Affectionately known as the Peace Garden State, North Dakota is home to nearly 775,000 residents. Despite the region’s chilly winter temperatures, there’s plenty that makes North Dakota a great option for retirees who make up 15.7% of the population. The state is especially appealing in terms of finances, with a low overall cost of living, affordable health care costs and Medicaid waivers that can help some older residents pay for assisted living. The average monthly cost for assisted living in North Dakota is just $3,391, which is not only lower than the U.S. national average but also lower than the average in many nearby states. 

The following guide provides information for seniors in North Dakota who are looking to transition to an assisted living environment, including the average monthly costs of these facilities compared to nearby and other care options. It also contains information about the state’s Medicaid and Medicare coverage policies along with a list of free local resources that can help seniors navigate long-term care.

How Much Does Assisted Living Cost in North Dakota?

As reported by the 2021 Genworth Cost of Care Survey, assisted living services cost an average of $3,391 per month in North Dakota. This means that seniors can expect to save more than $1,100 per month on their long-term care bills compared to the average U.S. state. It’s also much more affordable than in several nearby states. Neighboring Wyoming is more expensive at an average cost of $4,169 per month. Assisted living is also pricier in both Montana and Minnesota, which cost an average of $4,450 and $4,508 per month, respectively. Just below North Dakota, South Dakota has similar assisted living costs. In fact, rates are even a little bit cheaper at $3,350 per month.

The Cost of Assisted Living in North Dakota’s Top Cities

Assisted living costs not only vary among states but can also be different between cities in the same region. For example, in North Dakota, the cost of care in the capital city of Bismarck averages around $3,710 per month. Further east in Fargo, costs are about $100 higher per month. The most affordable city in the state is Grand Forks. Here, assisted living costs just $2,200 per month, which is nearly $1,200 below the statewide median.

The Cost of Assisted Living vs. Other Types of Care

Depending on a seniors’ level of need, there are a variety of other care options available in North Dakota. Adult day care is similarly priced to assisted living care; however, it does not include the full-time supervision and assistance seniors receive at a long-term care facility, so it’s best suited to those who require minimal assistance. Seniors who wish to remain living at home may benefit from homemaker services or the assistance of a home health aide, both of which cost $5,689 per month. Nursing home facilities provide the highest level of care and 24-hour supervision, with an average cost of $11,978 per month for a semiprivate room.

Can You Use Medicaid to Pay for Assisted Living in North Dakota?

In North Dakota, the Medicaid State Plan covers some of the services associated with assisted living care through its Home and Community-Based Services Waiver program. Under this waiver, seniors receive coverage for health care services that can help prevent early institutionalization in a medical setting, though it does not cover the cost of room and board. Another program available to Medicaid-eligible seniors is the Program of All-Inclusive Care for the Elderly (PACE), which includes coverage for a full range of health care services.

Medicaid’s Coverage of Assisted Living in North Dakota

The Home and Community-Based Services Waiver program is intended to provide options for seniors who require a nursing home level of care so they can avoid or delay institutionalization. The program offers partial to full coverage of services that can be administered in a senior’s own home or in a non-medical, community-based setting, such as an assisted living facility. Some of these services include case management, personal care, transportation, therapeutic programming and specialized medical equipment.

PACE, while not a waiver program, can be of assistance to seniors in assisted living care. The program is designed for seniors who are 55 years of age and older and require a nursing home level of care but prefer to remain either living at home or in a community-based setting, such as assisted living. This program can help cover a range of health care services such as dentistry, specialized medical care, physical and occupational therapies, prescription medications and hospice care.

Waiver Programs for Assisted Living in North Dakota

Home and Community-Based Services Waiver

North Dakota Medicaid’s HCBS Waiver covers a range of services that seniors may receive in the environment of their choosing, including an assisted living facility. This includes case management services such as assessments, planning and monitoring, personal care assistance, specialized residential programming and recreation, household chores, non-medical transportation and specialized medical equipment such as mobility aids. The cost of room and board at an assisted living facility is not included. As it is not an entitlement program, applicants may be placed on a waiting list until funding is available. In addition to the requirements in place for the Medicaid State Plan, seniors applying for the HCBS Waiver program must also:

• Display a functional need for a nursing facility level of care
• Be at least 65 years of age or older, or be assessed with a disability
• Be able to self-direct their care services
• Reside at home or in a licensed residential care facility

To apply, seniors can fill out an application online or fill out a physical application form to be submitted either in person or by mail to their local Human Service Zone office. Individuals who require assistance with their application should contact their local Human Service Zone office.

Eligibility for Medicaid in North Dakota

Medicaid provides health coverage benefits to individuals who are living on a limited income and/or have limited resources. Therefore, there are certain limitations in place to determine a seniors’ eligibility to receive Medicaid benefits, specifically in terms of their financial situation.

An individual applicant’s yearly income cannot be higher than $11,280. Additionally, they may not have more than $3,000 in countable assets. If a married couple is applying together, they are allowed a combined annual income of $15,204 and $6,000 in assets. If only one senior in the partnership is applying, the annual income limitation is $11,280, but the non-applicant is permitted to retain half the couple’s total assets to a maximum of $137,400.

2022 Medicaid Income Limits for Seniors in North Dakota

	Income Limits*	Asset Limits
Single Applicant	$11,280	$3,000
Two-Person Household (Only One Person Applying)	$15,204	$3,000 for applicant50% of the couple’s total assets up to $137,400 for non-applicant
Two-Person Household (Both People Applying)	$11,280	$6,000

*per year

There are several other requirements in place to determine Medicaid eligibility. To qualify for Medicaid benefits in North Dakota, seniors must also be:

• 65 years of age or older,
• Or blind, disabled or living in a household with someone who is disabled
• A resident of North Dakota
• A legal U.S. citizen or permanent resident
  
  

Applying for Medicaid in North Dakota

The application process for North Dakota Medicaid programs is facilitated by the Department of Human Services. The quickest and easiest way for seniors to submit an application is online via the DHS website. If they prefer, seniors may also submit a paper application online or in person at their local Human Service Zone office.

Before You Apply:

When applying for their Medicaid waiver program, seniors will require the following information and corresponding documentation:

• Proof of name
• Date of birth
• Proof of U.S. citizenship or permanent residency
• Proof of residence in North Dakota
• Social Security number
• Policy numbers of any current health insurance plans
• Full list of countable assets
• Proof of income and expenses, including all forms of retirement income

Where to Go to Get Help

Navigating Medicaid can be challenging. The following agencies are available to provide information and answer any questions seniors may have about applying for health care benefits:

Resource	Contact	Service
North Dakota Department of Human Services	(701) 328-2332	In addition to being where seniors go to apply for their Medicaid benefits, the Department of Human Services is a comprehensive resource for information and guidance about applying for health care benefits. Here, seniors can learn about the different programs available to North Dakotans, access application forms, watch videos about applying for benefits online and locate their regional DHS office.
Human Service Zones	(701) 328-2310	Operating in each county across North Dakota, Human Service Zones can help assist seniors with their Medicaid applications. Trained professionals are on-site at each location to provide information about how to apply for benefits, eligibility requirements and what benefits individuals qualify for. These offices can also provide referrals to other statewide assistance programs.
Legal Services of North Dakota	(866) 621-9886	Legal Services of North Dakota is a nonprofit organization that offers free legal assistance to low-income and elderly residents of North Dakota. This includes helping seniors understand their health care coverage options and providing representation if they wish to appeal denied coverage claims.
Appeals Supervisor	(701) 328-2311	Seniors who feel they have been wrongly denied health care coverage can file an appeal to be processed by the Department of Human Services’ Appeals Supervisor. Seniors can contact the office of the supervisor directly or submit an online appeal request.

Can You Use Medicare to Pay for Assisted Living in North Dakota?

Unfortunately, Medicare does not cover the cost of assisted living in North Dakota. Unlike nursing homes, assisted living facilities are not considered to be “clinical settings’ and so are not eligible for Medicare coverage. That being said, you can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

For more information about Medicare visit medicare.gov.

Are There Other Financial Assistance Options for Assisted Living in North Dakota?

	How to Apply	How It Works
Aid and Attendance	Apply online at va.gov.	If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse Mortgages	Research and learn about the different types at ftc.gov	If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) Insurance	Learn about how to receive LTC insurance benefits at acl.gov.	While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free and Low-Cost Resources for Seniors in North Dakota

There are many local and statewide resources that can help seniors manage their long-term care needs. These range from resource directories to organizations that offer personal care, health care services, benefits counseling, care coordination and wellness programming. Provided by government agencies and nonprofits, these supports are often free or provided at a low cost.

Resource	Contact	Service
North Dakota Senior Service Providers	Online	North Dakota Senior Service Providers serves as a network of more than 30 nonprofits that operate in all 53 counties and four reservations across the state. The organization helps connect seniors with programs to suit their needs in their local region, of which there are eight. Some offerings include transportation, senior companion services, legal assistance, exercise programs and health maintenance services, as well as the programming at North Dakota’s 200 senior centers.
The Aging and Disability Resource Link (ADRL) of North Dakota	(855) 462-5465	The Aging and Disability Resource Link of North Dakota provides free and confidential assistance to help seniors locate services and support in their local community. Resource professionals are available to answer questions and direct seniors to resources such as in-home and community-based services, caregiver support and long-term care facilities in their area. The organization also conducts assessments for referrals to personal care services.
North Dakota Department of Veterans Affairs	(701) 239-7165	North Dakota Department of Veterans Affairs acts as a comprehensive resource to help veterans and their dependents access the benefits and programs they’re entitled to for their service. This includes both state and federal benefits, such as health care services, pensions, Aid and Attendance payments and support groups. Staff members assist these individuals by answering questions about the benefits they qualify for and how they can apply. These services may be accessed directly through the department or via their County Veterans Service Offices, Tribal Veterans Service Offices, or National Service Offices.
North Dakota Long-Term Care Ombudsman Program	(701) 328-4617 or (855) 462-5465	North Dakota’s State Long-Term Care Ombudsman Program advocates for the needs and rights of seniors living in long-term care facilities. Volunteer workers conduct flexible, weekly visits to address any concerns or complaints seniors and their family members may have in regards to their health, safety and care in their long-term care environment. The program can also help by answering questions about long-term care, providing information about residents’ rights and offering referral services.
Prescription Connection	(888) 575-6611	An initiative of the North Dakota Insurance Department, Prescription Connection helps seniors acquire the prescriptions they need. To qualify for this program, an individual must be a resident of North Dakota who is living on a limited income and does not qualify for other prescription drug programs administered by the state. Seniors can call the program’s main office to schedule an appointment and begin the application process.
State Health Insurance Counseling (SHIC) Program	(701) 328-2440 or (888) 575-6611	North Dakota’s State Health Insurance Counseling (SHIC) program provides free assistance with Medicare. Seniors can call the program to speak with trained counselors who help them understand their health care expenses, assist with filing claims and appeals, provide them with their current health care insurance options and offer advice about their options moving forward.

COVID-19 Rules for Assisted Living in North Dakota

The following information is based on research done on several government websites, including health.nd.gov and cms.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?	Yes
Can I visit my relative in person for end-of-life compassion care?	Yes
Will my loved one be required to self-quarantine after I visit him or her?	No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?	Yes
Are Hairdressers and other non-medical contractors still allowed in senior living facilities?	Yes
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?	Yes
Are visitors being screened for elevated temperatures?	Yes
Are visitors being asked questions about health, travel, and potential virus contact?	Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?	Yes
Are residents of senior living facilities who leave and return required to self-quarantine?	No (Conditions Apply)
Are senior living facilities required to cancel all group outings?	No
Are residents still eating together in the dining hall?	Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?	Yes (Conditions Apply)

Safety Measures for Staff & Contractors

Are staff members and contractors being screened for elevated temperatures?	Yes
Are staff members and contractors being tested for Coronavirus?	Yes (Conditions Apply)
Are staff members and contractors being asked questions about health, travel, and potential virus contact?	Yes

Safety Measures for Residents

Are staff members required to regularly screen residents for coronavirus symptoms?	Yes
Are residents relied on to screen themselves and self-report potential coronavirus symptoms?	No
Are staff members required to take residents’ temperatures?	Yes
Are residents being tested for coronavirus?	Yes (Conditions Apply)

Assisted Living Laws and Regulations in North Dakota

Throughout the state, assisted living facilities (ALFs) are licensed by the North Dakota Department of Human Services. Licenses are valid for one year and can be renewed so long as a facility complies with state regulations. ALFs must also comply with additional rules set out by the Department of Health. The State Ombudsman Program is responsible for overseeing and monitoring ALFs.