TABLE OF CONTENTS
Home-based care is ideal for older adults who want to continue enjoying the comfort and privacy of their own home but have certain tasks that have become challenging. There are two levels of home-based care. In-home care provides basic services such as companionship, meal preparation, transportation and help with personal grooming. Licensed or certified health care workers administer home health care and provide services such as medication administration and medical monitoring. According to the 2021 Genworth Cost of Care Survey, both care types cost $5,689 per month in North Dakota.
North Dakota residents pay a moderate price of $5,689 for home-based care and home health care. This rate is a few hundred dollars higher than the respective national average of $4,957 and $5,148 per month.
While care costs are higher in North Dakota than in many other U.S. states, rates are consistent with those in surrounding states. In South Dakota, residents pay $5,911 per month for both care types. In Minnesota, fees are considerably higher, with seniors paying $6,673 for home care and $6,912 for home health care. Montana residents pay $5,339 for both care types, more than the national average but affordable relative to North Dakota.
|Home Care||Home Health Care|
North Dakota seniors pay $5,689 per month for home care and home health care, making it one of the more expensive care types in the state. Assisted living, which provides a comparable care level in a residential community setting, is considerably cheaper at $3,391 per month. If you want to live in your home but need a more budget-friendly option, consider adult day health care, which has a similar monthly price as assisted living at $3,383. Nursing homes charge rates roughly double that of home care, with seniors paying $11,978 for semiprivate accommodations.
Home care is relatively expensive in North Dakota. Fortunately, depending on income, seniors may have service payment options. Under the state’s Medicaid program, they may be eligible to get up to 300 hours of care per month. This program is an entitlement, meaning that it’s available to all qualifying Medicaid beneficiaries without enrollment caps.
Medicaid State Plan – Personal Care Services is made up of three levels. Level A pays for up to 120 hours of care per month, Level B pays for up to 240 hours and Level C pays for up to 300 hours. Regardless of the level you’re approved for, covered services include:
To obtain services under any level, recipients must be on Medicaid and need care for at least 30 days. A case manager assesses the services received and the monthly number of eligible care hours. Depending on income, recipients may have to pay a deductible for their care.
If you need more care than the state plan provides, you may apply for services through the Home- and Community-Based Services Waiver. This waiver enables qualifying individuals to obtain care at home as an alternative to a nursing home. Unlike the state Medicaid plan, this waiver has an enrollment cap, and you may be placed on a waitlist if there aren’t any slots available.
Home- and Community-Based Services Waiver
The Home- and Community-Based Services Waiver is open to those who need nursing home care but want to live in their own home or apartment. This waiver covers several services, including:
To be eligible for services under this waiver, applicants must be at least 65 years old or disabled according to Social Security Disability criteria. They must be capable of living independently, and the waiver must pay for all needed services. Applicants must also live in their own home or apartment and meet Medicaid’s eligibility requirements, which we outline below.
To learn more about this waiver and apply for services, seniors can contact their nearest Human Service Zone Office.
To be eligible for Medicaid, an applicant’s income and assets must fall within strict limits. Single seniors may have up to $11,280 in annual income. This requirement includes all income sources, including wages, veterans pensions, stock dividends, retirement account withdrawals and public benefits. VA Aid and Attendance is the only income source that doesn’t count toward this limit. However, some expenses are deductible from countable income, such as health insurance premiums and taxes. Applicants may have up to $3,000 in countable assets. This includes bank accounts, investments, stocks and vacation properties. Primary residence, personal belongings and vehicle are not included. For married applicants, respective income and asset limits are $15,204 and $6,000.
|Income Limits*||Asset Limits|
Applicants must also meet other eligibility criteria to enroll in Medicaid. These include:
Seniors can apply for Medicaid through the state’s online public benefits portal. They can access paper applications online or call their county human service zone office to request one by mail. Applicants can submit completed applications in person or by mail to the office. For help with filling out or following up on an application, seniors can call the Department of Human Services at (800) 472-2622.
What Information You Will Need
Before applying for Medicaid, applicants need supporting documents to verify their service eligibility. These include:
If you need assistance applying for Medicaid or understanding your benefits, there are several resources that can help. The following table features websites, hotlines and programs that can aid you in getting the most from your benefits and resolving issues that arise.
|Contact||Area Served||Services Provided|
|County Human Service Zone Office||(800) 472-2622||Statewide||Seniors’ local human service zone office can provide one-on-one help with applying for Medicaid and waiver programs. This office can also give referrals for services and resources in the community that support their independence and financial security.|
|American Council on Aging||Online Only||Statewide||The American Council on Aging provides up-to-date information on North Dakota Medicaid’s eligibility requirements along with tips on qualifying for coverage if an applicant’s income and assets exceed the limits. This website also has contact information for Medicaid planners in the area who help identify solutions for excess resources.|
|North Dakota Department of Human Services||(701) 328-2311||Statewide||The North Dakota Department of Human Services houses the Fair Hearings Unit, which investigates complaints regarding unfair Medicaid claims practices. If you are denied coverage, you can file an appeal with this department to have a third party consider your case.|
|Legal Services of North Dakota||(866) 621-9886||Statewide||Legal Services of North Dakota has legal professionals specializing in helping older adults apply for Medicaid. Through this office, seniors can get phone or in-person support filling out and submitting an application and obtaining the necessary supporting documents.|
Medicare doesn’t pay for non-medical home care, but it can cover the cost of the medical version of home care, called “Home Healthcare” in some situations. In order to be eligible, you need to be homebound and have a referral from your doctor for the specific type of medical care that is needed. There are also other restrictions that apply.
Below is an overview of some of the services typically covered by Medicare for those who are eligible:
As mentioned above, home care is distinctly different from home healthcare, but there is some overlap – so while Medicare doesn’t cover non-medical home care, there are personal care services that may be covered in special circumstances – such as an occupational therapist helping with eating or dressing.
Read our guide to Medicare and Home Care Coverage for more information.
While the above programs can be a great way to make home care affordable for many people, they are not the right solution for everyone. Thankfully, there are other ways to make home care more affordable for you and your family. For more information about your other options, read our section on Other Ways to Pay for this guide.
North Dakota has numerous resources to help you get the care you need at home. Through the following agencies and programs, you can obtain case management, home-delivered meals, transportation and referrals for community-based services, which may help you reduce out-of-pocket care expenses and remain in your home safely and comfortably.
|Contact||Area Served||Services Provided|
|Valley Senior Services||(701) 293-1440||Red River Valley Region||Valley Senior Services is the Red River Valley region’s Area Agency on Aging. This local nonprofit organization helps older adults maintain as much independence as possible. You can obtain home-delivered meals, affordable transportation services, health services, and information on social and recreational activities through this agency. It also has information and referral specialists who point you toward programs and community resources to reduce your living and care expenses. If you live outside the Red River Valley area, you can find your local Area Agency on Aging by calling the state Aging Services Division at (855) 462-5465.|
|North Dakota Senior Service Providers||Online Only||Statewide||North Dakota Senior Service Providers is an online resource with up-to-date details and contact information on the 30 nonprofit agencies and programs serving North Dakota seniors. Seniors can find their local Meals on Wheels provider, transportation services, information and referral specialists and friendly visitor and phone call programs. The website also has information on the state’s 200 senior centers.|
|North Dakota Veterans Affairs||(701) 239-7165||Statewide||The North Dakota Veterans Affairs Department has information specialists who help older veterans obtain state benefits such as health care services, tax breaks, emergency financial assistance, affordable housing, billing assistance and home repair programs. It can also assist qualifying individuals in applying for federal benefits such as veterans’ and survivors’ pensions and Aid and Attendance.|
|Statewide||FirstLink provides free information services to North Dakota residents, helping them access public benefits, community-based programs and wellness services in their communities. You can contact FirstLink to determine whether you qualify for property tax credits and programs, such as Medicaid, and find home-delivered and congregate meals, utility assistance and transportation services.|
|Community Action Partnership of North Dakota||(800) 726-7960||Statewide||Community Action Partnership of North Dakota is a statewide nonprofit organization that provides free and low-cost services to qualifying individuals. Services vary depending on where you live, but you may obtain weatherization services, utility and rent assistance, home modifications and repairs and home-delivered meals through your local Community Action Program.|
|Homestead Property Tax Credit and Renter’s Refund||(701) 328-7088||Statewide||Those aged 65 and over with disabilities may qualify for a tax credit or renter’s refund to help reduce housing expenses and make it easier for low-income older adults to stay in their homes. To qualify for these programs, you must meet financial eligibility requirements.|
|State Health Insurance Counseling Program (SHIC)||(888) 575-6611||Statewide||SHIC is a statewide program that provides free Medicare counseling for beneficiaries, helping them understand their health insurance benefits and research private Medigap and Medicare Advantage plans. Seniors can also contact the SHIC helpline for one-on-one assistance with resolving issues such as denied health insurance claims or canceled policies.|
Rules and vaccination requirements for COVID-19 are constantly evolving in response to infection trends and new information. For the most recent guidelines, contact your local health department or Area Agency on Aging. As of April 2022, North Dakota requires home health care workers to be fully vaccinated against the virus unless they have exemption status.
At this time, there are no rules in place requiring home care workers to be vaccinated. However, agencies in your area may have mandates beyond what the state requires. If you’re concerned about your risk of exposure to COVID-19, or you want details regarding masking and sanitation practices, contact your home care agency.
In North Dakota, home care agencies aren’t regulated by the state if they only provide in-home care and companion services. The North Dakota Health Resources and Response, Division of Health Facilities governs agencies that provide skilled nursing services. This division has rules in place to ensure a consistently high standard of care for seniors.
|What Types of Care Can Be Provided?||Home care agencies in North Dakota provide in-home care and companion services. These services include meal preparation, shopping, help with budgeting and managing household expenses, housework, laundry, transportation, communication and mobility assistance. Caregivers may also accompany clients to medical appointments and essential errands.|
|Are Care Plans Required?||Home care agencies must develop their own procedures for creating client care plans. If the individual requires skilled nursing services, the agency must conduct an initial evaluation visit, develop a care plan that addresses the individual’s needs and review and update the care plan every two months.|
|Can Home Care Providers Assist with Medication Management?||Attendants may provide medication reminders and assist with self-administered medications. This procedure may include opening the original packaging and handling the individual premeasured doses.|
|Are There Special Requirements for Screening Home Care Aides?||The state doesn’t require background checks or screening procedures for home care aides. However, agencies may have their own hiring practices that include background checks.|
|Are Home Care Aides Required to Undergo Special Training?||Home care providers in North Dakota aren’t required to complete state-mandated special training. To ensure competency, agencies may have their own training modules and procedures.|
|Does Medicaid Cover Home Care in North Dakota?||North Dakota Medicaid pays for home care under its regular program and the Home- and Community-Based Services Waiver. The coverage under regular Medicaid is an entitlement, meaning it guarantees services to everyone who qualifies. Medicaid waiver programs have enrollment caps due to limited funding.|
|How Do I Report Abuse of Myself or a Loved One?||If you experience abuse or suspect that a loved one is being abused by a home care provider, you can report it to the North Dakota Human Services Department through the online reporting system. Alternately, you can call the central intake line at (855) 462-5465. It has live agents on weekdays between 8 a.m. and 5 p.m. If you call after hours, you can leave a message with your contact information.|
Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. To help you overcome this challenge, we’ve created a helpful checklist below that can help guide you through the process of both determining your needs, and finding a home care agency that will be the best fit for you and your family.