Updated August 27, 2026. Quick answer: North Dakota does not say spend-down. Its chapter says recipient liability, and which income level applies turns on the setting: “The nursing care income levels established in the Medicaid state plan are applied to residents receiving care in a nursing facility”, while the medically needy levels apply to someone at home or in a specialized facility.
What North Dakota requires
| What the state sets out | What it says |
|---|---|
| North Dakota’s name for it | recipient liability (NDAC 75-02-02.1) |
| Nursing facility residents | “The nursing care income levels established in the Medicaid state plan are applied to residents receiving care in a nursing facility” |
| At home or in a specialized facility | “Medically needy income levels established in the Medicaid state plan are applied if a Medicaid individual or unit resides in the individual’s or the unit’s own home or in a specialized facility” |
| Guardian and conservator costs | “The cost of services of an applicant’s or recipient’s guardian or conservator, up to a maximum equal to five percent of countable gross monthly income excluding nonrecurring lump sum payments.” |
| The $20 disregard | “A disregard of twenty dollars per month is deducted from any income, except income based on need” |
| Expenses that do not count | “Not subject to payment by any third party, including Medicaid and Medicare” |
How it works in practice
- Two levels, two settings. Someone screened as requiring nursing care but electing home and community-based services is measured against the medically needy level, not the nursing care level — which can change the liability substantially.
- The guardianship deduction is real money and is rarely mentioned: the cost of a guardian or conservator is deductible “up to a maximum equal to five percent of countable gross monthly income excluding nonrecurring lump sum payments”.
- The $20 disregard is per household, not per person. Where more than one aged, blind or disabled person lives together, “no more than a total of twenty dollars may be deducted”.
The mechanism itself — why an income cap exists and what the trust must contain — is explained on the income-cap and Miller trust page. This page is the record for North Dakota.
What this page does not settle
- Expenses a third party will pay do not count, including Medicaid and Medicare themselves. An expense also has to be claimed to be applied.
- This page reads one source: North Dakota Administrative Code Chapter 75-02-02.1, Eligibility for Medicaid. It is the state’s own publication on this rule, but no state puts its whole treatment of excess income in a single document, and a detail that decides your case may sit in one this page did not read.
- A spend-down fixes an income problem and nothing else. The resource test, the level-of-care test and the transfer-of-assets look-back are separate hurdles, each decided on your own file, and meeting this rule does not clear any of them.
- Every quotation here was read against the source on August 27, 2026. States revise these rules, and a figure or a section number can move without the page around it changing. Open the source before you rely on a detail.
Eligibility is decided by the state agency on the whole file, not by one rule on one page. Nothing here is legal advice, and no one should move, retitle or assign income on the strength of a web page.
Sources
The source above was retrieved and read against the state text on August 27, 2026. Every quotation on this page was checked against those bytes.
This page covers what happens to income above the eligibility standard. What North Dakota actually uses as that standard, and the state document it comes from, is on Medicaid nursing home income limit in North Dakota ($1,197/Month).
Related: North Dakota’s Medicaid home equity limit for a single applicant with no spouse or dependent child at home.
Related: North Dakota’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.