North Dakota Medicaid Look-Back Period

Last updated: August 21, 2026 Jurisdiction: North Dakota

North Dakota reviews five years of transfers

HHS says that when a person applies for Medicaid coverage of nursing-care services, it reviews transfers made within the past five years to decide whether a transfer was disqualifying. The rule reaches more than a simple cash gift: a transfer is disqualifying when fair market value is not received, and the fact sheet gives a land-and-equipment gift to adult children as one example. Retain deeds, appraisals, account records, contracts, invoices, and proof of payments for the full review period (ND Medicaid transfer fact sheet).

HHS includes nursing homes, hospital swing beds, other medical institutions, intermediate-care facilities, and home- and community-based settings in the nursing-care-services description used by its fact sheet. Consequently, a plan cannot safely assume that an in-home services request avoids the same transfer history. A permitted transfer or exception is highly fact-dependent, so the statutory and HHS materials should be applied to the actual transaction rather than to a generic gift rule (ND Medicaid transfer fact sheet).

The penalty is based on a statewide nursing-facility cost

North Dakota calculates the penalty by dividing the uncompensated transfer amount by the average monthly cost of nursing-facility care in the state at the individual's first Medicaid application. The state-plan language confirms that North Dakota uses the statewide average monthly nursing-facility cost and has equalization between private-pay and Medicaid rates. HHS publishes a 2026 average Medicaid nursing-facility rate of $437.90 per day, but it does not label that figure as the live transfer-penalty divisor; a current penalty calculation should be obtained from HHS rather than created by multiplying a published rate (ND Medicaid transfer fact sheet; North Dakota transfer state-plan language; ND Medicaid long-term-care services).

HHS says a penalty generally begins on the later of the month of the transfer or the first month in which the person receives nursing-care services and is otherwise eligible. “Otherwise eligible” includes meeting nonfinancial requirements, being within asset limits, and having responsibility for enough nursing and other medical costs to meet client share. That timing rule can make an old gift relevant at a much later admission (ND Medicaid transfer fact sheet).

A hardship exception exists but is narrow

HHS permits an application for all or part of a transfer penalty to be waived for undue hardship. The request and supporting proof must generally be provided within 90 days of notice of the penalty, or within 90 days of a later change creating hardship; a facility may apply with appropriate consent. HHS requires proof that the penalty would deprive the person of necessities or endanger health or life, that recovery efforts have been exhausted, and that remaining assets are below the limit (ND Medicaid hardship fact sheet).

A hardship exception is not routine planning. Ask HHS for the current divisor, preserve transaction records, and get state-specific legal advice before transferring a home, life estate, trust interest, or other major asset.

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North Dakota Medicaid Look-Back Period

North Dakota reviews five years of transfers

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