Planning in North Dakota should start with client share, not with an automatic assumption that a Qualified Income Trust is the standard tool. HHS describes its medically needy coverage as designed for people whose income is too high for ordinary Medicaid but whose medical expenses exceed their client share, and its January 2026 policy defines recipient liability as a monthly deductible calculated from net income, allowable deductions, and the applicable income levels. That income-and-deduction calculation should happen before anyone changes asset ownership or buys a financial product.
Resources still matter alongside the income calculation. The public HHS standard requires less than $3,000 in countable resources for a single long-term-care applicant and less than $6,000 for a couple, subject to standard exclusions and special spousal rules. When one spouse is institutionalized or on an HCBS waiver, state law adopts the maximum federal Community Spouse Resource Allowance, while the administrative code allows the applicant spouse to retain $3,000. Requesting an asset assessment before large purchases, retitling property, or starting a spend-down is a sound first move.