Medicaid Member Handbook

Health care coverage is important because it can help you and your loved ones live healthier by helping you pay for medical expenses. Your Medicaid coverage gives you access to routine health care, specialist, testing, prescriptions, and more. We want you to live a safe and healthy life and for North Dakota to become the healthiest state in the nation. Medicaid varies from state to state. This handbook explains the North Dakota Medicaid program.

Getting Information About Your New Coverage

Welcome to Medicaid! You will be getting a notice about your new Medicaid coverage with Identification (ID) numbers for each member of your household. You will get your Medicaid ID cards about 4 to 6 weeks after your notice arrives.

Always carry your Medicaid ID card with you because an emergency could happen at any time. You should show your ID card every time you go to an appointment or fill a prescription. 

Self-Service Portal

The Self-Service Portal (SSP) is your online space to apply for assistance, complete a review, update your information, view details about your case, report changes, upload documents, and view notices.  You can:

• Explore the Self-Service Portal website 
• Get Self-Service Portal help on our webpage

ND Medicaid Webpages

Our website shares information and updates about our programs, resources, and more. We offer ways to connect with us to ask a question or apply for help. Throughout this handbook you will find links to webpages for many topics.

• Use our search window to find Medicaid-related information. This window is at the top right of our website. Simply type what you are wanting to find or start with typing, “Medicaid” in our search bar. Our website will suggest pages that are related to your search, helping you find the information you are needing!
• Visit our Medicaid webpage to see Medicaid-related information and links to pages that relate to Medicaid. 
• Visit our Medicaid Member Engagement webpage to explore more about the Medicaid Member Engagement Committee, Medicaid E-Newsletter, and more! 

ND Medicaid Call Centers

Customer Support Center: 

Our Customer Support Center helps our Medicaid members with questions about coverage, getting help from other assistance programs, arranging out-of-state travel, or updating personal information like your phone number or address change. 

• Toll-Free: 1-866-614-6005
• Local: 1-701-328-1000
• TTY: 711
• Email: applyforhelp@nd.gov 
• Mail: Customer Support Center 
  PO Box 5562 
  Bismarck, ND 58506

Provider Relations:

If you have questions about coverage for filling prescriptions for medications or medical supplies, you can contact our Provider Relations department.

• Toll-free: 1-877-328-7098
• Local: 1-701-328-7098
• Email: mmisinfo@nd.gov  

Health Tracks:

If you need help with your child’s Health Tracks checkups, referrals, or to arrange rides to your child’s Health Tracks appointments, you can contact Health Tracks:

• Visit our Health Tracks webpage
• Toll Free: 1-701-328-2014
• TTY: 711

Human Service Zone Offices

North Dakota is divided into 19 human service zones. Human service zones process eligibility for Health and Human Services (HHS) programs. Every zone has an office where you can get help with Medicaid, Child Care Assistance Program (CCAP), Low Income Home Energy Assistance Program (LIHEAP), Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), and more. Most zones support more than one county. 

• Find a human service zone office near you.

Help with Auxiliary Aids and Services

• Text Telephone Devices (TTY or TTD): HHS phone lines offer the TTY feature for people with hearing impairments. TTY users may use relay North Dakota at 711 or 1-800-366-6888. 
• ND Medicaid covers sign and oral language interpreter services to make sure our members who have limited English proficiency or hearing loss can understand their health care services.

Translation Help

Translate this handbook with this button, found at the top, right corner of this website.
If you need translation assistance, you can contact 1-866-614-6005 toll free.

Member Feedback

We want to know if there is information you would like to see added to this handbook or if you have other related concerns. To share your feedback about this handbook:

• Email: medicaidmembers@nd.gov

Why We Will Communicate with You

• It is time to review your coverage. 
• We need to update you about our program changes.
• We are sending you our yearly newsletter.

Changes You Need to Tell Us About

We need to know about any changes for you or the people in your household. Some common changes are:

• You moved to a new address.
• The size of your household has changed. This may happen when someone becomes an adult, moves out, passes away, or is born.
• Someone in your household’s job or income changed.
• You started, changed, or ended another health care insurance.
• Someone in your household has become pregnant.

What Documents We May Need

We may need documents that prove the information about your household is accurate. Examples of this are:

• Income (paystub)
• Assets (checking and/or savings account balances)
• Expenses (latest bills)
• Residency (lease agreement)
• Citizenship (social security number)

Different Ways to Update Us

You can select different ways to communicate with us: 

• Receive messages, upload documents, and upload documents, and enter information in your Self-Service Portal.
• Sign up for text message notifications by selecting this option in your Self-Service Portal. 
• Sign up to receive email notifications in your Self-Service Portal.
• Email and attached your uploaded documents to the Customer Support Center. 
• Send your information, through the mail, to the Customer Support Center address.

When communicating with us, be sure to include your client ID number. This number can be found by calling our Customer Support Center. 

Your health care provider can prevent or treat common illnesses and conditions when you see them regularly. You can call your provider’s office to ask for a yearly exam or to visit about a specific health concern. 

Adult Wellness

Adults need to see their primary care provider yearly to make sure they are healthy. This exam is meant to check your overall wellness, lifestyle, or specific health concerns. During your yearly wellness visit, your provider may take your height, weight, temperature, and blood pressure. Depending on your age or gender, your provider may suggest certain screenings or tests. 

Your provider may talk to you about screenings for chronic health conditions, such as diabetes, and cancer, care for chronic conditions, or visit with you about your diet, reproductive health, mental health, or lifestyle practices. 

Seeing your health care provider isn’t the only yearly exam you need. You should also visit your dental and eye care providers. 

This section covers some common ways your provider may examine your health.  

Behavioral Health Care

Your mental health is just as important as your physical health for well-being. Your primary care provider can visit with you about your lifestyle and mental health at your yearly wellness visit, or at a separate appointment. You can also visit your local human service center for behavioral health concerns. You can learn more about behavioral health care benefits in the Behavioral Health Care and Substance Use Disorder section of this handbook.

Screenings

Preventive services detect health concerns early. Medicaid covers many preventive services. Some of these are:

Breast and Cervical Cancer Screenings

Medicaid pays for breast and cervical cancer screenings. Screenings save lives and early detection is your best protection. A mammogram is the best way to find breast cancer in its earliest most treatable stage. A Pap test and HPV test are the best ways to find cervical cancer early so that it can be treated successfully.

Medicaid’s Breast or Cervical Cancer Early Detection program covers treatment for breast cancer, cervical cancer, or pre-cancer. This program also serves those who were enrolled in Women’s Way when they were diagnosed with and needing treatment for breast cancer, cervical cancer, or a pre-cancerous condition related to breast or cervical cancer. 

To learn more about Medicaid’s Breast or Cervical Cancer Early Detection Program contact:

• Customer Support Call Center 
• Visit our Human Service Zone office webpage to find your local office and talk to an eligibility worker

Colorectal Cancer Screenings

Colorectal cancer is one of the most commonly diagnosed cancers. It affects both men and women. Recent trends show rates rising in younger people. Screenings find cancer, and in some instances, can even prevent it. Your outcomes can be greatly improved by finding colorectal cancer in its early stage. People of average risk should start screening at age 45 and continue through age 75. People of increased risk should be screened sooner and/or more often. You may be at increased risk if you have a family history of colorectal cancer, polyps, or have certain medical conditions like ulcerative colitis. There are different test options. Some tests can be done at home. Ask your primary provider how to make an appointment for your screening.

Lung Cancer Screenings

In North Dakota, lung cancer is the most diagnosed cancer that affects both men and women. Lung cancer has the highest rate of late-stage diagnosis and has the highest mortality rate. Lung cancer screenings are recommended for older adults who are current or previous longtime smokers who do not have any signs or symptoms of lung cancer. Doctors use a low-dose CT (LDCT) scan of the lungs to look for lung cancer. If lung cancer is detected at an early stage, it's more likely to be cured with treatment. Ask your primary care provider if you should be screened. Below are resources for understanding more about lung cancer screenings. 

You can learn more about getting help to quit smoking in the Tobacco Cessation section found in the Medicaid Programs section of this handbook.

Immunizations

Immunizations aren’t just for children. There are several routine vaccines you may need as an adult. Adults need to keep their immunizations up to date because the immunity you built up from childhood vaccines can wear off over time. You are also at risk for different diseases as an adult. Immunizations are one of the most convenient and safe preventive care measures available. You may need other immunizations based on your age, health conditions, job, lifestyle, or travel habits. Your provider can help you understand which immunizations are right for you. 

Child Wellness

Children go through many changes as they develop so they need to see their health care provider more frequently than adults. Health Tracks can help you make sure your child’s mental and physical health care is on track.

Health Tracks

Health Tracks is a Medicaid benefit that covers your child’s checkups, vaccines, screenings for health concerns, referrals for further care, and other preventive health care. These checkups happen from the time they are born through age 20. Health Tracks can even help arrange rides to your child’s Health Tracks appointments. Medicaid members do not need to apply for Health Tracks separately from Medicaid.  You can learn more about Health Tracks: 

• Visit our Health Tracks webpage
• Toll Free: 1-701-328-2014
• TTY: 711

Well-Child Check Ups

Children should get a well-child checkup at regular times, even when they are feeling well. Your child’s checkup may offer:
 

• Dental screening including fluoride varnish 
• Developmental and behavioral screening
• Growth and development checks
• Health education for parents and teens
• Hearing screening
• Hearing aids
• Immunizations
• Labs
• Nutrition counseling 
• Other health services 
• Physical exam
• Substance use education and more
• Vision screening

Babies grow fast and need a lot of well-child checkups. They need checkups when they are ages:

• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months

Your toddler should have a well-child check when they are ages:

• 15 months
• 18 months
• 24 months
• 30 months

Your child should have a well-child checkup every year from age 3 until they are age 21. Added checkups are also covered based upon a child’s needs.

Dental

Your child may be able to get orthodontic care. Orthodontia treats more serious dental conditions such as teeth and jaw alignment. Schedule an appointment with your child’s dentist if you feel that your child may need to see an orthodontist. Your child may be screened to see if they are able to have covered orthodontia services. These services could include

• Orthodontic exams 
• Braces

Dental Care

Regular dental care is also important for your well-being. By addressing dental issues early, dentists can help you maintain good oral hygiene, reduce the risk of tooth decay and gum disease, and other dental problems. You can learn more about preventive dental care in the Dental section of this handbook.

Vision Care

Getting your yearly visit with an eye care provider can help you correct your vision, address concerns you have for your eyes, or maintain good vision. You can learn more about preventive vision care in the Vision chapter of this handbook.

How to Choose a Primary Care Provider

Staying healthy is more than just going to the doctor when you’re sick. Your primary care provider helps you stay healthy by overseeing routine health care and offering preventive services. Regular preventive services help you know if you are developing a serious illness, giving you the best chance for a healthy life. Tips for choosing your primary care provider are:

• Pick someone who makes you feel comfortable: You may want to go to a provider who knows your health history. Your provider should be able to communicate with you in a way you understand. You should feel that your provider understands your health concerns. Decide if you want one primary care provider for your whole family or a different provider for each family member.
• Ask about special needs: If you or someone in your house has special health care needs, ask if the provider can meet your needs.
• Choose a location close to home, school, or work: Make sure that you can easily get to your provider’s office.  
• Make sure your provider accepts ND Medicaid: The provider you choose must be enrolled as a ND Medicaid provider.  
• Ask if your provider is accepting new Medicaid patients.
• Make your first appointment: After you choose your primary care provider, call their office to schedule a preventive visit. 

Talking to Your Doctor

Your primary provider can help you navigate your health care. Clear and honest talks with your provider can help you both make informed choices about your health care. It’s important to be honest and upfront about your symptoms even if you feel embarrassed or shy. Have an open dialogue with your provider— ask questions to make sure you understand your diagnosis, treatment, and recovery. Here are a few tips to make the most of your appointment:

• Write down a list of questions and concerns before your appointment.
• Consider bringing a close friend or family member with you.
• Take notes about what the provider says or ask a friend or family member to take notes for you.
• Learn how to access your medical records, so you can keep track of test results, diagnoses, treatments plans, and medications and prepare for your next appointment.
• Ask for the provider’s contact information and how you should ask for additional information or help.
• Remember that nurses and pharmacists are also good sources of information.

Finding Your Primary Care Provider

We can help you find a primary care provider. To find a primary care provider:

• See our list of Provider Directory
  •  Once you have chosen a provider, make sure to call their office and ask if they are:
    • Accepting new patients
    • Accepting Medicaid
• Contact Medical Services 

Patient Expectations

• Appointment Scheduling: When you have a scheduled appointment but feel that you cannot make it, call your provider, and cancel or reschedule the appointment as soon as you know you cannot go.
• Pre-planning health care: Make appointments further out for health care you know will be needed, such as immunizations or your yearly wellness check and sports physical.

Seeing a Specialist

When your primary care provider cannot offer the care you need, they may send you to a Medicaid enrolled specialist. Your primary care provider will still oversee your routine health care needs. 

Getting a Referral to a Specialist

You may need a referral to see a specialist. A referral is an order from your primary care provider saying you are needing medical treatment in a specialized area of health care. Some specialists may still need a referral from your primary provider. Your primary provider will still oversee your routine health care needs.

Finding a Specialist

Provider List coming soon.

COVERED SERVICES

ND Medicaid covers preventive, emergency, and specialty care for your mental and physical health. All covered services must be medically necessary for ND Medicaid to cover the cost of services. Medically necessary means that you truly need to have the service. Your provider can help guide you in understanding if the medical care you want would be medically necessary for you.

Your provider can help you know whether ND Medicaid covers a service. 

Generally, ND Medicaid covers medical services, that are:

• Provided by an ND Medicaid enrolled provider
• Medically necessary
• A ND Medicaid covered service

Some services have:

• Limits, and/or
• Authorizations or referrals needed before receiving a service

If you are unsure whether a service is covered, ask your provider before you receive the service. Your provider should be able to help you.

NONCOVERED SERVICES

ND Medicaid does not cover all health care services. ND Medicaid will not cover your medical care if you are getting:

• Services, drugs, or supplies that are meant for cometic purposes or do not directly relate to your health care
• Drugs that are not FDA approved
• Care more than 50 miles outside of North Dakota without being approved by ND Medicaid
• Care from a provider who is not enrolled in ND Medicaid
• Services and hospital stays that are not medically necessary 
• Not a ND Medicaid covered service

You may be responsible for your medical costs if you get medical care that is not covered by ND Medicaid.

ENROLLED PROVIDERS

Your medical costs may be covered when they are billed by providers who are enrolled in ND Medicaid. This means that the provider has a contract with the ND Medicaid program. Your medical costs may not be covered if you see a provider who is not enrolled in ND Medicaid. Sometimes you may need to see a provider who is out-of-state. These providers will need to enroll with ND Medicaid to cover your medical costs. 

You can learn more about seeing a provider outside of North Dakota in the Out of State Services chapter of this handbook.

Understanding Behavioral Health Care

Behavioral health services help you with mental health and substance use disorders (SUD). Mental health services may include treatment for anxiety, depression, or behavior problems. Substance use disorders involve alcohol or drug misuse. Some people have what’s called co-occurring (meaning having both) mental health and substance use disorders. 

Providers who may work with you include social workers, counselors, therapists, doctors, psychologists, psychiatrists, and technicians. Mental health and SUD treatment is available for members of all ages. Some treatments need a referral or an authorization. 

ND Medicaid covers a wide range of supportive mental health and substance use disorder treatments, medications, and services. We cover individual, family, and group counseling and psychotherapy. Your treatment may occur in an outpatient, inpatient, or residential treatment setting. We also cover services like behavioral and crisis interventions and home and community-based services (HCBS) to support members living successfully in their communities.

Specialized Behavioral Health Services

Specialized behavioral health services offer diagnostic testing, psychological testing, psychotherapy, partial hospitalization, and more. You can learn about some of these services available to you below.

Applied Behavioral Analysis

Youth with autism may qualify for Applied Behavior Analysis (ABA) services. ABA services are a form of behavioral therapy. The goal of ABA services is to assist with the youth’s independence and successful home and community living. It uses positive reinforcement to teach and promote the following skills: social, communication, learning and academic, and self-care.  ABA services include a comprehensive assessment, care plan development, referral, monitoring, and follow-up, as well as skills training for youth and their families. 
Youth with autism may qualify for services through the Autism Spectrum Disorder Waiver. You can learn more about the Autism Waiver in the Medicaid Waivers chapter of this handbook.

Behavioral Health Rehabilitative Services

Behavioral health rehabilitative services are short-term services meant to reduce, change, or eliminate undesirable behaviors and introduce new skills to develop positive behaviors. Services are for members of all ages needing mental health help or behavioral interventions who are:

• At risk of entering or reentering a mental health facility or hospital with a qualifying World Health Organization Disability Assessment Schedule (WHODAS 2.0) score of 25 or higher or a Daily Living Activities (DLA-20) score of 5 or less; and/or
• In need of substance use disorder treatment services; and/or
• Diagnosed with a mental health disorder and: 
  • From a household that is in crisis and at risk of major dysfunction that could lead to disruption of the current family makeup; and/or
  • In a family that has experienced dysfunction that caused disruption of the family.

These services help restore you to your best functional level with interventions, assessments, screenings, skills training, and individual or group counseling. Referrals are needed for these services.

Substance Use Disorder Services

Substance Use Disorder (SUD) services support your recovery from the use of alcohol, harmful substances, illegal drugs, or misuse of prescriptions. A team of professionals work together with you to stabilize your health. 

Your SUD treatment will start with an assessment and a plan for treatment will be developed. Your treatment plan may include counseling, individual or group therapy, interventions, and more. Medicaid covers treatment for youth and adults including non-intensive and intensive outpatient services, partial hospitalization services, clinically managed low and high-intensity residential care, clinically managed residential withdrawal, and medically monitored intensive inpatient services.

SUD treatment offers a wide range of services. Medicaid covers many SUD services. You can find out more about your SUD coverage in our Substance Use Disorder Treatment Services Policy.

We also cover Medication for Opioid Use Disorder (MOUD). MOUD is a treatment that uses medication to treat opioid use disorders. MOUD treatment is offered through Opioid Treatment Programs and office-based Opioid Treatments. These services are for members with diagnosed moderate or severe opioid use disorder who are determined eligible for and agree to MOUD treatment. 

Targeted Case Management

Targeted Case Management is available for adults with serious mental illness (SMI) and youth with serious emotional disturbance (SED), A case manager will help you access medical, social, educational, and other services for your care and treatment.
An adult is considered to have SMI if they have: 

• A diagnosed mental disorder expected to last a year or longer; and
• A moderate level of functional limitation; and
• One of the following:
  • Psychiatric treatment that was more intensive than outpatient services. These services must have occurred more than once and was related to their mental illness; or
  • A history of documented problems resulting from mental illness for at least one year. The documented problems must be verified by family or a local health care provider; or
  • Had a single episode of continuous structured supportive residential care. This does not include hospitalization. The episode must have lasted for at least two months.

A child is considered to have SED if they are younger than 21 years old and have: 

• A diagnosed mental disorder expected to last a year or longer; and
• A moderate level of difficulty functioning in school, at home, and/or in community activities. This is measured by a WHODAS 2.0 score of 25 or higher or a DLA-20 score of 5 or less; and
• One of the following:
  • A psychiatric crisis or emergency that needed emergency intervention to prevent institutional placement; or
  • Need for long-term mental health services.

Temporary or expected functional limitations caused by stressful events in the member’s environment does not make them eligible for targeted case management.

1915(i) Behavioral Health Supports and Services

1915(i) behavioral health supports and services are non-traditional Medicaid services to support qualifying people of all ages with certain behavioral health conditions to live successfully in their homes and communities. Some 1915(i) services are Home and Community Based Services (HCBS) such as peer support, non-medical transportation, housing support, supported education and employment, and more.

Every member receiving 1915(i) services and supports will have a care coordinator. Their care coordinator will work with them to develop a person-centered plan of care. They will work together to choose service providers for needed services. 

Members must complete a separate application for the 1915(i) program and meet eligibility criteria. 

You can find a full list of covered 1915(i) services:

• Visit our Accessing 1915(i) Services webpage  

You can apply for 1915(i) services by completing an application. You will need to be assessed by a provider to see if you qualify for these services. 

• Application for 1915(i) Services 

Coverage Limits

Generally, North Dakota Medicaid cannot pay for residential or in-patient care at residential mental health or SUD treatment facilities with more than 16 beds. Out-patient care may be covered at these facilities. This is called an Institutions for Mental Disease (IMD) exclusion and is a federal Medicaid rule. You can find a list of IMDs in North Dakota here.

Where to Get Treatment

You can make an appointment with your primary provider to talk about your mental health or use of substances. You can also talk to your provider about these concerns at your annual wellness visit. Your primary provider can help you plan for treatment and next steps.

Your behavioral health provider may offer telehealth appointments. You can learn more about this in the Telehealth chapter of this handbook.

You can see the Coverage 2 Care (C2C) Road Map to Behavioral Health to better understand behavioral health care.

The following sections offer more ways to find help.

Mental Health

• View the North Dakota Mental Health Program Directory to find programs and services for counseling and treatment, early intervention, recovery support, and other resources.

Substance Use Disorder

• Visit the Find Treatment Website to enter your zip code or city and state for a list of treatment facilities near you and access nation helplines. 

1915(i) Behavioral Health Services and Supports

If you have questions about 1915(i) services, please reach out to a 1915(i) Navigator.

• Call: 701-328-4850
• TTY: 711
• nd1915i@nd.gov

Crisis Services

Contact 988 by call, text, or online chat. 988 is always available if you are having thoughts of suicide, a mental health or SUD crisis, or are in emotional distress.
You can call or visit your local human service center and ask to be seen for your concern. Human service centers have Open Access clinic hours where you can be seen as a walk-in, without making an appointment. 

• Visit our website to find a local human service center.
• Visit the Find Treatment Website to enter your zip code or city and state for a list of treatment facilities near you and access nation helplines. 

Chiropractic care is to adjust your spine and neck to help relieve pain and support your body’s alignment. Your chiropractic services must be medically needed. Some services you can get are:

• New patient exam with your chiropractor
• Up to 20 spinal manipulations per year (manual, with or without use of activator or similar instruments)
• Up to 2 x-rays per year

If your chiropractor feels that you need further care beyond the listed services above, they will need to get Medicaid’s approval. 

You can visit with your primary care provider to decide if you need chiropractic services and to find a chiropractor.

Medicaid helps cover dental care for children and adults. Healthy teeth and gums have a big impact on your health. Some medical conditions and medications can put you at risk for oral health problems like gum disease.

You can take care of your oral health by seeing your dentist for regular cleanings and exams. Coverage starts over for each person every January 1st. 

Dental coverage includes the following services. These services may have limits or requirements based on your age and/or dental situation:

• 2 exams and cleanings per year
• Crowns (with prior authorization)
• Dentures or Partial Dentures (with prior authorization)
• Fillings and tooth removals
• Fluoride varnish (kids only)
• Night guards/TMJ splints Oral Surgery, anesthesia, and follow-up visit 
• Root canal treatment (front teeth only for adults)
• X-rays

Adults should see their dentist for a routine annual exam, two yearly cleanings, and application of fluoride. 

Members who have mental, physical and/or behavioral health care needs may have dental case management services. These services are designed for members who cannot schedule or coordinate complex treatment plans on their own.

Children, ages 0-20, are still growing and need more dental services. Children should see their dentist twice per year for a routine exam, cleaning, and fluoride varnish. Children should also have sealants applied to their adult molars. Sealants help protect your child’s adult teeth as they start to come in.  Your child can get these treatments at their dentist.

Fluoride varnish can help protect your child’s teeth from cavities. Your child can get a fluoride varnish at participating local public health units and participating providers during their ND Medicaid Health Tracks well-child check. 

As your child’s adult teeth come in, their dentist may perform an orthodontic screening for braces. If your child meets the requirements, they could receive orthodontia services such as braces! Your child can get orthodontia care with a referral through our Health Tracks benefit. They will need two orthodontia screenings, one from your dentist or public health unit, and one from an orthodontist. You can learn more about Health Tracks in the Understanding Your Routine Health Care section of this handbook.

Your dental provider can help you understand the dental services that are covered, if they have limits, or need a prior authorization or referral. 

WHERE YOU CAN GET DENTAL CARE

Dentist Office

You can visit a dentist’s office to get basic oral care. You may be referred to an orthodontist or oral surgeon for other services beyond basic oral care. To make a dental appointment, call the dentist’s office, ask if they accept Medicaid, and if they are taking new Medicaid patients. 

Federally Qualified Health Centers (FQHC) and Rural Health Clinics

Your local FQHC or rural health clinic may offer some dental services in-office or by tele-dentistry. You can contact your local center or clinic to learn more. 

School Setting

Children may be able to get sealants and fluoride varnish application at their school! Find out if your child’s school participates in the SEAL!ND program:

• Ask your child’s school
• Contact HHS Oral Health Prevention Coordinator
  • Call: 701-328-4515
  • Email: tlhruby@nd.gov 

You can learn more about the School-Based Fluoride Varnish & Sealant Program on the SEAL!ND webpage.

Tele-Dentistry

Tele-dentistry helps you connect, virtually, with your dentist at a distance. Your dentist may meet with you over a video. They may review your imaging, photographs, or impressions through electronic communication. You can learn more about different telehealth options in our Telehealth section of this handbook.

Find a Dentist

To find a dentist in your area:

• Visit www.insurekidsnow.gov, or
• Visit Low-Cost Dental Care (smilenorthdakota.org, or
• Contact our Customer Support Center

Durable Medical Equipment (DME) are supplies, equipment, or prosthetics needed to perform daily living activities because of a medical condition, injury or illness. 

You may need DME if you notice changes in your strength, balance, or ability to complete daily activities like walking, bathing, or toileting. These changes could happen because of a change in your age, health, or abilities. 

DME includes:

• Mobility equipment and lifts
• Devices to help with breathing
• Diabetes devices and supplies
• Bathing and toileting aids
• Ostomy supplies 
• Hearing devices
• Incontinence and urinary products
• First aid and wound care supplies
• Prosthetics and orthotics
• Enteral nutrition products

How to Get DME

You should ask your health care provider if DME could help you. You can do this at your next scheduled appointment. You can also make an appointment to talk to your provider if you notice changes to your health or daily abilities. If you are seen in an urgent care or emergency room, these providers can also order DME for you if needed. 

A DME provider is a medical supply store or pharmacy that carries medical supplies and equipment and is enrolled in ND Medicaid. You have the right to choose which enrolled DME provider to use. DME providers can help you understand which DME are covered and if you meet coverage criteria. You may have more than one DME provider depending on what supplies/equipment your health care provider orders. You can contact your DME provider if you have questions about how to use your DME. 

Other Ways to Get DME and Assistive Devices

Waiver programs can help cover DME that is not normally covered by ND Medicaid. Let your DME provider know if you are covered by a waiver program. You can find out more about ND Medicaid waiver programs in our Medicaid Waivers chapter of this handbook.

The Life Skills and Transition Center has specialists and professionals who build and make changes to DME. They can come to you and do a personal assessment. They will make sure your DME fits and works well for you. They also loan gently used DME at no cost. You can contact the Life Skills and Transition Center for more information:

• Call: 1-701-352-4545
• Visit the Life Skills and Transition Center webpage 
• Adaptive Equipment Services
• Life Skills Transition Center
  816 W. Midway Dr.
  Grafton, ND 58237

The Health Equipment Recycling Organization (HERO) collects and sells donated DME to those in need at a lower cost. HERO offers items for mobility, bathroom safety, wound care, and personal hygiene, and more. You can contact HERO for more information:

• Call: 1-701-212-1921
• Visit the Healthcare Equipment Recycling Organization website
• HERO Fargo
  5012 53rd St. S, Ste. C
  Fargo, ND 58104

North Dakota Association for the Disabled, Inc. may be able to offer funding to help you buy DME. Their Healthcare Equipment Loan Program (HELP) provides free equipment loans for up to 90 days. They also loan special vans and ramps for people who use wheelchairs full-time. You can contact the North Dakota Association for the Disabled, Inc. for more information:

• Call: 1-800-532-6323
• Visit the North Dakota Association for the Disabled website 

Vocational Rehabilitation assists individuals with disabilities to improve their employment opportunities. Vocational Rehabilitation may be able to help cover the DME you need for work. You can contact Vocation Rehabilitation for more information:

• Call: (701) 328-8950
• Toll-Free: (800) 755-2745
• TTY: 711
• Visit the Vocational Rehabilitation Program webpage 

ND Assistive is different from DME providers or lenders. ND Assistive lends out adaptive equipment, assistive technology, and modification devices. Some devices they lend out are computer hardware and software, device mounts, alarms and alert systems, mobility equipment, communication devices, smart home devices, and low vision or hearing devices. ND Medicaid may be able to pay for in-home assessments for members with developmental disabilities or home and community-based services waivers. ND Assistive may be able to help you pay for DME through their grant program and financial loan program. You can contact ND Assistive for more information:

• Call: 1-800-895-4728
• Visit the ND Assistive website

Donating DME

Did you know that you can donate DME that is no longer being used? You can give someone the chance to improve their daily life with DME they may not be able to afford. This includes members and families who access Medicaid waivered services. 

Contact any of these places to donate:

• Healthcare Equipment Recycling Organization (HERO):
  • Call: 1-701-212-1921
  • Visit the Healthcare Equipment Recycling Organization website
  • HERO Fargo
    5012 53rd St. S, Ste. C
    Fargo, ND 58104
• North Dakota Association for the Disabled, Inc.:
  • Call: 1-800-532-6323
  • Visit the North Dakota Association for the Disabled website 

Members should not donate items that they need. Members should not donate items with the intent of being given new or updated equipment in return. 

If you have more questions about Medicaid coverage for your DME or want to know about more covered DME, you can contact:

• Your provider
• Provider Relations Call Center
• DME Administrator
  • 701-328-2764 
  • TTY: 771
• Email: tamholm@nd.gov
• View our DME webpage

Coverage for Emergency Services

A medical emergency is an event that could result in harm or danger for your health. If you are pregnant this includes your health and the health of your unborn child. During an emergency you should go to the nearest hospital or call 911. An ambulance can bring you to the hospital and care for you during your ride. Medicaid helps pay for these costs. Medicaid only covers ambulance services for medical emergencies. If you use an ambulance for a non-emergency, you will need to pay for the ambulance charges. You should find other ways to get to the hospital or emergency room if you feel like you need to be seen but are not having an emergency.

Urgent care services are for an illness or injury that is not life threatening but needs to be treated right away. Urgent care clinics (or walk-in clinics) can see you the same day. They can be used outside of normal office hours or when your regular provider cannot offer a timely appointment.

After care is the care that your provider may give you after you have had a medical emergency. Your emergency room providers will help you to know when you should get after care. 

Getting Help in an Emergency

If you are having an emergency: 

• Call: 911
• Call or Text: 988 (Suicide and Crisis Lifeline) if you are having a behavioral health emergency
• Go to your nearest hospital emergency room 
   

Medicaid pays for Non-Emergency Medical Transportation (NEMT) for any covered medical service for members who need help getting to their appointments. NEMT may use public transport, taxis, personal vehicle transport, non-emergency ambulances, air transport, and transportation network companies.

To get more help with a ride, call the Customer Support Center.

• Toll-Free: 1-866-614-6005
• Local: 1-701-328-1000
• TTY: 711
• Email: applyforhelp@nd.gov 
• Mail: PO Box 5562, Bismarck, ND 58506
• Fax: 1-701-382-1006

Getting Serices in Another State

Sometimes you need to see a provider that is not in North Dakota. Your current provider may send you to a provider in another state. Medicaid can help with these costs. Before you get services outside of North Dakota, Medicaid needs to approve your medical services to pay for them. Your provider will help you get your out-of-state services approved. 

Planning Your Travel

You may need help planning your travel for out-of-state services. Once your human service zone worker gets your out-of-state approval and they authorize your services, they can help you plan your travel, including help finding a ride, meals, or lodging.

• Contact your Human Service Zone Eligibility Worker
• Customer Support Center contact information:
  • Toll-Free: 1-866-614-6005
  • Local: 1-701-328-1000
  • TTY: 711
  • Email: applyforhelp@nd.gov 
  • Mail: PO Box 5562, Bismarck, ND 58506
  • Fax: 1-701-382-1006

Telehealth uses technology so patients can be seen by their provider without going into the office. Telehealth may be covered when it is offered by providers who are enrolled with ND Medicaid.
 

Telehealth can be used for services including:

• Psychotherapy
• Vision
• Speech & Hearing
• Neuropsychology
• Physical & Occupational Therapy
• Diabetes Management
• 1915(i) Services
• Behavioral Services
• Dental

Call your provider and ask if you can use telehealth for your appointment. They will tell you how to use telehealth with the provider. 

More information coming soon!

Visit our webpage for Tribal Health and Indian Health Services 

Medicaid helps pay for vision care so you can keep your eyes healthy, check your vision, and correct your vision when needed. 

North Dakota Medicaid offers additional programs that are listed below:

Breast and Cervical Cancer Screening Program

Medicaid pays for breast and cervical cancer screenings. Medicaid also pays for tools and tests that a provider uses to know if a patient has cancer. Medicaid covers women who don't have insurance and need medical care for breast cancer, cervical cancer, or pre-cancer.
To learn more about Medicaid Breast and Cervical Cancer Early Detection Program contact:

• Customer Support Center contact information:
  • Toll-Free: 1-866-614-6005
  • Local: 1-701-328-1000
  • TTY: 711
  • Email: applyforhelp@nd.gov 
  • Mail: PO Box 5562, Bismarck, ND 58506
  • Fax: 1-701-382-1006
• Visit our Human Service Zone office webpage to locate your local office and talk to an Eligibility Worker

To learn more about our Women’s Way program:

• Visit our Women’s Way webpage

Children's Health Insurance Plan (CHIP)

This is a Medicaid plan that can cover health care for a child that does not qualify for Medicaid.

You can contact us for more questions about CHIP:

• Visit our Children's Health Insurance Program webpage 
• Customer Support Center contact information:
  • Toll-Free: 1-866-614-6005
  • Local: 1-701-328-1000
  • TTY: 711
  • Email: applyforhelp@nd.gov 
  • Mail: PO Box 5562, Bismarck, ND 58506
  • Fax: 1-701-382-1006
• Visit our Human Service Zone office webpage to locate your local office and talk to an Eligibility Worker
• Email: medicaidcc@nd.gov

Colorectal Cancer Screenings

Colorectal screenings regularly check on the health of your colon and rectum. These screenings are important because cancer can develop in these areas of the body. This cancer may grow without you knowing it. When this happens, your provider may not know you have this cancer until it has grown into a later stage. Finding this form of cancer earlier offers you a better chance of surviving and tolerating the treatment.  
People who are ages 45-64 should get regular colorectal screenings regularly.

You can ask your primary provider how often you should be screened and how to make an appointment for your screening.

Visit our Colorectal Cancer Screening program webpage to find out more
 

Tobacco Cessation

North Dakota’s Medicaid program covers medication and counseling to help you quit using tobacco. Medicaid members do not need a prior authorization from their provider to get medication or counseling. 

North Dakota offers NDQuits to help North Dakotan’s quit smoking. This program also helps you quit using smokeless tobacco products like vapes or electronic cigarettes. You can begin a free program that helps you quit your way With NDQuits.

Find out more or sign-up:

• Toll-Free: 1-800-784-8669
• Email: ndquits@nd.gov
• Visiting our website: NDQuits

Medicare Savings Programs

These programs assist with Medicare costs for members who have low income and assets.

• Medicaid Saving Programs pay for:
  • Medicare Part B monthly cost and yearly cost
  • Medicare co-insurance costs (20% of costs for services that Medicare allows
  • Monthly Medicare part A monthly cost (if not free)
• Income and Assets
  • Monthly income is:
    • Wages
    • Social Security
    • Pensions 
    • Veteran’s benefits
    • Other sources
  • Monthly income must be less than the current income eligibility level. Only a portion of your wage is counted. Some assets are not counted. Your savings and other assets must be less than the Medicare Part D Low Income Subsidy asset levels for the year you apply. Income levels change yearly. Contact the Medicaid Eligibility Call Center for the current levels.
• Eligibility
  • These plans are for people who have Medicare Part A and Premium-Part A
  • If you are eligible for one of the Medicare Savings Programs you are automatically able to get extra help with Medicare Part D Drug Plans

We get many questions about Medicaid. You can see some of our most frequently asked questions (FAQ) to see if you can find an answer!

Health Information Privacy Rights

By law, Medicaid must keep your PHI private. Medicaid gets PHI from you when:

• You apply for Medicaid
• When your health care providers send PHI to Medicaid to request approval and payment for your health care. 

Protected Health Information (PHI) is:

• Any information that could be used to identify you like your:
  • Name
  • Address
  • Birth date
  • Phone number
  • Social Security number
  • Medicare or Medicaid number
  • Health information
  • Diagnosis
  • Treatments you have had
• Information that is created or received by Medicaid that relates to your:
  • Past, present, or future physical or mental health condition
  • Health care services given to you
  • Payment for health care services
• Information about your health insurance policies

The law makes Medicaid give you it’s Notice of Privacy Practices (NPP). The NPP describes Medicaid’s legal duties and privacy practices about your PHI. The NPP is shared in our facilities, on our website at: Notice of HIPAA Privacy Practices, and upon request. To request a copy of the NPP, please contact the Privacy Officer:

• Toll-Free 1-800-472-2622
• TTY: 1-800-366-6888
• Mail: Privacy Officer, North Dakota Department of Human Services, State Capitol, 600 East Boulevard Ave. Dept. 325, Bismarck, ND 58505-0250
   

Economic Assistance helps lower income North Dakotans when they are struggling to live safe and healthy lives. We can connect you to resources that can help meet your basic needs. There are several programs that assist in different ways.

Child Care Assistance Program (CCAP)

The CCAP helps pay for a portion of your childcare. This help is for low-income families who are working or in training or education programs. 

Supplemental Nutrition Assistance Program (SNAP)

SNAP offers help to buy food for lower income families so they can have a healthy diet and move toward self-sufficiency. 

Low Income Home Energy Assistance Program (LIHEAP)

LIHEAP assists households with the cost of heating, cooling, winterizing, emergency fuel assistance and more. 

Temporary Assistance for Needy Families (TANF) Program

TANF helps low-income families move from needing public assistance to being self-sufficient. TANF offers cash assistance, work readiness, training, and job placement services.

You may have already applied for these programs when you filled out your application for Medicaid. If you did not apply, are unsure if you applied, or would like to apply for any of these programs now:

• Visit our Apply for Help webpage
• Customer Support Center contact information:
  • Toll-Free: 1-866-614-6005
  • Local: 1-701-328-1000
  • TTY: 711
  • Email: applyforhelp@nd.gov 
  • Mail: PO Box 5562, Bismarck, ND 58506
  • Fax: 1-701-382-1006