Important changes coming to North Dakota Medicaid.
Starting Jan. 1, 2027, some North Dakota Medicaid Expansion members ages 19 to 64 will need to complete 80 hours of work or other qualifying activities to keep their coverage.
This federal change is to encourage people to work, learn skills for a job and give back to their communities.
Most North Dakota Medicaid Expansion members will not be impacted.
Does this apply to you?
The new federal rules do not apply to:
- Children (0-18)
- Older adults (65 and older)
- Parents, guardians or family caregivers of a child age 13 or younger
- Parents, guardians or family caregivers to someone with a disability
- People with special health needs that impacts daily living
- People in a drug or alcohol treatment program
- Pregnant women or current members who were pregnant in the last 12 months
- Native Americans or Alaska Natives
- People who are or were released from jail or prison in the last three months
- Former foster youth under age 26
- A veteran with a total disability rating from Veterans Affairs
- People who qualify for Medicare
People already meeting work requirements under the Temporary Assistance for Needy Families program (TANF) or the Supplemental Nutrition Assistance Program (SNAP) will not need to meet Medicaid work requirements.
What counts toward 80 hours?
Work
Job or earn at least $580 per month
Job Training
Take part in job training or work program
Education
Attend college or career/technical education program at least half-time
Community Service
Volunteer in your community
You can combine activities to reach 80 hours.
Example: 60 hours of work + 20 hours of volunteering = 80 hours.
If you are required to meet these new rules and you don’t, you could lose your Medicaid Expansion coverage.
Applying for Medicaid Expansion for the first time?
You'll need to show that you met the required work or other approved activities during the month before you applied.
Take Action: Here’s how you can prepare
We want everyone who qualifies for Medicaid Expansion to stay covered. Be sure to keep your contact information up to date, so we can send you important updates. Also, check this page often for new information.
Update Information
If you have moved or your contact information has changed, let us know!
Check Your Mail
If you get a letter from North Dakota Medicaid, open and read it.
Respond
Missing deadlines could result in a loss of coverage.
Update your information in the Self-Service Portal (SSP)
New to the SSP? Visit the SSP Help Page for videos, FAQs and more.
You can also update your contact information or ask questions about your coverage by contacting the Customer Support Center.
Phone: Toll-Free 866-614-6005 or 711 (TTY)
Email: applyforhelp@nd.gov
Mail: P.O. Box 5562 Bismarck, ND 58506
In-Person: Visit a human service zone office. Find one near you.
Customer Support Center is available Monday-Friday, 8 a.m.- 5 p.m. CT.
Other changes coming
The new work requirements are just one of several changes coming to Medicaid. Other updates include more frequent reviews and new cost-sharing requirements for some members. Learn more at hhs.nd.gov/stayenrolled.
Frequently Asked Questions
In July 2025, Congress passed a law that changes Medicaid rules nationwide. Beginning Jan. 1, 2027, all states must require some Medicaid Expansion members to meet community engagement requirements, also known as work requirements, to keep their coverage.
The new federal law requires some Medicaid Expansion members to take part in work requirements to keep their coverage.
These members will need to participate in 80 hours of approved activities or earn at least $580 per month and then report that to North Dakota Medicaid.
Approved activities include:
- Work (paid, non-paid, internship, self-employed)
- Learning new job skills in a training program
- Going to school at least half time
- Volunteering or community service
A mix of these activities can count.
The new work requirements apply only to some Medicaid Expansion members ages 19 to 64. However, many members will be excluded and will not have to meet work requirements.
Work requirements do not apply to:
- Children (0-18)
- Older adults (65 and older)
- Parents, guardians or family caregivers of a child age 13 or younger
- Parents, guardians or family caregivers to someone with a disability
- Former foster youth under age 26
- Native Americans and Alaska Natives
- A veteran with a total disability rating from Veterans Affairs
- People with special health needs that impact daily living
- People in a drug or alcohol treatment program
- Pregnant women or current members who were pregnant in the last 12 months
- People who are or were released from jail or prison in the last three months
- People with a serious physical, intellectual or developmental disability
People already meeting work requirements under the Temporary Assistance for Needy Families program (TANF) or the Supplemental Nutrition Assistance Program (SNAP) will not need to meet Medicaid work requirements.
Work requirements will begin for Medicaid Expansion members who have a review due on Feb. 28, 2027, and new applicants starting Jan. 1, 2027.
They will have two ID cards. The Blue Cross Blue Shield North Dakota card is used for visits to a provider and the ND Medicaid ID card is used when picking up prescriptions.
Most members will not need to do anything extra to show they meet the work requirements. North Dakota Medicaid will use data sources we already have to check if members meet the requirements.
If we can verify that a member has already met work requirements and other eligibility factors, we’ll send the member an approval notice.
If we can't verify if a member met work requirements, we will contact the member and ask for more information.
We’ll send a notice listing what information we need. This information must be sent back to the Customer Support Center within 30 days of getting the notice.
If a member does not do this, he or she may be denied or lose coverage. This is why members need to make sure their contact information is up to date in our records.
Customer Support Center
Email: applyforhelp@nd.gov
Mail: P.O. Box 5562 Bismarck, ND 58506
In-Person: Visit a human service zone office. Find one near you.
There are several ways current members or new applicants can send proof to us.
Online: Self-Service Portal
Email: applyforhelp@nd.gov
Mail: P.O. Box 5562 Bismarck, ND 58506
In-person: Visit a human service zone office. Find one near you.
The months we look at to see if people meet the work requirements are different for current Medicaid Expansion members and people applying for the first time.
People applying for North Dakota Medicaid Expansion
For new 2027 applications: North Dakota Medicaid will check if qualifying activities were completed in the month before someone applies.
Example: If a person’s application is dated Jan. 29, 2027, we’ll look back to December 2026 to see if he or she met the work requirements or qualifies for an exclusion.
For current Medicaid Expansion Members
For 2027 renewals: North Dakota Medicaid will check that members met work requirements for at least one month in their last review period.
Example: A member’s renewal is due June 30. Their review period is Jan. 1 to June 30, 2026. We’ll look back to January, February, March, April, May and June to see if the member met work requirements or an exclusion in any of those months. It does not need to be every month, just one month in the review period.
If a member gets a letter asking for more information, it will give examples of what they can send as proof.
Some examples:
- Pay stubs
- Employer letter showing hours worked and rate of pay
- College transcript that shows credit hours
- Letter from community service organization listing the number of volunteer hours in a month
- Letter from work program that shows participation hours and name of work program
Members should use one of these options to report any changes to their mailing address, phone number or email address.
- Use the Self-Service Portal: applyforhelp.nd.gov
Contact the Customer Support Center:
- Phone: Toll-free 866-614-6005, 711 (TTY)
- Email: applyforhelp@nd.gov
- Visit a human service zone office:
Individuals can also update their contact information by calling Blue Cross Blue Shield of North Dakota toll-free 1-833-777-5779.
A person is considered having a special health need if they:
- Are blind or disabled by Social Security Administration
- Have a substance use disorder and in recovery less than five years
- Have a disabling mental health condition
- Have a physical, intellectual or developmental disability that makes it hard to do daily living tasks like bathing, eating or getting dressed
- Have a serious or complex medical condition that prevents them from meeting the work requirements. (Some examples include cancer and heart disease)
This is an adult who regularly cares for a child under age 14 or a person with a disability who needs help with everyday tasks.
There are three ways a person can meet the family caregiver exclusion.
- Live with a child under 14 or a person with a disability and regularly care for them.
- Don’t live with the person, but are a family member who regularly cares for them.
- Don’t live with them and aren’t a family member, but provide at least 80 hours of care each month.