Almost all of North Dakota is covered by ranches and farms with rich deposits of oil, coal and gas underneath. Home to just over 750,000 people, North Dakota is the nation’s fourth most sparsely populated state, with wide-open Great Plains vistas and plenty of land where active seniors can hunt and fish. Just over 15% of North Dakota’s people are seniors aged 65 and over, with 53 senior living facilities in the state to care for them. These communities tend to be located close to North Dakota’s three sizable cities, but some can be found on the large stretches of Native American lands that cover much of the state.

Cost of care in comparison to the national average varies in North Dakota. For instance, assisted living at $3,405 a month is more than $600 less than the national average, according to the Genworth 2019 Cost of Care Survey. However, both in-home care and nursing home care are more expensive than the national average.

The cost of care can be daunting for many seniors on fixed incomes, which is why this guide goes over many of the likely costs seniors in North Dakota face for assisted living. It also identifies many resources seniors in North Dakota can use to help manage the cost of senior care at every level.

The Cost of Senior Living in North Dakota

Note: There currently isn’t authoritative data on the average cost of Independent Living Facilities nationwide, so instead, we use the cost of Assisted Living to estimate it. Since the cost of Independent Living is typically 30-40% lower than the cost of Assisted Living, the numbers below were calculated by subtracting 35% from the cost of Assisted Living.

Note: Memory care is typically provided in communities licensed as assisted living facilities, and in general, costs 20-30% more than standard assisted living services. No authoritative cost data is available for this type of care, so we estimated memory care rates by adding 25% to assisted living fees in the Genworth 2021 Cost of Care Survey.

There’s a senior living option suitable for all older adults, regardless of their position on the health scale. The four most common types are independent living (for relatively able-bodied seniors), assisted living (for people struggling with daily tasks), memory care (for those with cognitive impairments) and nursing home care (for people recovering from surgery or major illnesses). According to data from the 2021 Genworth Cost of Care Survey, the costs for each can vary greatly.

Costs differ partly because of the level of care provided and the facility’s location. The most affordable option is independent living, which averages $2,204 in North Dakota, followed by assisted living, at $3,391. Memory care is next, at $4,239, while a semiprivate room in a nursing home is likely to cost around $11,978 per month.

The Cost of Assisted Living in North Dakota

At $3,391 per month, assisted living fees in North Dakota compare favorably with the national average of $4,500. The state is also among the most affordable in this part of the country, undercutting Montana’s average of $4,450 by $1,059, and Minnesota’s $4,508 by $1,117. Only South Dakota’s average of $3,350 is lower, although only by $41.

The Cost of Nursing Home Care in North Dakota

In contrast to assisted living, where North Dakota competes successfully with its neighboring states, the $11,978 typical fee for a nursing home semiprivate room is the most expensive in the region. In cost terms, only Minnesota comes close, at $11,601, although the gap is still $377 — a significant amount when multiplied by 12 for the annual figure. Median fees drop below the national average of $7,908 for seniors residing in Montana and South Dakota, where costs are around $7,574 and $7,118, respectively. 

Can You Use Medicaid to Pay for Senior Living in North Dakota?

North Dakota’s Medicaid program can pay some senior living costs, but who is eligible and how much support they receive depends on the applicant satisfying strict criteria. As Medicaid is an entitlement program, it financially assists seniors whose conditions entitle them to care, but this doesn’t mean it can’t help others in need. They may apply for one of six waiver programs, each focused on different aspects of senior care.

Nursing home residents on low incomes can apply for Medicaid to cover all of their costs. Seniors with health conditions that can be treated elsewhere, such as in an assisted living facility, can apply for one of two waivers — the Basic Care Assistance Program and the Medicaid Waiver for Home and Community Based Services. Both provide limited support for medical purposes but not room and board. Seniors in independent living facilities aren’t deemed to require medical care so don’t qualify for Medicaid or waiver programs.

	Medicaid Coverage Level	Type of Medicaid Coverage	Entitlement?*
Assisted Living	Partial	Medicaid Waivers	No
Independent Living	None	N/A	N/A
Memory Care	Partial	Medicaid Waivers	No
Nursing Home Care	Full	Medicaid	Yes

*Note: Entitlement programs mean that everyone who qualifies will receive coverage and be accepted into the programs. If the program is not “entitlement,” then participant caps could be in place, and there may be a waiting list. 

Medicaid’s Coverage of Assisted Living & Memory Care in North Dakota

Although North Dakota’s Medicaid program can cover seniors residing in nursing home facilities, there are two waiver programs for those whose health conditions justify this type of care but prefer to reside in an assisted living or memory care facility.

Basic Care Assistance Program

In North Dakota, an establishment providing health, personal and social care programs to five or more people, including room and board, is known as a basic care facility. Seniors residing in such institutions may be eligible for the Basic Care Assistance Program. It doesn’t cover room and board costs but can plug the gap between the senior’s income and the overall costs of their health care. The senior is expected to personally cover as much of their costs as possible, but the program does allow for a $60 per month allowance and, when applicable, enough retained income to meet essential expenses, such as health insurance premiums.

To qualify, the applicant must already qualify for Medicaid, be 65 years old or more and participate in an assessment of their health care needs that determines the most suitable type of care. To apply, seniors can make an appointment with their nearest human service office or call to request a printed application form, which they should complete and return to the same location. Alternatively, applicants can visit North Dakota’s Human Services website and complete an online application.

Medicaid Waiver for Home and Community Based Services

The Medicaid Waiver for Home and Community Based Services covers the shortfall if the senior’s income doesn’t meet the fees for their medical and health care expenses in an assisted living/memory care facility. It can’t pay for room and board. The program is intended to support no more than 500 seniors at a time, so applicants should prepare to join a waiting list.

To be eligible, the applicant must qualify for Medicaid, currently reside in their own home and be able to direct their care. They must also be at least 65 years old or disabled and submit to a health needs screening. To apply, seniors should contact their nearest human service zone office to make an appointment.

Medicaid’s Coverage of Nursing Home Care in North Dakota

Approximately half of North Dakota’s nursing home residents receive some or all of their health care costs through Medicaid. Successful applicants must pay for as much of their care as their incomes and assets allow, with Medicaid covering the shortfall. Unlike the waiver programs, Medicaid also pays room and board fees. North Dakota’s Human Services department employs a team of eligibility workers statewide who work exclusively with seniors and their families to determine the type of care needed and arrange appropriate financial support. 

Eligibility for Medicaid in North Dakota

To be eligible for Medicaid in North Dakota, applicants must have incomes and assets on or below the program’s limits. For single applicants who live alone or with their spouse, the maximum income can’t exceed $11,280 per year, while for two applicants in a two-person household, the joint annual income shouldn’t surpass $15,204. Regardless of the applicant’s circumstances, personal assets shouldn’t be more than $3,000. However, when one senior from a two-person household applies, their spouse’s assets can’t exceed $137,400.

2022 North Dakota Medicaid Limits

	Income Limits*	Asset Limits
Single Person	$11,280	$3,000
Two-Person Household(Only one applicant)	$11,280	$3,000 for applicant $137,400 for non-applicant
Two-Person Household(Two applicants)	$15,204	$3,000 per applicant

*per year

Medicaid applicants must also satisfy other criteria in addition to their incomes and assets. The senior must be:

• A U.S. citizen or permanent legal resident
• A North Dakota resident
• Aged 65 or older
• Medically in need of nursing home levels of care

Applying for Medicaid in North Dakota

The fastest way of applying for Medicaid in North Dakota is online. To use this option, the senior must first create an account and then follow the step-by-step application process. Alternatively, seniors can print a copy of the application form and hand in a completed copy to their nearest human service zone office. If this option is impractical, seniors should contact their human service zone office, which will mail a copy for the applicant to complete and return.

Before You Apply

It’s wise to have all the information ready before applying, as it can minimize delays in the application process. Seniors should present proof of:

• Incomes of all applicants and members of their households
• Assets of all applicants and of the remaining spouse if one person from a two-person household applies
• Legal resident status
• North Dakota resident status
• Health insurance policies, including the spouse’s

How to Get Help

Seniors who want to know more before applying or feel more comfortable with expert help can consider one of the following organizations. Some are online only, while others can provide face-to-face or phone support.

Resource	Contact	What You Should Know
North Dakota Department of Human Service	(800) 472-2622	Operating from centers statewide, the department can provide free information and advice to seniors confused about Medicaid and its waiver programs. Each center has trained counselors who can guide seniors through the application process.
Legal Services of North Dakota	(866) 621-9886	Legal Services of North Dakota is a nonprofit organization comprised of lawyers, paralegals and other volunteers who freely assist seniors in need. They can only help in civil law matters, which include challenging denied Medicaid claims and pursuing government benefits, such as Supplemental Security Income.
American Council on Aging	Online Only	This resource is only available online but provides up-to-date information about Medicaid in North Dakota written by experts. All of the site’s content is free, including useful tools that can help visitors determine their eligibility for Medicaid and indicate where to spend down their assets to fall within the program’s limits.

Can You Use Medicare to Pay for Senior Living in North Dakota?

Unfortunately, Medicare does not cover the cost of assisted living, independent living, or memory care. Unlike nursing homes, these care types are not considered to be “clinical settings” and so are not eligible for Medicare coverage. That being said, those who live in these communities can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

When it comes to nursing home care, it gets much more complicated. Medicare does provide limited coverage for a qualified stay in a nursing home,but there are strict rules and requirements of which you should be aware. This benefit is available to seniors who have been hospitalized for at least three days, excluding the date of discharge.

Once you’ve met the hospitalization requirement, Medicare will pay for up to 100 days in a skilled nursing facility (per benefit period). While the first 20 days are covered in full, there is a daily coinsurance rate that must be paid starting on day 21. After day 100, seniors are responsible for the entire cost.

	Medicare Coverage	Medicare Coverage Duration	Coinsurance Requirement?
Assisted Living	None	N/A	N/A
Independent Living	None	N/A	N/A
Memory Care	None	N/A	N/A
Nursing Home Care	Limited	100 Days Per Benefit Period	Yes – After 20 Days

What Nursing Home Care Services Does Medicare Cover?

Medicare covers a number of specific services, including:

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

What Nursing Home Care Services Aren’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.

Medicare Support & Resources in North Dakota

North Dakota seniors needn’t struggle with understanding Medicare, as there are several helpful resources that can answer their questions and work with them to get the most from the insurance. Those listed here provide their services for free.

Resource	Contact	What You Should Know
State Health Insurance Counseling	(888) 575-6611	The State Health Insurance Counseling program manages advisors in state-run centers throughout North Dakota. They inform seniors about Medicare and supplementary programs, such as Medicare Advantage and Medigap, and help them navigate the application process. The advisors can also discuss private health care insurance. However, seniors won’t be sold policies, as the advisors are unbiased and focused solely on assisting their clients.
Medicare.gov	(800) 633-4227	Medicare.gov is a federal website with plenty of information for seniors who prefer to conduct their own research. It can help visitors understand the qualification criteria for Medicare and answer common questions, such as if the insurance is still valid if the applicant continues working after their 65th birthday. There’s a live function too, allowing visitors to get answers to their questions day or night.
Senior Medicare Patrol	(800) 233-1737	The Senior Medicare Patrol educates people about fraud prevention and detection, helping them identify and report errors on their bills. It’s also a point of contact for seniors who believe fraudsters have discovered their Medicare insurance numbers and used them to deceptively purchase health care services.
Social Security	Online Application	The federal website is a rich source of information for visitors who want to know more about Medicare. It also provides practical assistance, such as links to resources that can deal with Medicare cards that are lost or were never received. There are also numerous pages providing information and assistance for existing Medicare beneficiaries who want to learn how to get the most from their plans.

Are There Other Financial Assistance Options for Senior Living in North Dakota?

Depending on your unique situation, there may be other financial assistance options to partially or fully cover the cost of senior living in North Dakota. Below, we cover some of the common ways that seniors can make senior living options such as assisted living or memory care more affordable.

	How to Get Started	What You Should Know
Aid and Attendance	Apply online at va.gov.	If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse Mortgages	Research and learn about the different types at ftc.gov.	If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) Insurance	Learn about how to receive LTC insurance benefits at acl.gov.	While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free Senior Living Resources for Seniors in North Dakota

There are many nonprofit organizations and government agencies within North Dakota dedicated to helping seniors. Those listed here can support veterans not receiving the benefits they’re entitled to, assist seniors struggling to prepare their taxes and help adults diagnosed with dementia. There’s also assistance for senior living facility residents unhappy with their standard of care.

Resource	Contact	What You Should Know
North Dakota Veterans Affairs	Multiple Numbers	North Dakota Veterans Affairs advocates for U.S. military veterans and their dependents, helping them identify and apply for local, state and federal benefits. The department can also help vets, including those residing in rural areas, access free or subsidized transportation.
RSVP of North Dakota	(833) 746-8644	RSVP is a program developed by AmeriCorps and administered locally by RSVP of North Dakota, a nonprofit that connects volunteers to other nonprofits in need of assistance. The organization works with seniors who want to volunteer their time and skills to help their communities. For all volunteers, RSVP of North Dakota arranges free accident and liability insurance during their working hours.
Alzheimer’s Association – Minnesota-North Dakota Chapter	(952) 830-0512	The Minnesota-North Dakota chapter of the Alzheimer’s Association provides local support for seniors diagnosed with the condition and loved ones dealing with the impact. The chapter operates from centers in major cities across the state, organizing support groups for seniors and caregivers, in addition to managing programs for individuals with early-stage Alzheimer’s. The website includes the Alzheimer’s Navigator, a resource to help seniors and their families get answers to their questions at every stage of their journeys.
Long-Term Care Ombudsman Program	(855) 462-5465	Seniors, their families and third parties can contact the Long-Term Care Ombudsman Program if they’re unhappy with a facility’s care standards. The program will dispatch an ombudsman to investigate and pursue resolutions with the care provider if the investigation reveals concerns. Ombudsmen regularly visit facilities to educate residents about their rights. They can also issue copies of inspection reports to seniors comparing facilities for their long-term care.
AARP Foundation Tax-Aide Program	(888) 687-2277	The AARP Foundation Tax-Aide Program is designed to help seniors prepare and submit their taxes on time. Trained IRS-certified volunteers can provide face-to-face assistance in approved centers across the state or by phone. Seniors who need the most help can make a request for a volunteer to do most of the prep work for them. Alternatively, seniors can use the program’s free online software and only get help from volunteers by phone when they need it.
Healthcare Equipment Loan Program	(800) 532-6323	NDAD is the North Dakota Association for the Disabled. It operates a health care equipment loan program, providing gently used devices to seniors free of charge for up to 3 months. As the program relies on donated equipment, there may be a waiting period for some devices. Typically loaned equipment includes powered wheelchairs, scooters, rollators, walkers, crutches and portable ramps. NDAD distributes equipment from its offices in Bismarck, Grand Forks, Minot, Williston and Fargo.

COVID-19 Rules and Restrictions for North Dakota Senior Living Facilities

The following information is based on research done on several government websites, including health.nd.gov and cms.gov. These rules apply to nursing homes 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.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?	Yes
Can I visit my relative in person for end-of-life compassion care?	Yes
Will my loved one be required to self-quarantine after I visit him or her?	No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?	Yes
Are Hairdressers and other non-medical contractors still allowed in senior living facilities?	Yes
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?	Yes
Are visitors being screened for elevated temperatures?	Yes
Are visitors being asked questions about health, travel, and potential virus contact?	Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?	Yes
Are residents of senior living facilities who leave and return required to self-quarantine?	No (Conditions Apply)
Are senior living facilities required to cancel all group outings?	No
Are residents still eating together in the dining hall?	Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?	Yes (Conditions Apply)

Safety Measures for Staff & Contractors

Are staff members and contractors being screened for elevated temperatures?	Yes
Are staff members and contractors being tested for Coronavirus?	Yes (Conditions Apply)
Are staff members and contractors being asked questions about health, travel, and potential virus contact?	Yes

Safety Measures for Residents

Are staff members required to regularly screen residents for coronavirus symptoms?	Yes
Are residents relied on to screen themselves and self-report potential coronavirus symptoms?	No
Are staff members required to take residents’ temperatures?	Yes
Are residents being tested for coronavirus?	Yes (Conditions Apply)

Senior Living Laws and Regulations in North Dakota

Note: All these rules typically apply to non-clinical senior living facilities, such as independent living, assisted living, and memory care facilities. Nursing homes and other senior living facilities with a clinical setting may have additional or slightly different requirements and regulations.

North Dakota licenses all senior living facilities through the state Department of Health, Division of Health Facilities. The Department of Health defines an senior living facility as any senior care residence with five or more full-time residents who are not related to each other or a facility that advertises itself as accepting seniors from the general public for board and care.

Senior living facilities in North Dakota are required to provide each new resident with a written lease or rental agreement that itemizes the cost of every service the facility offers. Residents may opt into or out of any service, which can only be charged if provided with the resident’s consent. State law permits these facilities to charge private insurance carriers for most or all of the cost of long-term care, provided the facility maintains a current license.

The Department of Health regulates facilities by setting admission standards, memory care guidelines, medication policies and staff training and retention requirements.

Admission Requirements

Seniors moving into a senior living facility in North Dakota must undergo a preadmission medical screening by a physician or nursing home staff member to evaluate their total medical and lifestyle needs. A plan of care must be developed that accounts for the resident’s medication, therapy and social needs, which must be updated as a resident’s condition changes. Medical staff must certify that all of the senior’s needs can be attended to within the scope of care provided by the specific facility being applied to.

Seniors may be admitted to senior living if they are capable of self-care with minimal to moderate assistance with two or more activities of daily living. An exception may be made for residents who need hospice care, provided the facility is able to “wrap around” the resident’s needs and provide full-time care in accordance with the revised care plan.

Memory Care Regulation

Senior living facilities may not admit residents with Alzheimer’s disease or other forms of dementia. Basic care facilities, which are separately licensed, may do so only if they are capable of attending to all of the resident’s needs. A special care unit must be set up to look after memory care-dependent residents, with secure windows and doors to prevent wandering and other disruptive behaviors. Staff assigned to a special care unit must have training to care for seniors with dementia, as well as briefing on emergency evacuation procedures. Facilities with a special care unit must schedule regular occupational and mental health therapy sessions, along with stimulating social events, for residents capable of participating.

Medication Management

Senior living residents who are capable of self-management may keep and take their own nonprescription and over-the-counter medications. Prescribed medications listed on the resident’s care plan may also be kept under the resident’s control if the resident can safely manage them. Nonmedical staff may prompt residents for dose times, log consumption and assist with dose preparation, such as grinding for mixing with applesauce or juice.

Staffing Requirements

Senior living facilities must appoint an administrator to manage the site on a full-time basis. A substitute administrator may be appointed to act in the primary administrator’s place during absences, provided they meet the same standards the state sets for principal administrators.

Facilities must maintain enough staff on site to adequately care for each resident’s needs. No specific ratio is mandated by law, but sufficient personnel must be available, awake and on duty to evacuate residents in emergencies and to care for their daily needs.

Facility administrators must be at least 21 years of age and pass a background screening check. Administrators must complete a minimum of 12 hours of training annually to maintain certification. Staff members must be at least 18 and also pass a preemployment background screening for hands-on care positions. In addition, new staff members must receive initial training in resident rights, fire and accident prevention, and mental and physical health needs for seniors, including behavior problems and infection control. Training in these areas must be repeated annually for as long as the staff member is employed in a resident-facing position.

Frequently Asked Questions

How much does assisted living cost in North Dakota?

Assisted living in North Dakota costs an average of $3,405 a month. This is $645 a month less than the national average seniors pay elsewhere ($4,051), and it’s significantly lower than the cost of both skilled nursing in North Dakota and assisted living in many other states.

Does North Dakota Medicaid pay for assisted living?

Medicaid in North Dakota doesn’t directly pay for assisted living. The low-income health insurance program may, for many North Dakota seniors, pick up some or all of the cost of basic medical needs, but no Medicaid plan in the state currently pays for the board and care costs assisted living communities charge.

Does Medicare pay for assisted living?

Original Medicare provides both inpatient and outpatient services for eligible seniors aged 65 and over, but it doesn’t directly pay for the monthly cost of assisted living. While many seniors can use Medicare benefits to help pay for some of their needs, such as the Part D prescription drug benefit, no Medicare provision covers nonmedical board and care. Some seniors do get their health insurance through a Medicare Advantage plan. Because these plans are issued by private companies, the details of what they cover vary somewhat between programs. Consult with a plan representative about any possible residential care benefit.

What are “activities of daily living”?

Activities of daily living are the regular activities many seniors need assistance to perform and which personal caregivers are able to help with. In this category are personal care needs, such as bathing and dressing, as well as household chores, such as meal preparation and light housekeeping.

What is the difference between assisted living and nursing homes?

Assisted living and skilled nursing facilities differ in how medically intensive each level of care can be. Nursing homes in North Dakota frequently provide IV lines, wound care, therapeutic services and post-acute rehabilitation for seniors who have recently been discharged from a hospital. Assisted living facilities provide a much less clinical environment where seniors can live as independently as their health allows, with some nonmedical assistance from personal caregivers.

Learn More About Senior Living in North Dakota

For more information about specific types of senior living in North Dakota read our Guide to Assisted Living and Independent Living.

The Top Cities for Senior Living in North Dakota

Learn more about the cost of senior living in the top North Dakota cities. Additionally, find reviews and information about assisted living facilities and other senior living communities across the state