Tribal Health and Indian Health Services

North Dakota Health and Human Services mission is to provide quality, efficient, and effective human services, which improve the lives of people.

What is North Dakota Medicaid?

Medicaid is a federal and state partnership program that makes coverage available for basic health services for qualified families with children, women who are pregnant, and the elderly or disabled. Medicaid is overseen at the federal level by the Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services (HHS). In North Dakota, Medicaid is administered by North Dakota Health and Human Services. Medicaid was federally authorized in 1965; North Dakota implemented Medicaid in 1966.

How does someone become eligible for Medicaid?

A person can meet income guidelines and be under age 21, a woman who is pregnant, those that have breast or cervical cancer, are blind or disabled, are age 65 and older, or individuals who are a member of a family with children.

Eligibility is also based on income and, in some situations, assets. Not all assets a person owns are counted. Some assets that are not counted include: the home the applicant lives in, one car or other vehicle for personal use, personal belongings, burial plans or property that produced earned income such as a farm.

What is the North Dakota Children's Health Insurance Program (CHIP)?

The Children's Health Insurance Program (CHIP) is a state and federal partnership that provides coverage for children in families with qualifying income. CHIP was federally authorized in 1997; North Dakota adopted CHIP on Oct. 1, 1999.

How does someone become eligible for CHIP?

Eligible children cannot have health insurance coverage (Indian Health Service is not considered health insurance coverage), must be 18 years of age or younger and live with families with qualifying incomes.

How can an individual apply for Medicaid or CHIP services?

How do Medicaid and CHIP work with Indian Health Service?

Native Americans who are eligible for health care through the Indian Health Service (IHS) are also entitled to Medicaid and CHIP coverage if they meet the categorical and financial eligibility requirements for the North Dakota Medicaid and CHIP programs. In cases when a recipient is eligible for both Medicaid and IHS services, and a service (such as hospital care) is covered both by Medicaid and by the IHS, the Medicaid program is required to pay for the service. When a Medicaid recipient receives a service provided by the IHS that is not included as a Medicaid service, IHS has the responsibility to pay.

North Dakota Medicaid Tribal Consultation Information

• Tribal Consultation State Plan Amendment (Approved February 2012)
• Tribal Consultation Letters
• HHS Tribal Consultation Meetings

North Dakota Medicaid Information

• Home and Community-Based Services
• The Coordinated Services Program
• Health Coverage for Children
• State Plan Amendments
• Tribal ND Medicaid 101 Presentation

Eligibility Information

• Information on North Dakota's Health Tracks - also known as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.
• Asset Information for Medicaid and CHIP Eligibility

Federal Guidelines

• Federal Indian Health Service (IHS.gov)
• CMS Medicaid Information (Medicaid.gov)

IHS/Tribal 638 Encounter Rates

Current IHS/Tribal 638 Encounter Rates - Reimbursement to IHS/Tribal 638 facilities will be on a daily encounter basis and based on the approved all-inclusive rates published each year in the Federal Register by the U.S. Department of Health and Human Services.

IHS/Tribal 638 Care Coordination

• SHO #16-002 Federal Funding for Services "Received Through" an IHS-Tribal Facility (124kb pdf)
• ND Care Coordination Agreement Template (128kb pdf)
• ND HHS -Tribal Entity Agreement for Tribal Health Fund (15kb Word Doc)
• ND HHS - Tribal Facility-IHS Care Coordination Billing Guidelines (193kb pdf)
• ND HHS – Tribal Care Coordination Presentation (Updated May 2024)
• Tribal Care Coordination Guidance
• Tribal Care Coordination Fund Annual Report Form - SFN 1115
• Tribal Care Coordination FAQ