Program Description
North Dakota’s 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 (nursing home placement).
Personal Care Services are available on an intermittent, as well as 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 is willing to accept the Medicaid approved hourly rate for care.
Eligibility Guidelines
Eligibility criteria for MSP-PC are related to one’s functional and financial need.
General Requirements
Functionally, 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:
- An individual must need assistance with one of the following seven ADLs: taking a bath, dressing oneself, feeding oneself, using the bathroom, continence, transferring (such as getting out of bed and into a chair), or mobility inside the home.
- Assistance must be needed with three of the following IADLs: preparing meals, doing laundry, taking medication, and doing housecleaning.
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:
- An individual must need assistance with one of the seven ADLs mentioned above.
- Assistance must be needed with three of the IADLs mentioned above.
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:
- An individual must also need assistance with a minimum of five of the ADLs.
Financial Requirements
Income Limits
In 2023, a single senior must have monthly income no greater than $1,009. While a married couple is allowed $1,364 a month in income. These figures update in April each year.
Asset Limits
Countable assets are limited to $3,000 for individuals and $6,000 for couples. However, some items are not counted toward this limit, including one’s home, as long as the equity value is under $688,000 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.
Over the Financial Limits?
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 things 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.
WarningMedicaid has a 60-month look-back period in which all transfers within this time frame are scrutinized. Assets are not allowed to be gifted in order to meet financial requirements, otherwise the individual will be penalized with a period of Medicaid ineligibility.
Benefits and Services
Assistance with ADLs is a benefit of all three levels of care, and includes:
- Personal hygiene and dressing
- Mobility and positioning
- Toiletry and incontinence
- Eating
Aid with IADLs is also available, such as:
- Shopping for groceries and other essentials
- Preparing meals
- Medication management
- Managing money
- 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.
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.
How to Apply / Learn More
To apply for the Personal Care Services program, one can contact the Aging and Disability Resource Link at 855-462-5465 or their local Human Service Zone at 866-614-6005.
A caseworker will do an initial assessment to determine the 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 Human Service Zone office in your county.
More information about the Personal Care Services program can be found here.
