This page provides a plain-English summary of key elder care and estate planning information specific to North Dakota residents. It covers North Dakota Medicaid limits, estate tax rules, advance directive information, and links to important North Dakota agencies and resources.
Information on this page is updated periodically but laws and limits change frequently. Always verify current figures with the relevant agency or a licensed attorney.
North Dakota Medicaid — 2026 Eligibility Limits for Long Term Care
North Dakota’s Medicaid program is administered by the North Dakota Department of Human Services — DHS. North Dakota expanded Medicaid under the Affordable Care Act in 2014 providing coverage to adults up to 138 percent of the federal poverty level. Note that North Dakota updates its FPL-based income limits on April 1 of each year rather than January 1 like most states.
Income limit — nursing home Medicaid uses Share of Cost — no income cap North Dakota is one of the few states that does not impose a hard monthly income cap for nursing home Medicaid eligibility. Instead North Dakota uses a Share of Cost model — meaning nearly all of a resident’s income must be contributed toward nursing home care costs after allowances for a personal needs allowance Medicare premiums and any spousal income allowance. Having higher income does not disqualify a person from North Dakota nursing home Medicaid but does mean contributing more toward care costs.
HCBS Waiver income limit — much lower than nursing home North Dakota’s Aged and Disabled Waiver uses a significantly lower income limit of $1,197 per month for a single applicant — based on 90 percent of the Federal Poverty Level effective April 2026. This is one of the lower HCBS income limits in the country. Applicants with income above $1,197 per month can use a medically needy spend-down pathway applying excess income toward qualifying medical expenses to reduce countable income to the threshold.
Asset limit — single applicant — higher than most states A single applicant must have $3,000 or less in countable assets — 50 percent higher than the $2,000 standard used by most states. Exempt assets include the primary residence with equity up to $752,000 if the applicant intends to return home, one vehicle, personal belongings and household furnishings, and irrevocable funeral trusts up to $10,000. Note that IRAs and 401(k)s are counted as countable assets in North Dakota.
Home and community based care — Aged and Disabled Waiver North Dakota’s primary HCBS program for seniors is the Aged and Disabled Waiver which provides home and community based services for North Dakota residents who need nursing facility level care but want to remain at home or in a community setting. The asset limit is $3,000 for a single applicant and the income limit is $1,197 per month effective April 2026.
An important distinction in North Dakota is that HCBS services can be provided in a broader range of settings than most states — including the applicant’s own home adult day care adult foster care memory care facilities and assisted living residences. This gives North Dakota families more options for care settings while using HCBS Waiver benefits. The state may decline enrollment if community care costs would exceed the cost of nursing home care for that individual.
State Plan Personal Care Services — MSP-PC North Dakota also offers a State Plan Personal Care Services — MSP-PC — program that provides in-home personal care assistance for eligible Medicaid members. MSP-PC does not require nursing facility level of care making it more accessible for some applicants.
Married couples — one spouse applying When only one spouse applies for North Dakota Medicaid the community spouse — the spouse who remains at home — may retain 50 percent of the couple’s combined countable assets up to a maximum of $162,660. If 50 percent of the couple’s assets is less than $32,532 the community spouse may retain up to $32,532. The applicant spouse retains $3,000.
Monthly Maintenance Needs Allowance The minimum Monthly Maintenance Needs Allowance for the community spouse is $2,644 per month in 2026. North Dakota uses the minimum standard.
Personal needs allowance — higher than most states North Dakota nursing home Medicaid recipients are allowed to keep $115 per month as a personal needs allowance — among the higher allowances in the country. The remainder of income is applied toward the cost of care.
Look-back period and divestment penalty North Dakota has a 60-month — five year — look-back period for nursing home Medicaid and Aged and Disabled Waiver applications. Asset transfers made within 60 months of applying that were for less than fair market value may result in a penalty period of ineligibility. The 2026 divestment penalty divisor in North Dakota is based on the statewide average monthly cost of nursing facility care.
Estate recovery North Dakota requires Medicaid estate recovery. After a North Dakota Medicaid recipient dies the state seeks reimbursement from the estate for long term care costs paid. Planning with an elder law attorney can help protect assets from estate recovery.
How to apply for North Dakota Medicaid Applications can be submitted online through the North Dakota Medicaid portal at nd.gov/dhs, by phone at 1-800-755-2604, or in person at your local North Dakota DHS county social service office.
North Dakota Medicaid administering agency North Dakota Department of Human Services — nd.gov/dhs
North Dakota Estate Tax — 2026
No North Dakota state estate tax North Dakota does not impose a state estate tax in practice. While North Dakota law technically ties its estate tax to the federal state death tax credit under IRC Section 2011 the federal tax code no longer permits a credit for paid state estate taxes — meaning North Dakota’s estate tax produces no actual tax liability. No North Dakota estate tax applies to any estate.
No North Dakota inheritance tax North Dakota does not impose an inheritance tax. Beneficiaries who receive assets from a North Dakota decedent owe no North Dakota inheritance tax regardless of the size of the inheritance or their relationship to the deceased.
Federal estate tax North Dakota residents may be subject to the federal estate tax. The federal estate tax exemption is $15,000,000 per person in 2026 following enactment of the One Big Beautiful Bill Act. The exemption is portable between spouses meaning a married couple can protect up to $30,000,000 from federal estate tax with proper planning. The top federal estate tax rate is 40 percent on amounts above the exemption.
No North Dakota gift tax North Dakota does not impose a state gift tax. Federal gift tax rules apply — the annual gift tax exclusion is $19,000 per recipient in 2026.
Oil and gas mineral rights — important estate planning consideration for many North Dakota families North Dakota has been one of the leading oil and gas producing states in the country since the Bakken shale boom. Many North Dakota families own mineral rights that can have significant and fluctuating value. Mineral rights pass through estates like other property and can complicate estate planning — particularly with respect to valuation for federal estate tax purposes royalty income taxation and the potential impact on Medicaid planning. North Dakota families with mineral rights should work with an estate planning attorney who has experience with mineral rights and oil and gas interests.
North Dakota income tax — no tax on Social Security North Dakota has a flat state income tax rate of 1.95 percent for most taxpayers in 2026 — one of the lower flat rates in the country. Social Security benefits are not taxed in North Dakota. Pension income and IRA and 401(k) distributions are taxable in North Dakota at the flat rate.
North Dakota property taxes North Dakota has an effective property tax rate of approximately 0.92 percent — near the national average. Agricultural land is assessed differently from residential property and agricultural property tax credits are available for qualifying farmers.
Step-up in basis Inherited assets in North Dakota receive a stepped-up tax basis to fair market value at the date of the original owner’s death. This is particularly important for inherited mineral rights and agricultural land in North Dakota which may have appreciated significantly.
North Dakota Advance Directives
North Dakota law recognizes the following advance directive documents:
North Dakota Durable Power of Attorney for Health Care Names a healthcare agent to make medical decisions on your behalf when you are unable to do so. Must be signed and witnessed by two adults or notarized.
North Dakota Declaration — Living Will Documents your wishes regarding life-sustaining treatment when you have a terminal condition or are in a persistent vegetative state. Must be signed and witnessed by two adults.
North Dakota POLST — Physician Orders for Life-Sustaining Treatment North Dakota uses a POLST form for seriously ill patients that documents specific medical orders regarding CPR hospitalization and artificial nutrition. Must be signed by a physician or nurse practitioner.
North Dakota Do Not Resuscitate Order A physician order directing emergency personnel not to perform CPR. North Dakota has standardized out-of-hospital DNR protocols.
North Dakota Advance Directive Registry North Dakota does not maintain a statewide advance directive registry. Copies of your advance directive should be given to your healthcare agent physician and any hospital or care facility where you receive care.
Free North Dakota advance directive forms Free North Dakota-specific advance directive forms are available at caringinfo.org and from the North Dakota Medical Association at ndmed.org.
North Dakota Key Agencies and Resources
North Dakota Department of Human Services — DHS Administers North Dakota Medicaid including long term care programs. Website: nd.gov/dhs Phone: 1-800-755-2604
North Dakota Aging Services Division Coordinates programs and services for older North Dakotans including home care nutrition programs caregiver support and the North Dakota SHIC program for free Medicare counseling. Website: nd.gov/dhs/aging Phone: 1-701-328-8910 North Dakota SHIC — free Medicare counseling: 1-888-575-6611
North Dakota Area Agencies on Aging North Dakota is served by Area Agencies on Aging that coordinate local services for older adults and caregivers across the state’s rural geography. Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov
North Dakota Long Term Care Ombudsman Program Advocates for the rights of residents of nursing homes and assisted living facilities. Investigates complaints and helps resolve problems free of charge. Website: nd.gov/dhs/aging/ombudsman Phone: 1-800-451-8693
State Bar Association of North Dakota Lawyer Referral Service Connects North Dakotans with attorneys including those who specialize in elder law and estate planning. Website: sband.org Phone: 1-701-255-1404
Legal Services of North Dakota Provides free civil legal services to low income North Dakotans including seniors on issues related to Medicaid benefits housing and elder law. Website: legalassist.org Phone: 1-800-634-5263
North Dakota Veterans Resources
North Dakota Department of Veterans Affairs — NDDVA Provides services and benefits to North Dakota veterans and their families including free VA claims assistance and connections to North Dakota veterans resources. Website: nd.gov/veterans Phone: 1-701-239-7165
North Dakota Veterans Home North Dakota operates a state veterans home providing long term care to eligible veterans and their spouses located in Lisbon. Website: nd.gov/veterans/veterans-home
North Dakota Senior Property Tax Benefits
Homestead Credit North Dakota homeowners aged 65 and older or permanently and totally disabled who meet income requirements may qualify for a property tax credit on their primary residence. The credit reduces the amount of property taxes owed. Apply through your county auditor.
Disabled Veterans Property Tax Credit North Dakota veterans with a service-connected disability of 50 percent or more may qualify for a property tax credit on their primary residence. The credit amount increases with higher disability ratings and is a full exemption for veterans rated totally and permanently disabled. Apply through your county auditor.
Agricultural Property Tax Credits North Dakota offers property tax credits for qualifying agricultural land which can be relevant for North Dakota seniors with farm or ranch property.
Finding Elder Law and Estate Planning Attorneys in North Dakota
The following resources can help you find a qualified elder law or estate planning attorney in North Dakota:
- National Academy of Elder Law Attorneys — NAELA — naela.org — searchable directory by location
- State Bar Association of North Dakota Lawyer Referral Service — sband.org — 1-701-255-1404
- North Dakota Chapter of NAELA — North Dakota has an active NAELA chapter with members throughout the state
- Legal Services of North Dakota — legalassist.org — free legal assistance for income-qualifying seniors — 1-800-634-5263
The information on this page is for general informational purposes only and does not constitute legal or financial advice. North Dakota Medicaid rules and other figures change frequently. Note that North Dakota updates its FPL-based income limits on April 1 rather than January 1. Always verify current information with the relevant agency or a licensed attorney. Laws vary and individual circumstances differ significantly.
Last updated: May 2026