Medicaid Frequently Asked Questions

Anyone can ask for help from our programs. People who can get help usually live in North Dakota. Medicaid can help people who do not make enough money to pay for health care coverage.

A formula is used to see if you qualify for Medicaid. Medicaid also helps people who do make enough money to pay for health care coverage, but have other costly factors in their lives. Find out more about getting help.

North Dakota Health and Human Services has a wide range of programs and services. You can go to the Financial Help webpage to find other programs that may be able to help with your financial needs.

• Help paying for health care
• Basic care facility coverage
• Help paying for child care
• SNAP (Supplemental Nutrition Assistance Program)
• TANF (Temporary Assistance for Needy Families)
• LIHEAP (Low Income Home Energy Assistance Program)
• Help with Medicare premiums
• Help with health care costs due to being aged or having a disability

You can fill out the Application for Health Care if:

• You are pregnant
• Your family has children under 21 years old
• You ONLY want help paying for health care

You can fill out the Application for Assistance if you want:

• Help paying for health care
• Basic care facility coverage
• Help paying for child care
• SNAP (Supplemental Nutrition Assistance Program)
• TANF (Temporary Assistance for Needy Families)
• Help with Medicare premiums
• Help with health care costs due to being aged or having a disability

These applications can be filled out online by selecting the link above or you can apply in-person with the help of your local human service zone office. Filling out as much of the form as you can helps them review your information and process your requests faster. You can print, sign, and fill out your Application for Assistance form and bring it with you. You can go to the locator map to find contact information for a human service zone office.

You can find more information about covered services: 

• On our Medicaid webpage
• Contacting the Customer Support Center at:
  • Toll-Free: 1-866-614-6005
  • (711) TTY 

When does my coverage begin?

If you qualify for Medicaid, the program may pay for health services that were given to you up to three months before the date that the human service zone office got your signed application.

What if I receive a bill that I thought Medicaid would pay? 

• Start by calling the medical provider that sent you the bill. Ask the provider to explain which services are listed on the bill. Some examples of why Medicaid may not pay for a bill are:
• You may not have given your Medicaid ID number to your provider’s office
• Medicaid may not cover the service that your provider gave you
• Your Medicaid coverage may have a client share. Client share means that you must pay a part of your bill
• Some medical services need a referral from your provider. If your services needed a referral and you did not get one before services received, Medicaid may not pay for them. 
• If you still have questions, call Provider Relations:
  • Toll-Free: 1-877-328-7098
  • (711) TTY 

What does Medicaid consider as income?

Medicaid can help people who do not make enough money to pay for health care coverage. A formula is used to see if you qualify for Medicaid. Income is any money that you get, and you can currently spend. You might get this money from wages, child support, social security benefits, other retirement benefits, etc. If the formula shows that your income is higher, you may have to pay a client share.

What is Recipient Liability/Client Share?

The Client Share is the amount you need to pay toward your medical costs for the month. Your Client Share is based on how much you make every month. It is like an insurance policy deductible.

Will Medicaid take my property to pay for medical costs?

The Medicaid program does not take your property away when your medical bills need to be paid. When a person passes away, their money and belongings may go into an estate. Medicaid may use the estate recovery process to recover the cost of benefits paid out. This process may happen for members who were at least 55 years old when they passed away. This process may happen for members who were under 55 years old and permanently living in an institution when they passed away. Medicaid only uses the Estate Recovery process if there is not a living spouse, living child who is younger than 21, or living child is blind or permanently and totally disabled.

Are there income and asset limits for Medicaid? 

Getting Medicaid depends on how much money you make and what your assets are worth. Assets are accounts, property, and items that are worth money. Medicaid has different ways to cover your medical costs and will calculate your income and assets differently. Most of the time, assets are not considered for children, families with children, and pregnant women. Assets are a factor for people with a disability or people over age 65. You can call the Customer Support Center at 1-800-614-6005 or a human service zone office for more details.

For more help with questions: 

• Call the Customer Support Center at 1-866-614-6005
• Email applyforhelp@nd.gov
• Visit a human service zone office

You can ask for a fair hearing if you do not agree with a decision about your Medicaid eligibility. To ask for a hearing, you can contact a human service zone office.

Medicare (parts A, B, and D) is health insurance through the Social Security Administration.

Medicaid is a state-run program that helps pay for your medical costs. Medicaid may work with Medicare to help pay medical costs in some cases.

There are strict federal and state laws that protect your privacy. Our team must follow these laws. Team members that help you get programs and services and process payments are the only people that can see your information. We cannot share your personal information with others. 

If your children, under 18 years old, have Medicaid and one parent is not living in the home, you may have to work with Child Support to confirm the paternity of those children. You may need to get a court order making sure the parent has private health coverage for the children or pays for uncovered medical expenses. 

If you are pregnant or only your children receive Medicaid, you do not have to cooperate with Child Support, but you are encouraged to do so.

If you want to get Medicaid and working with Child Support might not be the best for your child (example: a domestic violence situation), you may claim “good cause.” You will need to give more information so “good cause” can be proven.

You can visit the Child Support website for more information about Child Support.

North Dakota Health and Human Services (HHS) has the right to know about any third-party payers. A third-party payer is another insurance company like Blue Cross Blue Shield of North Dakota. Some people have Medicaid and another insurance at the same time. Medicaid needs your other insurance company to pay their part of your medical bills first. 

A human service zone office must try to get third-party information. You must tell a human service zone office or HHS if you have health insurance from another company other than Medicaid. If you think you have good cause not to share your third-party information, you should talk to a human service zone office or HHS. You need to report any payments you get for health care services within 10 days of getting a payment. 

Giving away your income or your property to show that you have less can harm your chance of qualifying for Medicaid.

Selling your assets for less than they are worth could mean that you cannot get nursing home services, home and community-based services or swing-bed services in a hospital.