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Nursing Homes in North Dakota

Stretching across the Great Plains, the midwestern state of North Dakota is home to more than 760,000 people, around 16%, or 120,000, of whom are seniors aged 65 and older. North Dakota offers a variety of features that support happy and healthy retirement living, including a plethora of outdoor recreational opportunities, low crime rates and access to 47 hospitals, including Sanford Medical Center Bismarck, CHI St. Alexius Health Bismarck and Sanford Medical Center Fargo, which was named the best hospital in North Dakota by U.S. News.

Nursing homes are one option for seniors who require long-term care. In these facilities, seniors receive 24-hour care and supervision from trained nursing professionals. According to Genworth Financial’s 2020 Cost of Care Survey, seniors can expect to pay an average of $12,167 per month for a semiprivate room in a nursing home, while a private room costs $12,764.

This guide provides an overview of nursing home costs in North Dakota compared to nearby states and the nation as a whole. It also includes information about financial assistance and the laws and regulations that nursing homes in North Dakota must abide by, as well as a list of resources available to seniors and their caregivers.

The Cost of Nursing Home Care in North Dakota

Nursing home care in North Dakota is considered very expensive compared to other U.S. states. According to Genworth Financial’s 2020 Cost of Care Survey, seniors can expect to pay an average of $12,167 per month for a semiprivate room in a nursing home, which is significantly higher than the national average of $7,756. North Dakota is one of the costliest states in the region. Even Minnesota, which costs an average of $11,026 per month is still over $1,000 cheaper than North Dakota. Wyoming and Montana are significantly more affordable, with average monthly costs of $8,258 and $7,665, respectively. Just below North Dakota, South Dakota is the least expensive option at $7,011.

Nursing home costs can vary greatly from city to city based on a variety of factors, such as population, location, cost of living and access to health care. The state’s highest nursing home rates are in Grand Forks, where seniors can expect to pay an average of $11,365 per month. To the south in Fargo, costs are slightly lower at an average of $10,942. The state’s least expensive nursing home care is found in the capital city of Bismark, where seniors can expect to pay around $10,646 per month.



Grand Forks




Seniors in North Dakota have additional options for long-term care, depending on the level of care and attention they require. These include in-home care, home health care, adult day care and assisted living care. For seniors who only require basic daytime care services, adult day care is an affordable option at an average cost of $2,245 per month. Seniors who wish to remain in their own homes have the option of homemaker services for $5,335 per month. Those who require light medical care may benefit from home health care, which costs an average of $5,529 monthly. Seniors who need comprehensive full-time care but are not yet ready for a nursing home may opt for an assisted living facility, which costs an average of $4,096 per month.

In-Home Care


Home Health Care


Adult Day Care


Assisted Living Facility


Nursing Home Care


Does Medicaid Cover Nursing Home Care in North Dakota?

Over 114,000 North Dakota residents are now enrolled in Medicaid, thanks to the recent Medicaid Expansion program. Seniors residing in nursing home facilities can use the plan to finance room and board, nursing care, medical supplies, wheelchairs and medical equipment. North Dakota recipients can also use Medicaid to cover the costs of certain therapies.

There are 79 licensed nursing homes in the state, of which 77 accept Medicaid. These facilities provide over 5,000 beds that allow seniors throughout the state to receive attentive long-term care from licensed medical professionals. The Basic Care Assistance Program enables senior citizens to cover a portion of their nursing care costs and other personal expenses. Furthermore, the Medicaid Waiver for Home and Community Based Services is available to individuals wishing to receive nursing care while remaining in their own homes and communities.

Medicaid Eligibility in North Dakota

To receive Medicaid, seniors must meet eligibility criteria relating to their finances and medical needs. Applications can easily be filed online by submitting an Application for Assistance form through the North Dakota Human Services website. From here, the application is directed to a Human Service Zone office or the Medical Service Division of the Department of Human Services, which will issue a decision within 45 days.

Generally speaking, any individual who’s blind, disabled or over the age of 65 will qualify for Medicaid so long as their income and countable assets are within the limits below. In order to receive Medicaid coverage for nursing home care, there is no set income limit, although most of the applicant’s income must go toward the cost of care. Assets are limited to $3,000 per individual and $6,000 per couple where both spouses are applying. 

The Spousal Impoverishment Prevention Coverage is available to couples where only one individual is seeking long-term care. In this scenario, the applicant may retain up to $3,000 in assets. From the date the applicant receives long-term care, the spouse who remains in the community may keep up to half of all remaining assets. There are both minimum and maximum amounts that the community spouse may retain in assets, and these are reviewed annually by North Dakota Human Services.


Household SizeNumber of ApplicantsIncome Limits Per Year*Asset Limits: Applicant(s)Asset Limits: Non-Applicants
One Person1No set limit$3,000
Two People1No set limit$3,000$148,620
Two People 2No set limit$6,000

*Except for a personal needs allowance of $65/mo. for single and $130/mo. for couples who are both recipients, Medicare premiums and possibly a spousal income allowance for a non-applicant spouse, all of a recipient's monthly income must be put toward the cost of nursing home care.

Any individual wishing to apply to the program must:

  • Be an American citizen or legal resident
  • Reside in North Dakota


How To Apply for Medicaid in North Dakota

Seniors interested in receiving Medicaid have several options available to them for the application process. Individuals can submit their documentation through the North Dakota Human Services website, request a mail-in form or manually return their application to their nearest Human Service Zone office. Once the online or paper form is received, a decision will be made within 45 days. Applicants can receive retroactive coverage for up to 3 months before the date of their application, so long as the services received were from a registered Medicaid provider in North Dakota and all eligibility requirements were met during this period.

Information You Will Need

  • Social Security card
  • Proof of age and identity (such as a birth certificate or driver’s license)
  • Proof of alien or citizenship status (such as a resident card, employment authorization card, passport, American birth certificate or an American Indian or Alaskan Native Tribal Document)
  • Proof of all income including self-employment income, money from friends or relatives and spousal support 
  • Proof of income derived from benefit programs (such as workers’ compensation, veterans’ benefits and unemployment benefits)
  • Proof of assets including real property, savings bonds, stocks, bonds and mutual funds
  • Proof of expenses (such as court-ordered payments or health insurance premiums)
  • Life insurance documentation
  • Any other documents the applicant thinks may support their file

Additional Medicaid Support and Resources in North Dakota

A number of resources are available to North Dakotans who are in the Medicaid application process. The table below provides a brief description of their services and contact details.

North Dakota Aging and Disability Resource Link(855) 462-5465The North Dakota Aging and Disability Resource Link is a free and confidential service that helps senior citizens find information about long-term care throughout the state. A quick online assessment will help the NDADR’s knowledgeable staff direct them toward any resources that could be helpful in the applicant's particular circumstances. The website contains a comprehensive directory of nonprofits and governmental agencies specializing in Medicaid applications, long-term care, disability services and legal aid.
American Council on AgingOnline OnlyThe American Council on Aging has various online services that help seniors determine their eligibility for Medicaid support. A fast and straightforward Medicaid Eligibility Test will immediately inform the prospective applicant if they qualify and if so, the fastest and most economic way to get through the process. If the individual is not eligible due to financial restrictions, they can find information on how to spend down their assets or income. is the official benefits website operated by the federal government. It's very helpful for individuals in the initial phases of their application, with comprehensive information about eligibility requirements. can help seniors find other financial assistance programs particular to their situation, including benefits for retired U.S. armed forces personnel.

Does Medicare Cover Nursing Home Care in North Dakota?

Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it’s most valuable for those who are recovering from an injury, illness or surgery.

Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.

What Does Medicare Cover?

Medicare covers a number of specific services, including:


  • Meals
  • A semiprivate room
  • Medications
  • Skilled nursing
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Audiologist care
  • Medical supplies
  • Medical social services
  • Nutritional counseling
  • Ambulance transportation


What Isn’t Covered by Medicare?

Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.

For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.

Medicare Support and Resources in North Dakota

When seniors and their loved ones are looking for long-term care in North Dakota, there may be great consideration to how much of their costs can be covered by Medicare. There are several government agencies and nonprofit organizations that can guide the applicant through the process and direct them to the financial support they need. Many of these are available to North Dakotans free of charge and are available on a 24/7 basis.

State Health Insurance Counseling(701) 328-2440SHIC is a free service provided by The North Dakota Insurance Department, a government agency that collaborates with a number of private insurance companies. It operates the North Dakota Long-Term Care Partnership, which helps elder North Dakotans purchase insurance policies that will provide them with financial coverage for long-term care while still remaining eligible for Medicaid. Counselors can offer advice to seniors to help them retain their assets, which would otherwise need to be spent on their long-term care.
BenefitsCheckUp(800) 794-6559BenefitsCheckUp is a free online tool from the National Council on Aging. It offers users a comprehensive overview of the benefits available to them from both federal and state government agencies. Seniors can complete a quick online questionnaire that will generate a list of financial assistance programs available to them, including medication benefits, veterans' benefits, transportation and tax relief. is an official government website containing information pertaining to the Medicare application process, costs and legal matters such as identity fraud. On the website, seniors can find the Medicare and You handbook, which thoroughly explains how to apply and what services can be covered by Medicare. For those requiring additional insurance to cover their long-term care, there's a detailed section on Medicare Supplement Insurance (Medigap) policies, which under some circumstances can provide additional funding for nursing home services. In addition to its hotline, has a useful Live Chat feature where users can receive advice 24/7, except for some public holidays.

Other Financial Assistance Options for Nursing Home Care in North Dakota

While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.

NameHow To ApplyHow It Works
Aid and AttendanceLearn more and apply online at 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 skilled nursing care.
Reverse MortgagesLearn more about your options and how to apply at ftc.govIf you own a home, you may be able to use a reverse mortgage to help pay for nursing care. 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) InsuranceLearn more about Long-Term Care Insurance and how to apply for a policy at who already have long-term care insurance may be able to use it to pay for skilled nursing care. 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 skilled nursing care will not typically be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in North Dakota

There are many resources in North Dakota that assist seniors in their retirement. has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.

Area Agency on Aging

Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.

Program NamePhone NumberDescription
North Dakota Department of Health and Human Services855-462-5465North Dakota's Area Agencies on Aging operates programs under the umbrella of the North Dakota Health and Human Services. The program offers specialized assistance to seniors based on an assessment of individual needs. These include services that help seniors stay in their homes instead of moving into long-term care. Examples include funding for in-home services, family home care and adult foster care. Other forms of practical assistance are homemaker services, such as chores, shopping, meal preparation and money management.

Cash Assistance Programs

Cash assistance programs in North Dakota provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.

Program NamePhone NumberDescription
North Dakota Lifeline Program800-234-9473The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones.

Financial Assistance for Senior Care and Senior Living

Whether living in their own home or in a senior living community, North Dakota seniors can find financial assistance from numerous local resources. These organizations help residents cover some of the costs associated with in-home or long-term care and connect them with other helpful community-based resources.

Program NamePhone NumberDescription
North Dakota Medicaid Waiver for Home and Community Based Services855-462-5465The Medicaid Waiver for Home and Community Based Services is designed to help older adults and people with disabilities remain living in their homes with access to local community services. This waiver provides a wide range of services including personal care, transport, chore services and respite care. It can also pay for minor home modifications. Services can be provided at home, in adult daycare, adult foster care or memory care facilities.

Food Assistance Programs

Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help North Dakota seniors afford the nutritious food they need.

Program NamePhone NumberDescription
North Dakota Commodity Supplemental Food Program (CSFP)The North Dakota Community Supplemental Food Program is a government program targeted at improving the health of seniors. CSFP food packages distributed to eligible older North Dakotans contain USDA-approved supplementary food items suitable for inclusion in a diet that addresses the nutritional needs of older adults. All low-income North Dakota residents aged 60 and over are invited to apply. Packages are available through nominated community action agencies with location details accessible online.
North Dakota Meals on WheelsNorth Dakota Meals on Wheels provides nutritious, well-balanced meals and support services for eligible seniors statewide. Seniors must be 60 years old or over to qualify, and the program focuses on those who aren't mobile enough to prepare or shop for food. Depending on circumstances, meals are served on a sliding-scale basis in a congregate setting, such as the local senior center, or they're delivered directly to the senior's front door with an accompanying safety check.
North Dakota The Emergency Food Assistance Program (TEFAP)The Emergency Food Assistance Program of North Dakota is a federal government program aimed at stemming food insecurity and nutritional deficiencies in older adults. North Dakota seniors aged 60 and over with limited financial means can access emergency food packages and attend free communal meals. TEFAP partners with local North Dakota agencies such as the Great Plains Food Bank in Fargo to distribute food to pantries statewide. Seniors can make inquiries through TEFAP or their local seniors' agency.

Free Used Medical Equipment

Due to the high cost of purchasing new medical equipment, several organizations in North Dakota collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.

Program NamePhone NumberDescription
North Dakota Healthcare Equipment Recycling Organization (HERO)701-212-1921Based in Fargo, this program provides donated durable medical equipment to people in need locally and worldwide. It also has a shopfront where anyone can purchase low-cost medical equipment and supplies.

Home Repair and Modifications

Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in North Dakota have different eligibility criteria and often assist retirees by providing grants or loans.

Program NamePhone NumberDescription
North Dakota Rehab Accessibility Project800-292-8621North Dakota Housing Finance Agency is in Bismarck, ND. The agency operates diverse programs to assist homeowners, renters and homeless people. Low-income individuals with a physical disability may qualify for financial assistance through the Rehab Accessibility Program. Grants for home renovations may cover fitting accessibility features, such as grab rails, ramps and wheelchair-accessible showers, as well as widening doorways and installing door levers. To qualify, households must earn less than 80% of the county's median income.

Social Security Offices

Social Security offices in North Dakota help seniors and disabled people access the benefits they're entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.

Program NamePhone NumberDescription
North Dakota Social SecuritySocial Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working.

Tax Assistance

Seniors can apply for tax assistance from several North Dakota resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.

Program NamePhone NumberDescription
North Dakota Homestead Property Tax CreditThe Homestead Property Tax Credit reduces the taxable value of a person's home. The credit amount is variable, based on an individual's income.
North Dakota Renter's Refund701-328-7088The Renter's Refund provides a partial refund for the rent of a person's place of residence or mobile home lot. The benefit provides a refund if 20% of your rent is more than 4% of your annual income. The overpayment is refunded, up to $400.

Utility & Energy Bill Assistance

Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. North Dakota retirees could also qualify for emergency funding programs if they're in danger of losing utility services due to unpaid invoices.

Program NamePhone NumberDescription
North Dakota Low Income Home Energy Assistance Program (LIHEAP)866-614-6005LIHEAP partially pays for home heating costs, including natural gas, electricity, coal or other fuel sources. It can also help with weatherization, furnace cleaning and repair, chimney cleaning and emergency assistance.

Veteran's Services

North Dakota retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they're eligible for and provide advice and information on a variety of issues.

Program NamePhone NumberDescription
North Dakota VA Benefits and Health CareNorth Dakota VA Benefits and Health Care helps seniors access long-term care and various in- and out-patient medical services throughout the state. Eligible veterans can receive treatment and nursing home care at clinics and veteran's centers in North Dakota, as well as utilize financial benefits such as Aid and Attendance. Typically, individuals must serve 24 months of active duty to be eligible for these benefits; however, this is sometimes waived for people discharged due to disability or hardship.

Nursing Home Laws and Regulations in North Dakota

Nursing Home Laws and Regulations in North Dakota
Licensing RequirementsIn North Dakota, skilled nursing facilities must pass an inspection and investigation to obtain a license from the state Health Department's Division of Health Facilities. Licenses must be renewed on an annual basis. The department must be given 30 days notice for any changes made to a facility's ownership, bed capacity or name.
Staffing RequirementsAll medical care in nursing homes is conducted under the supervision of the facility's medical director, who is responsible for coordinating care services.The facility must employ a director of nursing to oversee all nursing services. It is also required that a nursing home have a sufficient number of nursing staff on duty. This includes at least one registered nurse and one licensed nurse on duty for eight hours a day, seven days a week.
Staff Training RequirementsTo hold the position of medical director at a nursing facility, an individual must be a licensed physician. Similarly, a facility's director of nursing must be a registered nurse who is licensed to practice in the state of North Dakota.New employees are required to go through an orientation program. All current staff must complete an annual educational program that covers safety and emergency procedures, the prevention and control of infections, resident rights, advanced directives and how to provide care for residents with behavioral issues.
Admission RestrictionsNursing homes may refuse to admit residents whose needs cannot be adequately met by the accommodations and care services provided by the facility. In order to be admitted, residents must be referred under the order of a licensed health care practitioner and undergo a physical examination within 48 hours of admission.
Care Planning RequirementsNursing homes are required to develop a comprehensive care plan for each resident that's individualized to meet their needs and assist them in maintaining the highest level of functioning possible. Care plans must identify a resident's difficulties and strengths, outline measurable, behavior-oriented goals and include a plan of action. Plans are to be revisited on a quarterly basis.
Dietary and Nutritional Services RequirementNursing homes must provide their residents with at least three daily meals, served at regular times. Menus must be nutritious and meet the food and nutrition board's recommended dietary allowances. Facilities must make efforts to adjust menus to address resident requests or special dietary needs whenever possible.
Specialized Rehabilitative ServicesIn North Dakota, communities are required to provide specialized rehabilitative services that, at a minimum, include physical therapy, speech and language therapy, occupational therapy and behavioral health services for seniors with mental illnesses or impairments. These services may be provided directly by on-site staff members or by outside professionals.
Medication and Pharmaceutical ServicesNursing homes in North Dakota are required to provide pharmaceutical services for their residents. Any medication administered to a resident must be ordered in writing by a licensed health care professional, and a licensed pharmacist is to review each resident's medications on a monthly basis.
Activities Requirements Nursing facilities must provide ongoing activity programs that support residents' physical, mental and psychosocial well-being. Activities should be meaningful, stimulating and therapeutic and designed around residents' interests and needs.
Infection Control Requirements Nursing facilities are expected to have programs in place to protect residents' health that follow the standards set by the Centers for Disease Control and Prevention. This includes procedures, such as proper facility maintenance, disinfection of surfaces, staff hygiene measures and isolation protocols.
Medicaid CoveragesNorth Dakota's Medicaid program covers the cost of services for individuals who require nursing home care. Medicaid also offers waiver programs to cover certain services for seniors with similar care needs who have chosen to remain living independently at home.

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