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.
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.
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.
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.
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.
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.