the Bakken region — including drilling crew members, truck drivers, pipeline workers, and oil field service workers — had previously been underinsured despite relatively high wages, as many oil field jobs lack employer health coverage. The Bakken boom’s boom-bust cycle also creates periods where formerly well-paid workers find themselves at lower income levels qualifying for Medicaid. Starting January 2027, federal work requirements will apply to expansion adults. North Dakota has not historically implemented work requirements and may provide limited administrative resistance.

General Eligibility Requirements

• North Dakota Residency: You must currently reside in North Dakota.
• Citizenship / Immigration Status: U.S. citizens, nationals, and qualifying immigrants — including permanent residents with 5+ years in the U.S., refugees, and asylees — are eligible. Undocumented immigrants are generally not eligible for full Medicaid, though emergency services may be covered.
• Tribal Eligibility: North Dakota has five federally recognized tribal nations — the Standing Rock Sioux, Spirit Lake Nation, Three Affiliated Tribes (MHA Nation), Turtle Mountain Band of Chippewa, and Sisseton-Wahpeton Oyate. Tribal members may access Medicaid through Indian Health Service facilities and tribal health programs.
• Income: Varies by program — see limits below.
• Assets: Limits apply for long-term care and aged/blind/disabled programs only.
• Medical / Functional Need: Nursing home Medicaid and the Expanded Service Waiver require documented NFLOC.

2026 Income Limits for North Dakota Medicaid

North Dakota uses the standard 48-state FPL figures. Income limits below are expressed as monthly amounts.

Important Notes on Income

No QIT in North Dakota — Medically Needy Pathway Instead: North Dakota does not use a Qualified Income Trust (QIT) for nursing home or Expanded Service Waiver applicants with income above $2,901/month. North Dakota is the fourteenth no-QIT state in this series.

North Dakota’s medically needy income standard is $967/month for a single person — the same as Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire (at $591), and New Mexico. Medical expenses — including nursing home costs — are applied against income to reduce it to this threshold. Work with a North Dakota-licensed Certified Medicaid Planner.

North Dakota’s Personal Needs Allowance for nursing home residents is $50/month — in the middle range of the series, matching Iowa, Missouri, and New Mexico.

Married couples, one spouse applying: Only the applicant’s income counts toward the $2,901 limit. The community spouse may retain income up to a Minimum Monthly Maintenance Needs Allowance (MMMNA) of $3,948/month, provided housing and utility costs exceed $793.13/month (effective July 1, 2025 through June 30, 2026).

Use our FPL Calculator to check where your household falls, or see our North Dakota Medicaid income eligibility page for the full breakdown.

2026 Federal Poverty Level Reference (48 States & D.C.)

Asset Rules for North Dakota Medicaid

Asset tests apply only to long-term care (Nursing Home / Expanded Service Waiver) and Regular Medicaid (aged, blind, and disabled). ACA expansion adults, CHIP children, and pregnant women face no asset test.

Long-Term Care Medicaid (Nursing Home and Expanded Service Waiver)

North Dakota’s asset limits are above the national standard:

• Single applicant: $3,000 — 50% above the $2,000 national standard, matching Minnesota
• Married, both applying: $6,000 total
• Married, one applying: $3,000 for the applicant; up to $157,920 for the non-applicant spouse (CSRA)

Home equity limit: $730,000. The primary home is exempt if the applicant or their spouse lives there or intends to return, provided equity stays under $730,000. North Dakota’s residential real estate markets are well under this cap in most communities — but Fargo’s west side and south Fargo, and certain Bismarck residential neighborhoods, have seen appreciation that some properties may approach. More relevantly, farmstead properties with rural home sites on farm ground can have combined values approaching the cap in high-value agricultural counties like Cass, Richland, and Traill.

Non-countable (exempt) assets include:

• Primary home (subject to the $730,000 equity cap)
• One vehicle
• Household goods and personal effects
• Pre-paid funeral contracts (irrevocable, up to $10,000) — matching Iowa and among the higher caps in the series
• Medicaid Compliant Annuities
• Life insurance with a face value of $1,500 or less

North Dakota’s 60-Month Look-Back Rule

North Dakota enforces a standard 60-month (5-year) look-back period for Nursing Home Medicaid and the Expanded Service Waiver. All asset transfers within that window are reviewed.

Gifts or transfers below fair market value — including transfers of North Dakota farmland, mineral rights, or other assets — can trigger a penalty period of Medicaid ineligibility.

North Dakota’s Medicaid planning landscape is dominated by two asset types. First, Red River Valley cropland — some of the most fertile and valuable agricultural land in North America. Cass, Richland, Traill, and Grand Forks county cropland can sell for $4,000–$8,000+ per acre, meaning even modest farm transfers can create multi-year penalty periods. Second, Bakken formation mineral rights — oil and gas interests in Williams, McKenzie, Mountrail, Dunn, and Burke counties represent significant family wealth. Mineral rights transfers within 5 years of applying can trigger look-back review the same as real property.

North Dakota families with agricultural land or Bakken mineral rights should consult a Certified Medicaid Planner with North Dakota-specific agricultural and oil/gas experience well before a care need arises. There is no look-back period for Regular Medicaid.

North Dakota’s Medicaid Estate Recovery Program

After a North Dakota Medicaid long-term care beneficiary passes away, North Dakota’s Estate Recovery Program seeks reimbursement from the estate. Red River Valley cropland and Bakken mineral rights passing through the probate estate are common — and potentially high-value — recovery targets. Consult a North Dakota elder law attorney for protective strategies.

Regular Medicaid / ABD (Aged, Blind, and Disabled)

Asset limit is $3,000 for individuals and $6,000 for couples — the same limits as long-term care, matching Minnesota’s unified approach. No home equity cap and no look-back period apply. North Dakota’s medically needy spend-down pathway is available here when income exceeds the limit.

Medical and Functional Requirements

For Nursing Home Medicaid and the Expanded Service Waiver, applicants must demonstrate a Nursing Facility Level of Care (NFLOC) through a formal evaluation of:

• Activities of Daily Living (ADLs): bathing, dressing, eating, toileting, mobility
• Instrumental Activities of Daily Living (IADLs): cooking, shopping, managing finances, taking medications
• Cognitive or behavioral issues — including Alzheimer’s disease and dementia. A diagnosis alone does not satisfy NFLOC; documented functional limitations are required.

For Regular Medicaid (ABD), applicants must document disability or blindness per Social Security Administration (SSA) criteria. NFLOC is not required.

North Dakota’s vast geography — the state is 70,000+ square miles with under 800,000 people — creates significant NFLOC assessment challenges for residents in remote western counties, particularly in the oil patch region (Williston Basin) and the far northern prairie. Local HHS county offices and Area Agencies on Aging help coordinate assessments for remote applicants, but wait times in rural areas can be significant.

What Federal Policy Changes Mean for North Dakota Medicaid

The One Big Beautiful Bill Act, signed July 4, 2025, introduces Medicaid changes phasing in through 2028.

Work Requirements (Starting January 2027): Federal work requirements will apply to ACA expansion adults aged 19–64. North Dakota has not historically implemented work requirements. North Dakota’s oil field and agricultural workforce — with boom-bust income cycles and seasonal employment patterns — will need to document qualifying activity carefully during slow periods. Bakken oil field workers laid off during low-price periods may have gaps in documented employment. Seniors, disabled individuals, pregnant women, and children are exempt.

Reduced Retroactive Coverage (Starting January 2027): Coverage will only extend back 2 months from application, down from 90 days. North Dakotans who delay applying after a health event — including farm or ranch accidents common in agricultural communities — will face more uncovered medical debt.

More Frequent Eligibility Renewals (Starting December 2026): Renewals every 6 months instead of annually. North Dakota’s rural population — particularly in the western oil patch counties and remote northern prairie — may face high renewal lapse rates due to internet connectivity limitations and the state’s sparse service delivery infrastructure.

New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may owe up to $35 per specialist visit. Primary care and preventive services remain free.

Funding Cuts: Projected federal Medicaid cuts of approximately $1 trillion over 10 years may affect North Dakota’s rural critical access hospitals — many of the state’s hospitals in small communities like Watford City, Williston, Bottineau, and Rolla operate with very thin margins where Medicaid is the primary payer. Tribal health facilities serving the five tribal nations are also at risk.

For how these changes affect SNAP benefits alongside Medicaid, see our article on Big Beautiful Bill SNAP changes.

Options If Your Income or Assets Exceed the Limit

Medically Needy Pathway (No QIT Required): North Dakota uses a medically needy pathway rather than a QIT. The income standard is $967/month for a single person. Medical expenses — including nursing home costs — are applied against income to reach this threshold. Work with a North Dakota-licensed Certified Medicaid Planner who understands this approach.

Pre-paid Funeral Contracts (up to $10,000): North Dakota allows irrevocable pre-paid funeral and burial arrangements up to $10,000 as exempt assets — matching Iowa and among the higher caps in the series. A useful planning tool for applicants near the $3,000 long-term care asset limit.

Asset Spend-Down: Converting countable assets into exempt ones — home improvements, vehicle purchase, paying off debt — can reduce countable assets below $3,000. North Dakota’s higher $3,000 limit gives more planning room than most states. Agricultural landowners must be careful to structure farm asset transactions to avoid look-back violations.

Medicaid Compliant Annuities: In spousal situations, converting excess assets into a compliant annuity can reduce the applicant’s countable assets while generating protected income for the community spouse.

Certified Medicaid Planners: North Dakota’s Red River Valley cropland and Bakken mineral rights look-back complexity, estate recovery on agricultural land, and the no-QIT medically needy system make professional planning valuable. Seek a planner with North Dakota-specific agricultural and oil/gas mineral rights experience.

While addressing a Medicaid income or asset issue, check whether SNAP food assistance is available in parallel — see SNAP income limits for North Dakota.

How to Apply for North Dakota Medicaid

North Dakota uses the ND Apply Portal as the primary online application entry point for Medicaid and other HHS programs.

Application Methods

Online via ND Apply (Recommended): Apply at ndapply.com or through the federal marketplace at healthcare.gov for plan comparison. Before applying, use our Medicaid Eligibility Calculator to confirm which program applies. For step-by-step guidance, see our North Dakota Medicaid application guide.

Phone: Call North Dakota HHS Customer Service at 1-800-472-2622 for assistance.

In-Person or Mail: Download a paper application from hhs.nd.gov and submit to a local HHS County Office. North Dakota has HHS county offices across the state, though western oil patch counties (Williams, McKenzie, Dunn) and far northern prairie counties may have limited office hours and staffing relative to demand.

Long-Term Care Support: Contact the North Dakota Aging Services Division or a local Area Agency on Aging at 1-855-643-6564 for help with Expanded Service Waiver applications and NFLOC assessment coordination.

Documents You’ll Need

• Proof of North Dakota residency
• Proof of income (pay stubs, Social Security award letters, tax returns, farm income documentation, oil royalty statements)
• Proof of assets (bank statements, investment accounts, property records, cropland deeds, mineral rights documentation) — for long-term care and ABD applications
• Medical expense documentation — for medically needy spend-down applications
• Proof of citizenship, qualifying immigration status, or tribal enrollment
• Medical records documenting functional limitations (for Nursing Home / Expanded Service Waiver applications)
• Disability documentation per SSA criteria (for Regular Medicaid ABD)

Processing Times

Standard applications: Up to 45 days

Disability-based applications: Up to 90 days

Pregnant women: May qualify for presumptive eligibility for outpatient care while the full application processes.

Starting January 2027, retroactive coverage drops to 2 months before application. Apply promptly after any health event that generates significant medical bills.

North Dakota Medicaid and Other Benefit Programs

SNAP (Food Stamps): Many North Dakota Medicaid recipients also qualify for SNAP. See our North Dakota SNAP page or North Dakota SNAP application guide.

If you already receive benefits, see how to check your SNAP balance in North Dakota.

WIC: Pregnant women and young children qualifying for North Dakota Medicaid typically also qualify for WIC. See North Dakota WIC income guidelines.

Medicare: Many North Dakota seniors use both Medicare and Medicaid simultaneously. Understanding the difference between Medicare and Medicaid is essential — particularly for long-term care coordination in a state where Expanded Service Waiver waiting lists and rural nursing facility access are ongoing challenges.

SNAP Work Requirements: ACA expansion adults who also receive SNAP should know both programs will have federal work requirements starting in 2027. North Dakota’s oil field and agricultural workers face particular documentation challenges during low-activity periods. Read our guide on SNAP work requirements.

Frequently Asked Questions About North Dakota Medicaid

Does North Dakota Medicaid require a QIT (Miller Trust)?

No — North Dakota is one of fourteen states in this series that does not require a Qualified Income Trust for nursing home or Expanded Service Waiver applicants with excess income. North Dakota uses a medically needy pathway with a $967/month income standard.

Medical expenses — including nursing home costs — are applied against income to reduce it to this level. Work with a North Dakota-licensed Certified Medicaid Planner.

Does North Dakota Medicaid count farmland as a countable asset?

Yes — non-homestead cropland, pasture, and farm ground are generally countable assets for long-term care Medicaid in North Dakota. Red River Valley cropland — among the most productive and valuable in the world — can sell for $4,000–$8,000+ per acre. Even a relatively small farm transfer of 100 acres at $5,000/acre represents $500,000 in transferred value, which could create a penalty period of years if done within 5 years of a nursing home application.

North Dakota families with agricultural land should engage a Certified Medicaid Planner with North Dakota farm asset experience well before a care need arises. There is no look-back period for Regular Medicaid (ABD) — only for nursing home and waiver Medicaid.

Does North Dakota Medicaid count Bakken mineral rights as assets?

Yes — oil and gas mineral rights in the Bakken formation are generally countable assets for long-term care Medicaid purposes. The Williston Basin counties — Williams, McKenzie, Mountrail, Dunn, and Burke — have significant family mineral rights holdings resulting from decades of oil and gas development.

Mineral rights transfers within 5 years of applying can trigger look-back penalties proportional to the mineral interests’ value. The Bakken’s production cycle means mineral rights values fluctuate with oil prices — a Certified Medicaid Planner should assess current mineral rights value as part of long-term care planning.

What is the Expanded Service Waiver in North Dakota?

The Expanded Service Waiver is North Dakota’s primary HCBS program for seniors and disabled individuals who meet nursing facility level of care criteria but want to remain at home. It covers personal care aides, adult day services, meal delivery, home modifications, and respite care.

Slots are limited — waiting lists apply. In a small state with an aging rural population and home care workforce shortages — particularly in western North Dakota — the combination of slot limits and worker availability creates real access barriers. Apply as early as possible through the North Dakota Aging Services Division.

Can I get North Dakota Medicaid if I work in the oil fields?

Yes — if your income during any given month is at or below 138% FPL ($1,799/month for a single person), you may qualify for ACA expansion Medicaid. Oil field workers often experience boom-bust income cycles — periods of high earnings followed by layoffs or reduced hours during price downturns. During periods of low or no income, Medicaid expansion eligibility may apply.

Starting 2027, work requirements apply — but documented oil field employment clearly qualifies as work activity. The challenge is documenting work during gaps between jobs or during layoff periods. Keep records of employment dates, layoff notices, and any documented job search activity.

Can tribal members in North Dakota access Medicaid differently?

Yes — North Dakota’s five tribal nations (Standing Rock Sioux, Spirit Lake Nation, Three Affiliated Tribes/MHA Nation, Turtle Mountain Band of Chippewa, and Sisseton-Wahpeton Oyate) may access Medicaid through Indian Health Service facilities and tribal health programs. Contact your tribal health department for enrollment assistance specific to your nation’s Medicaid pathway.

What is the income limit for Medicaid in North Dakota?

For seniors and disabled in nursing homes or the Expanded Service Waiver: $2,901/month (single). Regular Medicaid (ABD): $967/month (single). ACA expansion adults: $1,799/month (138% FPL). CHIP children: $2,791/month (209% FPL). Pregnant women: $2,596/month (194% FPL).

See our North Dakota Medicaid income eligibility page for the full breakdown.

Does North Dakota Medicaid cover dental for adults?

North Dakota Medicaid provides limited dental coverage for adults — primarily emergency care and some basic restorative services. Coverage levels can change with state budget priorities. Verify current adult dental coverage with HHS or your Medicaid managed care plan.

See our full guide on what dental services Medicaid covers.

This guide reflects 2026 federal and North Dakota Department of Health and Human Services guidelines. Rules change — verify current requirements with HHS at hhs.nd.gov or by calling 1-800-472-2622 before making eligibility decisions.