Waiver Description
This Medicaid Waiver for Home and Community Based Services is designed specifically to help elderly and disabled North Dakota residents remain living in their homes, or in the community, 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 in which 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, in adult foster care, or in memory care facilities (for those with Alzheimer’s Disease and other dementias), 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.
North Dakota’s waiver allows some relatives to work in the capacity of a paid caregiver for their family member.
This waiver allows for consumer direction. This means participants are given the flexibility to choose their own care providers. Adult children can be hired as caregivers, and North Dakota is one of just a few states that allow spouses to be paid as caregivers. However, program participants are not given budgetary control. They cannot choose how much to pay their caregivers, only who administers their care.
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. This waiver is administered by the Aging Services Division within the North Dakota Department of Human Services.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
General Requirements
The North Dakota Aged and Disabled Waiver considers the applicant’s age and level of impairment as conditions for enrollment. Applicants under 65 years of age must be designated as disabled by Social Security. While those 65 and older must require nursing home level care, but need not be fully disabled.
Financial Requirements
The Aged and Disabled Waiver is a Medicaid program and therefore applicants must be financially eligible to receive Medicaid. North Dakota considers the applicant’s income and assets.
Income Limits
Unmarried, widowed, or otherwise single applicants are limited to $1,009 in income per month. Married couples with both spouses as applicants can have up to $1,364 per month. (These figures are effective until March 31, 2024.) 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 health-care costs. For example, if one’s income is $4,000 a month and their recurring medical expenses are $3,500 a month, they will very likely qualify as “Medically Needy” recipients.
If the applicant is married and his or her spouse is not seeking Medicaid assistance, the non-applicant spouse (called the Community Spouse) may be entitled to part, or even all, of his or her spouse’s income. In 2023, up to $2,550 of the applicant’s monthly income may be able to be transferred to the non-applicant spouse. This is referred to as the Monthly Maintenance Needs Allowance.
Asset Limits
A single applicant is permitted up to $3,000 in countable financial assets. Married applicants, with both spouses applying, can retain up to $6,000 in resources. However, some assets are not counted toward the limit. If an applicant lives in the home or has intent to return, the home is exempt, as long as the value of the home’s equity is under $688,000.
In addition to the home exemption, in 2023, the spouse of a married applicant who is not also applying for Medicaid benefits can retain up to $148,620 of the couple’s joint assets. This is called the Community Spouse Resource Allowance.
A final note on eligibility: North Dakota reserves the right to refuse acceptance into this waiver if the cost of care at home or in the community exceeds what it would have otherwise cost to care for the same person in a nursing home.
Confused?
Medicaid eligibility is complex. Fortunately, assistance is available to help families sort out their eligibility status. It is also possible for North Dakota residents to qualify for Medicaid even if their finances exceed these limits.
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
- Residential Care / Adult Foster Care
- Case Management
- Community Transitional Living Services
- Chore Services
- Emergency Response System
- Environmental Modification for the Home
- Family Personal Care (payments to spouses)
- Home Delivered Meals
- Homemaker Services
- Non-Medical Transportation
- Respite Care (offers a break from caregiving duties for the primary caregiver)
- Specialized Medical Equipment / Supplies
How to Apply / Learn More
This program is available throughout North Dakota. To apply, seniors can contact their local Aging and Disability Resource Center by calling 855-462-5465, or contact their local Human Service Zone.
More information on the program is available here.
