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.

$12167

North Dakota

$7756

The United States

$7665

Montana

$8258

Wyoming

$7011

South Dakota

$11026

Minnesota

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.

$10646

Bismarck

$11365

Grand Forks

$10942

Fargo

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.

$5335

In-Home Care

$5529

Home Health Care

$2245

Adult Day Care

$4096

Assisted Living Facility

$12167

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, a single applicant should have a net annual income of less than $18,075. In addition, the applicant shouldn’t have countable assets exceeding $3,000. In a household of two people where both are applying, their income shouldn’t exceed $24,353, and they shouldn’t have countable assets valued over $6,000. 

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.

2022 Medicaid Income Limits for Seniors in North Dakota

Income Limits*
Asset Limits

Single Applicant

$18,075

$3,000

Two-Person Household
(Only One Person Applying)

$24,353

$3,000 for applicant
Between $26,076 and
$130,380 for non-applicant

Two-Person Household
(Both People Applying)

$24,353

$6,000

*Per year

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.

Resource
Contact 
Service

(855) 462-5465

The 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.

Online Only

The 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.

(866) 762-2237

Benefits.gov 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. Benefits.gov 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.

Resource
Contact
Service

(701) 328-2440

SHIC 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.

(800) 794-6559

BenefitsCheckUp 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.

(800) 633-4227

Medicare.gov 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, Medicare.gov 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.

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 skilled nursing care.

Reverse Mortgages

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 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) 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 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.

COVID-19 Rules for Nursing Homes in North Dakota

The following information is based on research done on several government websites, including health.nd.gov. These rules apply to Independent Living Communities 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.

Visitation Policies

Rules for North Dakota Communities

Are loved ones allowed to visit to provide emotional support?

Yes

Are relatives allowed to visit for end-of-life care?

Yes

Are residents required to quarantine after visiting with a loved one?

No

Are visitors required to wear PPE (including masks) in order to visit residents?

Yes

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?

Yes

Are visitors checked for elevated temperatures?

Yes

Are visitors required to answer questions about health, travel, and potential virus contact?

Yes

Outings & Social Activities

Rules for North Dakota Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Yes

Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?

No

Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for North Dakota Communities

Are staff members regularly required to do a temperature check?

Yes

Are staff members regularly tested for COVID-19?

Yes (Conditions Apply)

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?

Yes

Are residents regularly screened for COVID-19 symptoms?

Yes

Are residents regularly checked for elevated temperatures?

Yes

Are residents regularly tested for COVID-19?

Yes (Conditions Apply)

Nursing Home Laws and Regulations in North Dakota

Nursing Home Laws and Regulations in North Dakota
Licensing Requirements
In 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 Requirements
All 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 Requirements
To 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 Restrictions
Nursing 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 Requirements
Nursing 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 Requirements
Nursing 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 Services
In 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 Services
Nursing 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 Coverage
North 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.