North Dakota Medicaid Waiver for Home and Community Based Services (Aged and Disabled Waiver)

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

This Medicaid waiver is designed specifically to help elderly or disabled North Dakota residents remain living in their homes or in assisted living or to return to living in these locations after placement in a nursing home. States have found by allowing family caregivers to share some of the responsibility of caring for loved ones, they can create a win-win situation. Families want their aging loved ones to be in an environment where they are familiar and be cared for by someone with whom they are comfortable and the states can save money through reduced admissions to nursing homes. Accordingly, applicants must, at a minimum, require nursing home level care but be willing and able to receive that care outside of a nursing home.

In addition to personal care at home, in adult day care or in adult foster care / assisted living, this program will cover minor home modifications for senior safety and improved access as well as Personal Emergency Response services to help monitor participants when no family members can be present.

ND's Waiver allows some relatives to work in the capacity of a paid caregiver for their family member. 

This waiver allows for consumer direction.  Meaning participants are given the flexibility to choose some of their own care providers.   Adult children can be hired as caregivers and North Dakota is one of just a few states which allows spouses to be paid as caregivers. However, program participants are not given budgetary control.  They cannot choose how much to pay their caregivers, only from whom they receive care.  Typically, caregivers are typically paid between 50% – 75% of the going rate for home care in the state.  As of 2017, it is estimated personal caregivers receive an hourly rate of $15 - $20.  

Note that this waiver is referred to by different names.  Formally, it is called the Medicaid Waiver for Home and Community Based Services but most persons including state employees simply call it the Aged and Disabled Waiver.

North Dakotans that do not qualify for Medicaid might receive benefits from the Service Payments for the Elderly and Disabled (SPED) and the Expanded Service Payments for the Elderly and Disabled (Ex-SPED) programs.  Learn more.


Eligibility Guidelines

The North Dakota Aged and Disabled Waiver considers the applicant's age and level of impairment as related conditions. If under 65 years of age, applicants must be designated disabled by Social Security. However, those 65 and older must require nursing home level care but need not be fully disabled.

The Aged and Disabled Waiver is a Medicaid program and therefore applicants must be financially eligible to receive Medicaid. ND factors in the applicant's income and assets. Similar to age and level of impairment, the applicant's finances are inter-related with their marital status.

Income Limits - Unmarried, widowed or otherwise single applicants in 2017 are limited to $834 in income per month. Applicants are permitted to subtract from their countable income all of their monthly bills for doctors’ visits, medications, health insurance, and other out-of-pocket care costs. For example, if one's income is $4,000 / month and their assessed, recurring medical expenses are $3,500 / month, they will very likely qualify as “Medically Needy” recipients.

If the individual is married and their spouse is not seeking Medicaid assistance, the couple can have their incomes assessed separately. The spouse’s income (the spouse not seeking Medicaid) can have a higher income and furthermore, some the applicant’s income can be allocated to the non-applicant spouse (called the Community Spouse). In 2017, $3,022.50 of the applicant’s income can go to their spouse. This is referred to as the Maximum Monthly Maintenance Needs Allowance.

Asset Limits – A single applicant is permitted up to $3,000 in countable financial assets. Should they own a home and live in that home (not in assisted living), then the value of their home equity is not considered up to a value of $560,000. The spouse of a married applicant, in 2017, can hold up to $120,900 of joint assets. If the spouse lives in the home, the home is exempt.

A final note on eligibility, ND reserves the right to refuse acceptance onto this waiver, if the cost to keep the participant living at home or in the community exceeds what it would have otherwise cost to care for the same person in a nursing home.

Medicaid eligibility IS complex. Fortunately, assistance is available to help families sort out their eligibility status. It is also possible for ND residents to qualify for Medicaid even if their finances exceed these limits. Find help in your area here.


Benefits and Services

This Aged and Disabled Waiver is intended to help participants avoid nursing home placement therefore the types of services available are chosen to help them and their caregivers in a home or group home environment.

  • Adult Day Care
  • Assisted Living / Adult Foster Care
  • Case Management
  • Chore Services
  • Emergency Response System
  • Environmental Modification for the Home
  • Family Personal Care (payments to spouses)
  • Homemaker Services
  • Non-Medical Transportation
  • Respite Care for the Caregiver
  • Specialized Medical Equipment


How to Apply / Learn More

This program is available throughout North Dakota. A fact sheet is available for printing, one can download it here. To apply for the Aged and Disabled Waiver, one should contact their local Aging and Disability Resource Center by calling 1-855-462-5465.   Waiting lists may exist as the waiver is only intended to manage approximately 500 concurrent participants.  Readers should also be aware that this Waiver may also be referred to as ND's Home and Community Based Services Waiver.    Limited information is also available on the ND Department of Human Services webpage.