Assisted Living in North Dakota
There are already more than 121,000 seniors living in North Dakota, as of the latest U.S. Census estimates, and the state is doing its best to attract even more retirees. In 2021, North Dakota added another reason for seniors to consider it as their new home by removing the state tax on Social Security benefits, and the state capital, Bismarck, joined the AARP Age-Friendly Network in the same year.
North Dakota performs well overall in our 2022 Senior Living Report where it’s ranked No. 15 of the 50 states and in the top three for its senior living and community engagement metrics. Elderly residents who need the kind of help available in assisted living facilities also have a great incentive to do so in North Dakota, where the average cost of $3,391 per month is much lower than most states.
This guide provides more details about assisted living costs in North Dakota, including potential funding sources and helpful resources for seniors in the state.
The Cost of Assisted Living in North Dakota
North Dakota is one of the most affordable states for assisted living, at an average cost of $3,391 per month according to the Genworth Financial 2021 Cost of Care Survey, which is roughly 25% below the norm for the United States. South Dakota’s assisted living facilities are priced similarly to their northern counterparts, with average savings of $41 per month. Minnesota and Montana have average costs just above and below the national average, at $4,508 and $4,450 per month, respectively. Seniors in Wyoming pay an average of $778 per month more than those in North Dakota.
The United States
Grand Forks has the lowest average cost for assisted living in North Dakota by a considerable margin, at $2,200 per month. The other two North Dakota cities included in the survey, Bismarck and Fargo, have average costs of $3,710 and $3,840 per month, respectively. Elsewhere in the region, in St. Cloud, Minnesota, and Rapid City, South Dakota, assisted living facilities are priced higher, at $4,100 and $3,914 per month, respectively.
St. Cloud, MN
Rapid City, SD
Assisted living is a relatively affordable mode of senior care in North Dakota, at $3,391 per month. Adult day health care has an average cost that’s just $8 per month lower than that of assisted living. In-home care services for seniors, including those providing light medical care, cost 68% more than assisted living facilities in the state. Nursing home care costs an average of $11,978 per month, which makes it over 250% more expensive than assisted living.
Home Health Care
Adult Day Health Care
Nursing Home Care (semiprivate)
Does Medicaid Cover Assisted Living in North Dakota?
Yes, but only partial coverage for assisted living is available. In addition to being financially eligible for Medicaid in North Dakota, seniors must qualify for the Home and Community-Based Services Waiver. The HCBS Waiver provides coverage for an expanded set of services intended to help people avoid or delay the need for nursing home placement by providing care in their own home or other residential (non-medical) setting, such as an assisted living facility. It’s not an entitlement program, however, which means applicants for HCBS services may be placed on a waiting list until state funding is available.
What Assisted Living Services Are Covered by Medicaid in North Dakota
North Dakota Medicaid and the HCBS Waiver cover the following services when provided in assisted living facilities licensed by the state.
- Case management (assessments, planning, monitoring, etc.)
- Personal care
- Residential care services (therapeutic programming, recreation, etc.)
- Housekeeping, laundry and meal preparation
- Non-medical transportation
- Specialized equipment (mobility aids, etc.)
It’s important to note that while Medicaid and its HCBS Waiver cover some of the services received in assisted living facilities, it doesn’t cover the room and board portion of the monthly bill.
Assisted Living Waiver Programs in North Dakota
Medicaid Waiver for Home and Community-Based Services
As mentioned above, the Medicaid HCBS Waiver covers various assisted living services. Applicants must meet all eligibility rules for the standard North Dakota Medicaid plan as well as the following list of requirements specific to the HCBS Waiver.
- Assessed as requiring a nursing facility level of care
- Aged at least 65 or assessed with a disability (based on Social Security definition)
- Able to self-direct their own care
- Living at home or licensed residential care facility (includes assisted living)
Applications for Medicaid and the HCBS Waiver can be submitted online, by mail and at local offices. Help in the application process is available by contacting the appropriate Human Service Zone office or via resources listed below in this guide.
How to Know If You’re Eligible for Medicaid in North Dakota
The standard Medicaid state plan in North Dakota is intended to help vulnerable members of the community, including the elderly, children, pregnant women and people with certain other conditions. However, this guide focuses on seniors who wish to live in assisted living facilities and their Medicaid eligibility requirements in particular.
Depending on income, Medicaid recipients may receive full coverage or be responsible for a share of costs. Countable assets include bank balances, stocks, bonds and other liquid assets. Excluded assets include the applicant’s home, one vehicle, personal and household items.
Annual Income Limits
Two-Person Household (Only One Person Applying)
Half of couple's assets up to $130,830
Two-Person Household (Both People Applying)
The applicant must also be a resident of North Dakota and a U.S. citizen or lawfully admitted permanent resident.
How to Apply for Medicaid in North Dakota
The North Dakota Department of Human Services manages the application process for Medicaid and the HCBS Waiver, among other public assistance programs. Applications can be submitted online at the department website, which also provides application forms that can be printed and submitted by mail or in person via local Human Service Zone offices throughout the state.
Information You Will Need
The following is a list of information and documents to prepare before submitting an application. Anyone who is unsure how to obtain such items should contact the department directly or request help from the resources below.
- Proof of age and identity (birth certificate, driver’s license, passport, etc.)
- Proof of the value of assets owned
- Proof of income and expenses
- Proof of residence (rent receipts, utility bills, lease, etc.)
- Social Security number
Non-citizen applicants must also provide proof of lawful alien status.
How to Get Help Applying for Medicaid
Help in determining eligibility and applying for Medicaid and how to receive a level of care assessment for the HCBS Waiver is available via telephone or in person via the local offices linked below.
Each county in North Dakota is served by a Human Service Zone office. These offices are staffed by professionals who can help by answering, identifying what is needed and locating the required documents, questions and getting the application process started.
Free legal assistance is available to seniors with a variety of legal issues, such as guardianships, medical bills, health care, SSI, Medicare and Medicaid. North Dakota residents who feel they've been wrongly denied any such services can ask for assistance here.
Fill out contact form on website
ACOA is a free service that connects seniors with resources who can help them understand and fill out Medicare paperwork. Resources include public employees working at Aging and Disability Resource Centers, Geriatric Care Managers, Elder Law Attorneys or private Medicaid planning professionals.
Does Medicare Cover Assisted Living in North Dakota?
The short answer is that no, Medicare does not cover the cost of assisted living in North Dakota. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.
For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in North Dakota.
Other Financial Assistance Options for Assisted Living in North Dakota
Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.
How to Apply
How It Works
Aid and Attendance
Learn more and apply online at va.gov.
Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.
Learn more about your options and how to apply at ftc.gov
If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
Long-Term Care (LTC) Insurance
Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.
Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.
Free and Low-Cost Resources for Seniors in North Dakota
Seniors who are currently in or planning a move to an assisted living facility may benefit from these resources. Whether it’s a simple question about aging-related issues or an important legal concern, there is help available throughout North Dakota.
The North Dakota ADRL connects seniors, people with disabilities and their caregivers with the appropriate local government agencies and service providers. Residents can call or email to ask questions about senior care, health insurance, financial assistance programs and other health and human services. The website also hosts a searchable database.
This helpline is a free service that helps North Dakota residents find the local services they need. Callers can ask about public benefits and other assistance programs available, such as housing and utility assistance, transportation, healthcare and support groups. The website can also be used to quickly search for resources.
This program is for low-income residents of any age who need help paying for prescription drugs but aren't eligible for such coverage from other state assistance programs. The North Dakota Insurance Department manages the program and eligible residents are provided with free or low-cost prescription drugs directly from pharmaceutical companies.
PACE is managed and funded by the state as an alternative to assisted living and nursing home care for people aged 55+ who qualify for nursing care but prefer to remain in their own home. Participants receive all of their healthcare needs via the program at a local PACE center and their home. If a current participant is no longer able to safely live at home, help is provided in the transition to assisted living or nursing home care.
Each county in North Dakota is represented by Veterans Service Officers. VSOs provide free, unbiased advice and help veterans and their eligible dependents get access to federal and state benefits. This includes help in the application process, such as finding documents and filing applications as well as the appeals process.
The LTC Ombudsman program helps residents of all long-term care facilities who have questions or complaints regarding their rights and the quality of care received. As part of the North Dakota Department of Human Services, ombudsmen are powerful advocates for residents and family members who feel unheard or neglected by facility staff.
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 3/22/2022, 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.
Are loved ones allowed to visit to provide emotional support?
Are relatives allowed to visit for end-of-life care?
Are residents required to quarantine after visiting with a loved one?
Are visitors required to wear PPE (including masks) in order to visit residents?
Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?
Are visitors checked for elevated temperatures?
Are visitors required to answer questions about health, travel, and potential virus contact?
Outings & Social Activities
Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?
Are residents who leave required to quarantine when they return?
Are senior living communities required to cancel all group outings?
Are residents allowed to eat meals together in a common area?
Are residents allowed to gather in common areas for group activites?
COVID-19 Safety Measures for Staff and Residents
Are staff members regularly required to do a temperature check?
Are staff members regularly tested for COVID-19?
Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?
Are residents regularly screened for COVID-19 symptoms?
Are residents regularly checked for elevated temperatures?
Are residents regularly tested for COVID-19?
Assisted Living Laws and Regulations in North Dakota
The North Dakota Department of Human Services is responsible for licensing assisted living facilities. Licenses are valid for 1 year and may be revoked for failure to comply with state regulations and other laws. These regulations are briefly described below.
Assisted Living Service Plan Requirements
The resident or legal representative must agree to and sign a written agreement detailing the cost of room and board as well as the required services, discharge criteria and inspection policies. The agreement must be made within 2 weeks of admission and updated quarterly to reflect changes in resident requirements, cost and other policies.
Assisted Living Admission Requirements
Each resident must undergo an initial evaluation to ensure the suitability of the facility based on the amount and type of services expected to be required as well as the skill level and/or certifications of staff required to provide such services. This includes mental, physical and social needs as well as behavioral issues. Assisted living facilities are responsible for developing admission criteria based on what can be safely and reasonably accomplished by staff.
Assisted Living Scope of Care
Staff must provide individualized support services that allow as much independence as possible based on each resident's needs and abilities. This includes assistance with activities of daily living, supervision, short-term medical care as needed, transportation, social activities and housekeeping.
Assisted Living Medicaid Policy
Assisted living facilities aren't required to accept payment for services via Medicaid. Residents must be eligible for the Medicaid Home and Community-Based Services Waiver to receive coverage for services, which may include personal care, social and recreational programming, supervision and security. Residents must be permitted to keep a minimum monthly personal needs allowance after other income has been used for room and board.
Assisted Living Facility Requirements
Facilities with more than two stories must maintain adequate fire escapes that are kept clear at all times. Residential units must be occupied by no more than four people, equipped with a sink and toilet, and at least one bathtub or shower per 15 residents.
Medication Management Regulations
Staff can assist residents in taking medications but must have appropriate certifications in order to administer medications. The facility must employ or contract with a health professional or pharmacist to provide an annual review of each resident's medication requirements.
Personal care staff must be available at all times, but there is no minimum staff to resident ratio. The facility must have a manager and administrator. If nursing services and/or medication administration is provided, the facility must employ nursing staff with appropriate certification.
Staff Training Requirements
Managers and administrators must have a minimum of 12 hours of in-service education per year. All staff must undergo yearly training on accident/emergency prevention and response, residents' rights and needs, infection control and management of residents' behavioral issues.
Background Checks for Assisted Living
State regulations don't require background checks for assisted living staff, but they must check all new employees against various registries and licensure boards to verify employment history, terminations, inappropriate conduct and disciplinary actions taken against them.
Requirements for Reporting Abuse
The North Dakota Department of Health contracts with the Long-Term Care Ombudsman Program for oversight of any complaints made by residents and people acting on their behalf, which are then forwarded to the relevant agency or other authority for investigation. Complaints can be raised directly with facility staff or submitted online, by mail, phone and fax.