How a nursing home penalty works
If someone gave away money or property and then needs Medicaid to pay for a nursing home, Medicaid can refuse to pay for a stretch of time. Here is the whole idea in three steps.
The state looks back five years
When you apply, the state asks what you gave away in the last five years — money to a child, a house signed over, help with a grandchild's tuition. Anything you handed over without getting fair value back counts.
It divides by one official number
Every state publishes a figure for what a month of nursing home care costs. The state divides what you gave away by that figure. That figure is the big number shown below for your state.
That is how many months Medicaid will not pay
During those months the person lives in the nursing home and Medicaid pays nothing toward it. The family pays, or the home goes unpaid.
If Nothing Was Given Away, None Of This Applies To You. No gifts in the last five years means no penalty, and nothing on this page changes that.
North Dakota Medicaid transfer-penalty divisor
figure not published yetUncompensated value divided by the average monthly cost, or daily cost as appropriate, of nursing facility care in North Dakota at the time of the application during which the disqualifying transfer was determined. 510-05-80-15.
We Will Not Print A Number We Cannot Source. The only figures in the policy are inside a WORKED EXAMPLE about a hypothetical December-2011 application: '$6,238 per month and $205.07 per day'. Manual Letter 3804 is dated 12/1/2023 but the example was not re-priced, and the manual states the current divisor nowhere. Publishing $6,238 as North Dakota's divisor would be publishing a 2011 number from a hypothetical.
How we are getting it: Find where ND actually publishes the annual average cost of nursing facility care -- it is not in the 510-05-80 chapter. Failing that, a records request to ND HHS.
Three things people get wrong
In Most States The Date That Counts Is The Day You Apply, Not The Day Of The Gift.
States change this number every year or two, and most measure a gift against whichever figure is in force when the application goes in — so a gift from 2019 gets measured against today's figure, not 2019's. Not every state does this: Arizona locks the figure to the county and month of your first approval. Ask which rule yours uses.
When The Number Goes Down, The Penalty Gets Longer.
It seems backwards, but everything is divided by this number. A smaller number means more months. Pennsylvania's figure dropped 21% between 2022 and 2024, which made the penalty for the same gift about a quarter longer.
Waiting At Home Does Not Run Out The Clock.
The penalty does not start on the day of the gift. It starts once the person is in the nursing home and would otherwise qualify for Medicaid. Staying home for two years first does not use up any of the penalty.
Getting a bed once the penalty ends
A penalty running out does not produce a bed. One has to be free, and the home has to accept you — and a facility looking at a known penalty is looking at months it will not be paid.
9,096 people aged 65 and over live in North Dakota counties with no certified nursing facility. If that is where your family is, the nearest bed may be a long drive from everyone who visits.
During The Penalty You Are A Private Payer. 53% of patient days in North Dakota are paid by Medicaid at state rates. For the months of your penalty you would be paying full private rate — the most profitable resident in the building. That is worth saying out loud when you ask about admission.
CMS Nursing Home Care Compare provider file and CMS SNF cost reports; Census population estimates for 2024.
Get told when North Dakota's figure changes
States change this number quietly, usually once a year, and never tell families. We watch the source documents. Eventually we will email you the day one moves.
Email alerts are not open yet. We are not collecting addresses until they are — we would rather hold nothing than hold your email and do nothing with it.
Want to know the day they open? Write to [email protected] and we will tell you. Everything on this site is free to use right now, with no sign-up at all.
What to ask before you rely on this
- “Which figure applies to my application date?” Ask the caseworker to name the number and the date it took effect, and write down their answer.
- “Does any exception apply?” Transfers to a spouse, to a disabled child, or a home transferred to a caregiver child who lived there for two years are commonly excepted.
- “Can we claim hardship?” Every state must have a hardship process for when a penalty would leave someone without needed care. It is rarely offered unless you ask.
Where to get help, free
We are a reference, not a substitute for someone who can look at your actual situation. Most of what a family needs here costs nothing.
- Long-term care ombudsman — free, in every state. Call them the day a discharge notice arrives, not after the deadline.
- Area Agency on Aging — free. Best first call for working out what North Dakota will and will not cover.
- Legal aid — free if you qualify on income. Handles denials and appeals.
- North Dakota bar association lawyer referral service — a screened referral, usually with a low-cost first consultation.
- An elder law attorney — worth paying for when there is a deadline or money still in play: returning or curing a gift, an appeal, a trust, an annuity, a hardship claim.
We Are Not Paid By Anyone On This List. No referral fees, no lead sales, no sponsored placement. If that ever changes we will say so here first.