North Dakota Medicaid Long Term Care Eligibility
North Dakota Long Term Care
- Adult Family Foster Care – Provides a safe, supervised family living environment, 24 -hours per day in a state-licensed setting
- Case Management – Assesses needs, helps with care planning, provider selection, referrals, and service monitoring
- Chore Service – Includes snow removal and heavy cleaning
- Emergency Response System- Provides telephone emergency response
- Environmental Modifications (Limited) – Modifies the home to enhance client independence (e.g. install safety rails)
- Family Home Care – Reimburses a family caregiver who meets the relationship requirements defined by state law and resides in a client’s home 24-hours per day
- Homemaker – Provides house cleaning, laundry, and/or meal preparation services
- Respite Care – Provides temporary relief to the full-time caregiver
1. Residency and Citizenship – the applicant must be a North Dakota resident and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
3. Income Limitations – The applicant’s income must be less than the cost of care in the facility at the Medicaid rate of pay. Medicaid must approve the level of care requested and the applicant must use part of their income to pay for care services. North Dakota calls this “recipient liability.” If single, but not medically needy, their monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $517 to get full coverage paid by Medicaid. If medically needy, however, Medicaid will pay as long as the income does not exceed $807 per month. Income that is not considered countable includes a personal needs allowance ($65.00/month per individual); health insurance premiums and medical expenses not covered by insurance or other benefits; certain spousal or dependent family members’ allowances; and a home maintenance allowance if the long term care recipient expects to return home within six months, but there is no one living in the home.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away.
- Transferring assets to: a spouse (or someone else for the spouse’s benefit), a blind or disabled child, a trust for a blind or disabled child, or a trust for a disabled individual under age 65 (sometimes for the benefit of the applicant in certain circumstances) will not result in Medicaid ineligibility.
Exempt Assets for an applicant in North Dakota include:
i. $3,000 or less in cash/non-exempt assets if single. If married and both spouses require care the asset limit is $6,000. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
ii. One home is exempt (equity limit $595,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum. The home may also be transferred to a sibling who has lived in the home during the preceding year or who holds equity interest in the home; or to a child who has provided care giving services and lived in the home for at least two years, thus preventing the applicant from entering a nursing home environment.
iii. One car, no equity amount specified. If two or more cars are owned then the most valuable car is exempt.
iv. An irrevocable funeral trust with a value of $1,500 or less. Revocable burial contracts are considered countable assets, but if the applicant does not have an existing irrevocable burial contract he/she may put up to $1,500 towards one.
v. Self-employment property (including tools, equipment and livestock).
vi. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vii. Indian trust and restricted lands and per capita and judgment funds.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $128,640. If the community spouse’s assets do not equal the minimum of $25,728, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $3,216.00. $3,216.00 is also the maximum amount of monthly income a community spouse can have. Dependents can keep a portion of the institutionalized person’s income to retain an allowance of $655/month.
North Dakota long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
Expanded eligibility including groups other than the aged, blind, or disabled: http://www.nd.gov/dhs/services/medicalserv/medicaid/eligible.html
North Dakota Medicaid page: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Public records concerning Medicaid and medical coverage: http://www.nd.gov/dhs/info/pubs/medical.html
Home and community based services: http://www.nd.gov/dhs/services/adultsaging/homecare.html
General Medicaid long term care information for the state of North Dakota: http://www.nd.gov/dhs/services/medicalserv/medicaid/longtermcare.html