Medicaid & Assisted Living in North Dakota: Yes

Updated September 4, 2026. Quick answer: yes, through Home and Community-Based Services (HCBS) Waiver, 1915(c) [ND.0273.R06.07]: “Adult Residential Care” service. Medicaid does not pay the facility’s room and board either way; only the care and service component.

What North Dakota covers

Waiver / state plan option	Home and Community-Based Services (HCBS) Waiver, 1915(c) [ND.0273.R06.07]: “Adult Residential Care” service
Covers an assisted living setting?	Yes: “A residential program specializing in care of individuals with chronic moderate to severe memory loss or an individual who has a significant emotional, behavioral, or cognitive impairments and needs the services of: independent living skills training, support and training provided to promote and develop relationships, participate in the social life of the community, and develop workplace task skills including behavioral skill building.”
Room and board	Never covered by Medicaid, in North Dakota or any state; see below.

The room-and-board split

Federal law is the floor every state builds on: “The Secretary may by waiver provide that a State plan approved under this subchapter may include as “medical assistance” under such plan payment for part or all of the cost of home or community-based services (other than room and board) approved by the Secretary” (42 U.S.C. §1396n(c)(1), Social Security Act §1915(c)). The words in parentheses do the work: whatever a state’s waiver pays for inside an assisted living community, it is not the rent, the meals, or the room itself. That portion stays the resident’s own to fund, out of income, savings, or a family contribution; the waiver only ever reaches the care and service layer on top of it. North Dakota’s own materials say the same thing directly: “Payment for residential services are not made for room and board, items of comfort or convenience, or the costs of building maintenance, upkeep and improvement.” (ND Application for 1915(c) HCBS Waiver, ND.0273.R06.07 (eff. Jan. 1, 2026), Adult Residential Care (Habilitation) service specification).

The waitlist

Open (no waiting list) : “ND has over 1150 enrolled QSPs statewide & we do not have a waiting list for waiver services.” (as of November 7, 2025 (application document date; waiver effective Jan. 1, 2026))

What you get to keep: the personal needs allowance

Not published in the materials reviewed this session. This is the amount of a waiver participant’s own income the state lets them keep for personal spending after the rest goes toward the cost of their care; it varies by state because each state sets its own figure inside the federal floor.

What this doesn’t answer

The personal needs allowance is unverified: the waiver application’s own “Allowance for the personal needs of the waiver participant” item presents several checkbox options but the extracted text did not show which option is selected or what dollar figure was entered, so it was not guessed. Everything else is confirmed directly from the state’s own 1915(c) waiver application: that the waiver’s Adult Residential Care service reaches a residential/group-living setting, that room and board is explicitly excluded, and that the state currently reports no waiting list.

Sources

Read September 4, 2026.

Same question, other states: Ohio · Oklahoma.

General information drawn from each state’s own Medicaid agency and federal statute, not legal, tax or financial advice. Medicaid is administered state by state; waiver names, coverage decisions, waitlists and allowance amounts change by state budget and legislative action. This page cannot see your own state’s current caseload. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.

Related: North Dakota’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.

Does Medicaid Pay for Assisted Living in North Dakota?