Medicaid Eligibility

ND Medicaid provides coverage for children birth through age 18. Children can get regular Health Tracks well-child checks, dental care, vision checks, and more.

To qualify, a child must:

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Meet monthly income level for their family size, which varies by coverage group

The table below shows monthly income limits for Medicaid for children birth through age 18.

Income levels effective: April 1, 2024

Once approved, children qualify for benefits for up to 12 months if they continue to live in North Dakota.

If a child up to age 21 is over the income limit for Medicaid and has a medical need, ND Medicaid provides a coverage option with a client share.

CHIP coverage is for children from birth through age 18. It helps meet the needs of families who can’t afford health care coverage for their children yet make too much to qualify for ND Medicaid. Although CHIP and ND Medicaid are different coverage groups, the insurance coverage is the same. 

Children can get regular Health Tracks well-child checks, dental care, vision checks, and more.

To qualify, a child must:

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Be uninsured (A child cannot have other credible health insurance)
• Meet monthly income level for their family size 

205% Federal Poverty Level
Income levels effective: April 1, 2024

Children with disabilities often have high medical needs. These needs can cost more than what private insurance will cover. This coverage lets families “buy-into” ND Medicaid. Families pay a monthly premium based on the family's income. The monthly premium is equal to five percent of the family's gross countable income.

There is no asset limit for this coverage. Children can qualify even if their family owns a home, has more than one car or has other assets.

A family can have private insurance and qualify for this coverage. If an employer of either parent offers medical coverage for the child and the employer pays at least half of the premium, the child must be enrolled in the private insurance plan.

To qualify, a child must:

• Be under the age of 19
• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Be disabled based on the Social Security Administration's definition of disability
• Meet monthly income level for their family size

250% Federal Poverty Level
Income levels effective: April 1, 2024

Learn more about Children's with Disabilities coverage.

This coverage is for women who are pregnant. It covers labor, delivery, prenatal care and more.  

After pregnancy, women who were on Medicaid during their pregnancy receive 12 months of coverage. Women can get checkups, behavioral health services, preventive services like mammograms, dental care and more.

To qualify, a woman must:

• Be pregnant
• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Meet monthly income level for their family size 

Note: The unborn child counts as a family member. 
175% Federal Poverty Level
Income levels effective: April 1, 2024

If a pregnant woman is over the income limit for Medicaid and has a medical need, ND Medicaid provides a coverage option with a client share.

A newborn automatically qualifies for ND Medicaid if their birth mother was covered by ND Medicaid on the day the child was born. Newborn coverage lasts for the first year. 

North Dakota provides health care coverage to qualifying children in the following groups:

• Children in foster care
• Children receiving an adoption subsidy
• Youth who age out of foster care until they reach age 26

To qualify, a child must:

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Be in foster care, a subsidized adoption, or a former foster care youth that aged out of foster care 

This coverage is for people who are 65 or older, blind, or have a disability based on the Social Security Administration's definition of disability.

To qualify, an individual must:       

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Have less than $3,000 in countable assets like savings and checking accounts, stocks, bonds or other types of assets for a single person or less than $6,000 for a couple. For each additional person in the household, $25 can be added to the asset limits. 
• Meet monthly income level for their family size 

90% Federal Poverty Level 
Income level effective: April 1, 2024

The value of a person’s home, one car, home furnishings, irrevocable burial plans, and other personal items are not counted towards the asset limit. 

If a person in this coverage group is over the income limit for Medicaid and has a medical need, ND Medicaid provides a coverage option with a client share.

This program is for people who receive Medicare. There are three Medicare Savings programs that can help pay a person’s Medicare Part B premium. The programs are Qualified Individual (QI1), Specified Low Income Medicare Beneficiary (SLMB) and Qualified Medicare Beneficiary (QMB). QMB can also help pay for Medicare Part A premium, coinsurance and deductibles.  

To qualify, an individual must:

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Qualify for Medicare and receive Medicare Part A or Part B (or both)
• Meet asset limits which cannot exceed the full low-income subsidy resource levels. These amounts change once a year. 
• Meet monthly income level for their family size 

Note: Individuals cannot be on both QI1 and Medicaid. They must choose which coverage option best fits their need.  

Learn more: Medicare Premium Assistance Program fact sheet 

This coverage is for people who qualify for Supplemental Security Income (SSI) through the Social Security Administration. 

People who qualify for SSI, qualify for Medicaid. A ND Medicaid application is needed to get coverage. Visit the Apply for Help webpage to apply. 

To apply for SSI, visit the Social Security Administration’s website.     

This coverage makes it possible for some individuals with disabilities to work and "buy in-to" ND Medicaid by paying a monthly premium based on their income. The premium equals five percent (5%) of their gross countable income. Native Americans do not pay enrollment fees or premiums. 

• Example: Joe earns $1,000 per month. His monthly premium is $50 per month.

To qualify, an individual must:

• Be a North Dakota resident
• Be 16 to 65 years old
• Have a disability based on Social Security Administration guidelines
• Be employed or become employed
• Pay a monthly premium
• Pay a one-time $100 enrollment fee
• Meet monthly income level for their family size

225% Federal Poverty Level 
Income levels effective: April 1, 2024

Learn more: Workers with Disabilities fact sheet

Long-term care coverage is for people who need support for a disability or chronic illness that limits their ability to do daily tasks like making meals, getting dressed or bathing.  

Some people may need this care short term after an illness or hospital stay while others may need it for many years. This care can take place in a nursing home, basic care facility, memory care facility or in their own home under the state's Home and Community-Based Services waiver. 

Individuals must qualify for a ND Medicaid coverage group. They also must:

• Be:
  • 65 years or older or 
  • Blind or 
  • Have a disability determined by the Social Security Administration or 
  • Medically frail
• Have a medical need for long term care services. In general, this means a person must be unable to care for themselves without outside help.
• Have less than $3,000 for a single person or $6,000 for a couple in their checking and savings accounts, certificate of deposits, etc.  

Use the long-term care application checklist to see what documents should be included with an application.  

Spousal Impoverishment Prevention Coverage

This coverage applies to couples where one person needs long-term care in a facility or at home.

To qualify:

• The individual must qualify for Medicaid and have been screened as needing long- term care.
• The care must be expected to be needed for at least 30 days in a row.
• The community spouse cannot be enrolled in Medicaid.

Learn more: Spousal Impoverishment Prevention Coverage fact sheet

This coverage is for parents and caretakers such as a grandparent, aunt/uncle, sibling, half sibling or step sibling caring for child(ren) under the age of 18 in their home. It provides medical, dental and vision coverage.

To qualify, an individual must:

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Meet criteria of a parent/caretaker 
• Meet monthly income level for their family size 

41% Federal Poverty Level
Income levels effective: April 1, 2024

If a person in this coverage group is over the income limit for Medicaid and has a medical need, ND Medicaid provides a coverage option with a client share.

Medicaid Expansion coverage is for adults ages 19 through 64 who do not qualify for another Medicaid coverage group. It helps with medical costs like checkups, preventive services, hospital visits and more. It does not provide dental or vision care.

To qualify, an individual must:

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Not qualify for Medicare or Supplemental Security Income 
• Meet monthly income level for their family size 

138% Federal Poverty Level
Income levels effective: April 1, 2024

Medically frail is for people who are enrolled in Medicaid Expansion, but have complex medical conditions that need broader coverage to cover more medical expenses.    

Medically frail means a person must have a:

• Serious and complex medical condition; or
• Behavioral health condition (serious mental illness and/or substance use disorder); or
• Disability that affects daily living

To apply for medically frail coverage, complete the Medically Frail Questionnaire.

Medically frail individuals do not have an asset limit. However, if the individual needs long-term care services, a review of assets for the last five years may take place. This is to make sure they did not transfer or give assets to others. 

This coverage is for people who have income that is too high for Medicaid, but have high medical bills they must pay. People who qualify for this coverage have a client share.  

Client share is the monthly amount a person must pay in medical bills before Medicaid will pay for covered services. It works like a monthly deductible.

To qualify, an individual must:

• Be a resident of North Dakota
• Be a US citizen or qualified noncitizen
• Be:
  • Age 65 or older, blind or disabled* or
  • Pregnant or
  • A child 0 through age 20, or 
  • A parent/caretaker such as an aunt/uncle, grandparent, etc.
• Have a medical need (have medical expenses that exceed client share)

* Aged, blind and disabled individuals must have less than $3,000 in countable assets like savings and checking accounts; stocks; bonds or other types of assets for a single person or less than $6,000 for a couple. For each additional person in the household, $25 can be added to the asset limits. 

Client Share Calculation 
Household’s monthly gross countable income 
- (minus) Allowable deductions (health care premiums, payroll taxes, etc.)
- (minus) Income limits based on household size (see chart below)
= Client Share (The amount an individual or household must pay before Medicaid can pay)

90% Federal Poverty Level
Income levels effective: April 1, 2024 

Learn more: Medicaid Client Share fact sheet 

This coverage is for noncitizens who do not qualify for Medicaid, but have an urgent health need, such as childbirth. It is temporary coverage and ends once the urgent medical need is over.  

To qualify, a noncitizen must:

• Be a resident of North Dakota

• Complete a Medicaid application and SFN 451 Eligibility Report on Disability/Incapacity form and submit medical records to the Customer Support Center for review.

       Note: The birth of a child does not require SFN 451 to be completed. Instead, complete a health care application.

• Meet all other requirements for Medicaid such as family income levels
       Note: Undocumented noncitizens do not need social security number or proof of alien status. 

Women's Way provides free breast and cervical cancer screenings and other treatment to qualifying individuals. Women who need ongoing treatment for breast or cervical cancer may qualify for Medicaid coverage through Women’s Way.  

Visit the Women's Way eligibility webpage to learn more. 

This short-term coverage is for legally admitted refugees who do not qualify for Medicaid or other health care services. It is available for qualified individuals for the first 12 months a refugee is in the United States or first 12 months after an asylee has been granted asylum.  

To qualify, an individual must:

• Be a ND resident
• Meet immigration status of refugee or other qualifying status
• Be ineligible for Medicaid
• Meet monthly income level for their family size 

200% Federal Poverty Level
Income levels effective: April 1, 2024 

This Medicaid waiver helps families care for a child diagnosed with autism spectrum disorder at home rather than having to place the child in a care facility. 

Some of the supports include assistive technology, respite care, remote monitoring, community supports and case management. An application is needed to see if you qualify.

To qualify, a child must:

• Be under the age of 18 
• Qualify to receive care in an intermediate care facility 
• Have diagnosis of autism spectrum disorder
• Be living in a home with parents or other legally responsible caregivers

After a child is approved for waiver services, the family will need to apply for Medicaid for the approved child.  
 

This Medicaid waiver helps families with a child that has a life limiting diagnosis from a doctor. It helps keep the child in their own home rather than long hospital stays. 

Services include case management, skilled nursing, hospice, respite, grief counseling and more. An application is needed to see if you qualify.

To qualify, a child must:

• Be under the age of 22
• Have received a life limiting diagnosis and is not expected to live longer than one year
• Be eligible to receive care in a skilled nursing home
• Be living in a home with parents or other legally responsible caregivers

After a child is approved for waiver services, the family will need to apply for Medicaid for the approved child.  
 

This Medicaid waiver is to help families keep their medically needy child at home rather than place them in a nursing home or hospital to receive needed care.  

Services can include transportation, individual and family counseling, equipment and supplies, case management and more. An application is needed to see if you qualify.

To qualify, a child must:

• Be ages 3 through 17
• Be eligible to receive care in a skilled nursing home
• Be living in a home with parents or other legally responsible caregivers

After a child is approved for waiver services, the family will need to apply for Medicaid for the approved child.  

This waiver is for older adults and people with physical disabilities who want to remain in their own home but need extra care with daily living tasks.

Some of the services include help with:

• Bathing, showering, toileting, taking medications, dressing and transferring in and out of bed or chair
• Respite care for primary caregivers to take a break and time for themselves
• Daily supportive services
• Doing household tasks like housecleaning, laundry and meal preparation
• Rides to nonmedical services such as the grocery store, pharmacy, etc.

To qualify, an individual must:

• Be on ND Medicaid 
• Be age 65 or older or between the ages of 18-64 and have a physical disability based on Social Security Administration guidelines
• Meet the nursing home level of care screening but choose to receive services in the community

Contact the state’s Aging and Disability Resource Link for more information on how to apply for services.  

This waiver is for children or adults with intellectual and/or developmental disabilities who want to remain in their own home, but need extra care with daily living tasks.

It covers services like employment supports, day services, family supports, residential services and more.  

To qualify, an individual must:

• Be a resident of North Dakota;
• Be a US citizen or qualified noncitizen;
• Be eligible for ND Medicaid;
• Meet criteria for developmental disabilities program management; and
• Meet the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IDD) level of care

Contact a North Dakota Health and Human Services regional human service center for more information about the screening.