Medicaid Estate Recovery in North Dakota

Who is subject to recovery

A Medicaid member who was age 55 or older when services were received, or who was permanently institutionalized at any age and received a Notice of Permanent Institutionalization.¹

What is recovered

North Dakota recovers the total medical assistance paid following the member's 55th birthday or institutionalization.¹

Section 50-24.1-07(1) allows the amount as a preferred claim against the estate after recipient liability, funeral expenses up to $3,500, last-illness expenses, and estate administration costs are paid.²

When recovery is deferred or barred

Section 50-24.1-07(2)(a) requires no claim to be paid, and no interest accrues, during the lifetime of a surviving spouse, or while there is a surviving child under 21 or a surviving child of any age who is blind or permanently and totally disabled.²

Under section 50-24.1-07, a timely filed claim is not disallowed by these deferrals.²

A deferral does not stop the claim being filed: HHS still files it against the estate, a surviving spouse gets an informational claim instead, and the claim may be paid voluntarily.³

Only the share passing to the protected survivor is shielded; estate distributions that pass to the decedent's other children remain subject to recovery.³

What counts as the estate

When the recipient's surviving spouse later dies, HHS may enforce the claim against that spouse's estate to the extent it holds assets traceable to the Medicaid recipient.^{3, 1}

Section 50-24.1-07(5) presumes that all assets in the surviving spouse's estate are assets the recipient had an interest in at death.²

Undue-hardship waiver

The Estate Recovery Policy Manual cites the federal requirement (42 U.S.C. 1396p(b)(3)) for a hardship waiver process and limits undue-hardship claims to surviving spouses, children under 21, and adult children with disabilities.³

How the state files its claim

Section 50-24.1-07(3) requires the personal representative to send the department a copy of the petition commencing probate, heirship, or joint-tenancy tax-clearance proceedings, with a list of legatees, devisees, surviving joint tenants, and heirs at law.²

If the department's claim is not paid in full, section 50-24.1-07(3) requires the personal representative to provide a statement of assets and disbursements in the estate.²

HHS files its claim with the clerk of district court after Letters are signed and the probate paperwork reaches it; distributions to heirs cannot be made until the debts are paid in full.³

An allowed claim begins earning interest 60 days after the claim-filing period expires, at 6% per annum, unless a deferral applies.³

Governing law: N.D.C.C. 50-24.1-07

Clerk of district court

Receives the HHS claim against the estate after Letters are signed³

1. 1.Estate Recovery (North Dakota Department of Health and Human Services)
2. 2.N.D.C.C. Chapter 50-24.1
3. 3.Estate Recovery Policy Manual, effective 12.01.2024