North Dakota Medicaid State Plan Personal Care Services, also referred to as MSP-PC, provides help to persons who require assistance with their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). By providing aid, which includes assistance with grooming, dressing, eating, and light housework, eligible applicants are able to continue to live independently in their homes, rather than require institutionalization.
Personal Care Services are available on an intermittent basis, as well as an ongoing basis. Participants must reside at home, in the home of a loved one, or in certain group living environments, such as adult foster care or assisted living. According to program regulations, participants cannot reside in a nursing home, hospital, or intermediate care facility.
There are three levels of Personal Care Services, Level A, Level B, and Level C. Each level has slightly different eligibility criteria, and the number of hours of personal care service available varies based on the level. MSP-PC is consumer directed, meaning eligible applicants can choose their own service providers. This can be a friend or relative, excluding spouses and legal guardians, given the individual is 18 years of age or older, is qualified to provide personal care services, meets the standards set forth by North Dakota’s Department of Human Services, and willing to accept the Medicaid approved hourly rate for care (estimated at $13.50 – $20.25 / hour).
In order to be eligible for MSP-PC, there are eligibility criteria related to one’s functional and financial need.
Functional Need – one must be determined to need personal care services for a minimum of 30 days. The level of personal assistance needed with ADLs and IADLs is determined via an assessment, which aids in determining which level of personal care services is needed. Below are the varying eligibility requirements for the three levels of care. There is no age requirement.
Level A – One of the following criteria must be met:
Level B – An individual must require a level of care that is consistent with that provided in a nursing home. In addition, one of the following criteria must be met:
Level C – An individual must require a level of care that is consistent with that provided in a nursing home. Furthermore, the following criteria must be met:
Financial Need – Financial eligibility criteria for North Dakota Medicaid varies depending on the age of the applicant. In early 2020, a single senior must have monthly income no greater than $883 (as of April of 2020) and countable assets (which does not count an applicant’s home’s value) of less than $3,000. However, a home is only exempt if the value of the homeowner’s equity does not exceed $595,000 and the applicant or his or her spouse resides in it. Other exemptions include household furnishings, personal items, one vehicle, and pre-paid funeral / burial plans. Please note that these income limits change annually. Full income eligibility information is available here.
Applicants over the financial eligibility limitations may still become eligible for Medicaid. North Dakota has a medically needy pathway that allows applicants with high medical costs to spend their excess income on these bills. Once their income has been spent down to the income limit, they are eligible for Medicaid. For those over the asset limit, one can spend excess assets on ones that are not counted towards the eligibility limit. For instance, one may make home modifications or room additions to encourage independent living. However, Medicaid eligibility is complicated, and it is suggested one seek the counsel of a professional Medicaid planner if over the above financial limits.
Assistance with ADLs is a benefit of all three levels of care, and includes personal hygiene and dressing, mobility and positioning, toiletry and incontinence, and eating. Aid with IADLs is also available, such as shopping for groceries and other essentials, preparing meals, medication management, managing money, and doing laundry.
Level A care allows a maximum of 120 hours of personal care services each month, Level B allows up to 240 hours, and Level C maxes out at 300 hours. It’s important to note, unlike Level A and Level B, Level C does not allow for assistance with IADLs.
Depending on an eligible individual’s income level, a small monthly payment, which is also referred to as a client share, may be required for services.
To learn more about the Personal Care Services program, click here. To apply for the Personal Care Services program, one must contact their local Department of Human Services. For more information, call 800-472-2622 or click here to find the local office in your county. A caseworker will do an initial assessment to determine personal care needs of the applicant. Eligible applicants must have an annual assessment for ongoing services.
If one is not currently on Medicaid, one must first apply and be found eligible for Medicaid. You can apply online here or apply in person at the social service office in your county.