Jane Dotson
Medicaid is a government-funded health insurance program that provides free or low-cost health coverage to eligible individuals and families with low incomes. In North Dakota, Medicaid offers a range of programs to cater to the needs of its citizens, including short-term coverage for refugees, Medicaid Expansion, and the Children's Health Insurance Program (CHIP). To qualify for Medicaid in North Dakota, applicants must meet certain eligibility requirements, including income and asset limits, and fall into a specific coverage group.
| Characteristics | Values |
|---|---|
| Application Process | Online, in person, by phone, or by mail |
| Application Form | Health Care Application for the Elderly and Disabled |
| Application Review | By an eligibility worker |
| Additional Information | May be requested |
| Decision | Approval or denial letter sent within a few weeks |
| Appeal | Possible |
| Coverage Groups | Many, including elderly residents, pregnant women, children, and families |
| Coverage Options | Traditional Medicaid, Medicaid Expansion, Children's Health Insurance Program (CHIP) |
| Income Requirements | Vary by coverage group and update with policy and law changes |
| Asset Requirements | Vary by coverage group and update with policy and law changes; proof of assets needed for blind, disabled, or age 65 and older |
| Identity Requirements | Birth certificate, government-issued ID, passport, permanent resident card/green card |
| Additional Benefits | Coverage for non-medical services, dental care, and prescription coverage |
| Medicaid Waivers | Five waivers targeting specific populations |
| Medicaid Advisory Committee | Medicaid Medical Advisory Committee (MMAC) |
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What You'll Learn
Income and asset limits
For seniors aged 65 and over, North Dakota Medicaid offers long-term care programs with different income and asset limits. The Medically Needy Pathway, also known as the "Spend-Down" Program, allows seniors with income above the Medicaid limit to become eligible if they have high medical expenses relative to their income. As of April 1, 2025, the medically needy income limit (MNIL) is set at $1,174 per month for individuals and $1,587 per month for couples. This program enables seniors to “spend down” their income on medical expenses, including health insurance premiums, transportation costs, and medical bills.
Additionally, North Dakota Medicaid provides Institutional/Nursing Home Medicaid, which is an entitlement program offering care exclusively in nursing homes. The Aged and Disabled Waiver, also referred to as the Medicaid Waiver for Home and Community-Based Services (HCBS), assists seniors and adults with disabilities in maintaining independent living. This program includes services such as personal care assistance, adult day care, home modifications, emergency response systems, and meal delivery.
For families and children with low incomes, Medicaid Expansion may be an option. This program has higher income limits for children's coverage, allowing them to qualify even if their parents do not. The Children's Health Insurance Program (CHIP) is specifically designed for children in families who earn too much to qualify for Medicaid but cannot afford private health insurance. CHIP has higher household income levels than Medicaid, set at 210% of the Federal Poverty Level (FPL).
To apply for Medicaid in North Dakota, individuals must provide proof of monthly income, such as pay stubs or tax returns, and proof of assets for certain groups, including the blind, disabled, or those aged 65 and older. Applications can be submitted online, in person, by phone, or by mail, and there is no need to wait for an open enrollment period.
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Coverage groups
To qualify for Medicaid in North Dakota, an applicant must fall into a coverage group and meet certain rules. Each coverage group has its own rules and income levels that can change when policies and laws are updated.
- Children and families — Medicaid provides coverage for children under the Children's Health Insurance Program (CHIP). Household income levels are higher for CHIP than for Medicaid. Children may be able to get coverage even if their parents do not qualify. Children with disabilities are also covered.
- Pregnant women — Medicaid covers prenatal care, labor, delivery, and postnatal care for up to 12 months after pregnancy. A newborn automatically qualifies for Medicaid if their mother was covered by Medicaid on the day they were born.
- The elderly — Medicaid offers long-term care programs for seniors who are 65 years of age and older, including nursing home care and assistance with daily living activities. Seniors who have income over Medicaid's limit may still qualify if they have high medical expenses relative to their income.
- Disabled people — Medicaid provides waivers and services to help adults with disabilities live independently, including personal care assistance, adult day care, home modifications, and emergency response systems.
- Legally admitted refugees — Short-term coverage is available for refugees who do not qualify for Medicaid or other health care services during their first 12 months in the United States.
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Medicaid waivers
To qualify for Medicaid health insurance in North Dakota, you must submit an application and meet the eligibility requirements for a specific coverage group. These groups are based on factors such as income and assets, and include qualifying low-income adults, children, pregnant women, older adults, and people with disabilities.
For example, one of the waivers in North Dakota is the Home and Community-Based Services (HCBS) waiver, which is designed for people who require extra support to remain at home rather than move to a residential care setting. This waiver includes services such as assistive technology, respite care, remote monitoring, and community supports. Another waiver is the Children's Hospice Home and Community-Based Services Waiver, which assists families in caring for a child with autism spectrum disorder at home.
To learn more about Medicaid waivers in North Dakota and determine your eligibility, you can visit the Medicaid waiver webpage or contact a North Dakota Health and Human Services regional human service center.
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Health insurance options
Medicaid
Medicaid is a government-funded health insurance program that covers medical bills for eligible individuals. It is jointly funded by state and federal governments. North Dakota Medicaid provides healthcare coverage for people who submit an application and meet the eligibility criteria. The eligibility criteria are based on factors such as income, age, disability, and citizenship.
Traditional Medicaid
Traditional Medicaid serves individuals within specific coverage groups, each with its own rules and income levels. These groups include citizens, qualified aliens, and those meeting certain asset limits. Enrollment in Traditional Medicaid can be done through an eligibility worker or online.
Medicaid Expansion
Medicaid Expansion is intended for families and children with low incomes who do not have other health insurance coverage. The eligibility criteria for children have higher income limits, allowing them to qualify even if their parents do not.
CHIP (Children's Health Insurance Program)
CHIP provides health insurance coverage for children in families who cannot afford private health insurance but earn too much to qualify for Medicaid. CHIP has higher household income limits than Medicaid, making it accessible to a broader range of families.
Medicaid Waivers
North Dakota has several Medicaid waivers that target specific populations, such as families with children diagnosed with autism spectrum disorder. These waivers help individuals receive care at home rather than in a medical facility.
Short-Term Insurance
Short-term insurance is available for legally admitted refugees who do not qualify for Medicaid or other healthcare services during their first 12 months in the United States.
Medicaid for Pregnant Women and Newborns
Medicaid provides coverage for pregnant women, including labor, delivery, and prenatal care. After pregnancy, women who were on Medicaid during their pregnancy continue to receive coverage for 12 months, including check-ups, behavioral health services, and preventive services. Additionally, a newborn automatically qualifies for Medicaid if their birth mother was covered by Medicaid on the day of their birth and receives coverage for the first year.
Medicaid for Seniors
North Dakota Medicaid offers programs for seniors, including long-term care in nursing homes and assistance with daily living activities. Seniors who do not meet the financial eligibility requirements can still qualify through the Medically Needy Pathway if they have high medical expenses relative to their income.
To explore specific eligibility and application processes, individuals can refer to the North Dakota Department of Human Services website or contact their local Human Service Zone office.
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Application and enrolment
To apply for Medicaid in North Dakota, you must submit an application and meet the eligibility criteria. There are no open enrollment periods, and you can apply at any time.
You can apply for Medicaid in North Dakota in several ways: online, in person, by phone, or by mail. If you are a senior citizen (65+) or a person with a disability, you can fill out a Health Care Application for the Elderly and Disabled form and submit it to your County Human Service Zone office. You can also contact this office to request that an application be mailed to your home.
If you are under 65 and do not have Medicare, you can also enroll through HealthCare.gov or use their call center at 1-800-318-2596. You can also enroll online directly through the state using the North Dakota Department of Human Services website. You can print a paper application and submit it to your local County Social Services Office, or call or visit your Human Services Zone office for in-person or phone assistance with enrollment.
If you are a parent in need of health insurance coverage, you can contact ND Navigators to discuss other coverage options, such as plans on the Health Insurance Marketplace. If you are a refugee or an asylee, you may be eligible for short-term coverage for the first 12 months in the US.
If you are applying for Medicaid, you should be certain that you meet all eligibility requirements before submitting your application. You will need to provide specific documentation along with your application, including proof of monthly income, proof of assets, and a form of identity.
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Frequently asked questions
You can apply for Medicaid in North Dakota online, in person, by phone, or by mail. You can also print a paper application and submit it to your local County Social Services Office.
To qualify for Medicaid in North Dakota, you must be a US citizen or a qualified alien, be a resident of the state, and meet certain income and asset limits. Additionally, you must not have other health insurance coverage.
Yes, North Dakota has five Medicaid waivers that target specific populations and provide a range of services. There are also programs like the Medically Needy Pathway and Aged and Disabled Waiver, which help seniors and adults with disabilities.
Yes, pregnant women in North Dakota who meet the income requirements are eligible for Medicaid coverage. Coverage includes prenatal care, labor, delivery, and postpartum checkups for 12 months after giving birth.
If your Medicaid application is denied, you can appeal the decision. North Dakota Navigators can assist with the enrollment application and help you gather additional information or appeal coverage denials.
