Level of Care A through D is a real eligibility gate
The nursing-facility policy says Medicaid will not cover services unless the member meets nursing-facility level-of-care criteria. It calls the routes Level of Care A, B, C, or D. Level A can be met through one listed condition, including coma, ventilator needs, certain respiratory needs, constant help at least 60 percent of the time with two specified activities of daily living, aspiration needs, or qualifying dementia-related deterioration. Other routes cover combinations of nursing, medical, functional, cognitive, and behavioral needs described in the policy (ND Medicaid nursing-facility policy).
The assessment should not be confused with the payment classification. Starting January 1, 2026, HHS uses the North Dakota Patient Driven Payment Model, under which a nursing facility completes an assessment every three months that sets a three-letter classification used to establish the daily rate. That is a provider payment process; the applicant's Level of Care A-D eligibility criteria remain their own requirement (ND Medicaid long-term-care services; ND PDPM resident guide).
Income, personal needs, and rates
North Dakota applies client share or recipient liability after the appropriate income deductions; HHS describes it as the monthly amount paid toward medical services before Medicaid pays. The most recently verified nursing-home personal-needs allowance in state-plan material is $115 monthly effective July 1, 2025. HHS announced a further personal-needs-allowance State Plan Amendment effective July 1, 2026 but the located notice does not publish the resulting nursing-home dollar amount, so confirm the live allowance instead of assuming $115 remains current (ND Medicaid recipient-liability policy; North Dakota 2025 state-plan amendment material; North Dakota July 2026 public notice).
HHS reports an average nursing-facility rate of $437.90 per day as of January 1, 2026 and says North Dakota has rate equalization between Medicaid and self-pay residents. The rate is useful planning context, but client share, coverage, and a transfer penalty are individual calculations, not a promise that the average rate will be paid in every case (ND Medicaid long-term-care services).
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