Eligibility

Medicaid provides coverage to qualifying individuals in the following groups:

• Individuals with income within limits
• Children in foster care or subsidized adoption
• Former foster care children up to age 26, under certain circumstances
• Children with disabilities (birth to 19)
• Pregnant women
• Individuals with breast or cervical cancer
• Workers with disabilities
• Other blind and disabled individuals
• Low-income Medicare beneficiaries (Medicare Savings Programs)

Most children under age 19 become continuously eligible for Medicaid. That is, once they are determined eligible, they stay eligible for up to 12 months without regard to changes in circumstances. Similarly, most pregnant women who become eligible remain eligible through their pregnancy and for 12 months after the pregnancy ends.

Medicaid coverage may begin up to 3 calendar months prior to the month of application.

The following is a general outline of Medicaid Program eligibility requirements.

State Residence

You must be a North Dakota resident to qualify for Medicaid in North Dakota.

Citizenship

You must be a United States citizen or an alien who is lawfully admitted for permanent residence. Some lawfully admitted aliens who were admitted to the United States after August 22, 1996, may have to wait for five years before full Medicaid benefits are available. After five years, aliens who are lawfully admitted, and who are credited with 40 qualifying quarters of social security coverage, may be eligible for Medicaid.

Note: Qualifying quarters for any quarter in which TANF, SNAP, Medicaid, or SSI benefits were received are not counted.

There is no waiting period for coverage of emergency services.

There is no asset limit for children, families, or pregnant women in the Children and Families coverage group, the Adult Expansion Group (individuals between the ages of 19 and 65), or the Breast and Cervical Cancer Early Detection group.

Generally, a person who is blind, disabled, or age 65 or older can have up to $3,000 in countable assets (such as savings accounts, checking accounts, stocks, bonds, or other types of assets) to qualify for Medicaid. The limit for couples is $6,000. For each additional person in the household, $25 can be added to the asset limits.

Individuals who qualify for the Workers with Disabilities coverage are allowed an additional $10,000.

Those requesting eligibility under the Medicare Savings Program has an asset limit of $9,430 for a one-person household or $14,130 for a two-person household.

Spousal Impoverishment Prevention Coverage

This coverage applies to couples where one needs Nursing Care Services in a facility or at home.

The spouse receiving the nursing care services is allowed $3,000. The spouse who remains in the community is entitled to keep half of the couple's countable assets, but not less than $30,828 and not more than $154,140 for the calendar year 2024.

The spouse receiving the nursing care services may keep up to $100 of their monthly income and may deem income to bring the income of the spouse in the community up to $2,550 per month and any dependent household members up to $822.

Assets That are Not Counted

• Your home
• One automobile
• Irrevocable Burial Plans
• Self-employment property (including tools, equipment and livestock)
• Non-saleable property, personal effects and clothing, household goods, and furniture
• Indian trust and restricted lands and per capita and judgment funds.
• Other miscellaneous assets

Income

Depending on the amount of net income, individuals may be eligible for full Medicaid benefits or may be responsible for a portion of their medical bills which is called Client Share (Recipient Liability).

Those who qualify under the new Adult Expansion group, families with children, and pregnant women are subject to MAGI (Modified Adjusted Gross Income) rules. MAGI rules differ from traditional Medicaid in that household size is based on tax filing status, and treatment of income is based on Modified Adjusted Gross Income.

The following expenses are allowed for those aged and disabled individuals subject to non-MAGI rules:

• Taxes and other work-related expenses
• Health insurance premiums
• Dependent care expenses
• Child support paid to a non-household member
• Other deductions may apply

Individuals in a nursing home are allowed to keep $100 of their monthly income to meet their personal needs. They also keep enough to cover their health insurance premiums and certain other expenses. If the individual has a family at home with a lower income, the individual can give some of his/her money to the family at home.

Individuals residing in an Intermediate Care Facility are allowed $135 to meet their personal needs. They also keep enough to cover their health insurance premiums and certain other expenses.