North Dakota Medicaid 2026: Who Qualifies, How to Apply

ND Medicaid pays for health care; it isn't a cash grant, and applying is free. Our North Dakota Medicaid income limits guide has every household size for every coverage group.

North Dakota Medicaid at a Glance (November 2026)

North Dakota runs 2 front doors for adult coverage: traditional ND Medicaid for parents, pregnant women, children, seniors and people with disabilities, and Medicaid Expansion for other adults 19 to 64. According to the ND HHS program data Grantsights read on November 13, 2026:

Sources: ND HHS Medicaid Expansion, eligibility, apply and Stay Covered ND pages, and the Application for Assistance Guidebook, checked November 13, 2026.

Grantsights analysis of the April 2026 charts shows how much the parent line matters: a parent of two children earning $3,000 a month is far over the $871 parent and caretaker limit for three, yet still under the $3,142 Expansion limit for the same household. That parent gets Expansion coverage without dental or vision, while the children qualify for ND Medicaid, which does include them.

Who Qualifies for ND Medicaid in 2026

According to the ND HHS eligibility data, there are more than 15 coverage groups, and most carry their own income line effective April 1, 2026. The main ones for working-age families:

• Medicaid Expansion: adults 19 through 64 who don't fit another group, aren't eligible for Medicare or SSI, and are under 138% of poverty. There's no asset test for this group, the HHS guidebook says.
• Parents and caretakers: a parent, grandparent, aunt, uncle or older sibling caring for a child under 18 at home, up to 41% of poverty. This is the adult group that includes dental and vision.
• Children: ND Medicaid from birth through 18, with up to 12 months of coverage once approved if the child stays in North Dakota. Uninsured children above the Medicaid line can get CHIP, which HHS says carries the same insurance coverage as Medicaid.
• Pregnant women: up to 175% of poverty, counting each unborn child in the household. A newborn is covered automatically for the first year if the mother had ND Medicaid on the day of birth.
• Aged, blind and disabled: 65 or older, blind, or disabled under Social Security rules, with the $3,000 asset limit. Workers with disabilities can buy in up to 225% of poverty by paying 5% of gross countable income plus a one-time $100 enrollment fee.

Over the line with big medical bills? HHS's "client share" option lets some people with income above the limit qualify once their medical bills pass a monthly amount that works like a deductible. It's open to people 65 and older, blind or disabled, pregnant, children through 20 and parents or caretakers, not to Expansion adults.

Noncitizen change, October 1, 2026. The Stay Enrolled page says refugees, asylees, humanitarian parolees and trafficking victims no longer qualify under the new federal law, while Cuban and Haitian entrants still do and pregnant refugees keep coverage. Newly arrived refugees may get Refugee Medical Assistance for their first 8 months in the U.S., up to 200% of poverty. The national Medicaid income limits guide compares North Dakota's lines with Minnesota, Montana and South Dakota.

What Expansion and ND Medicaid Cover

Expansion covers adults up to 138% of poverty, and its members carry 2 ID cards, according to the Stay Covered ND program page: the BCBSND card for doctor and hospital visits, and the ND Medicaid ID card for picking up prescriptions. For coverage questions and to find a doctor, call BCBSND Member Services at (833) 777-5779 (TTY 711) or use medicaid.bcbsnd.com.

What Expansion pays for. The HHS eligibility page describes Expansion as help with checkups, preventive services, hospital visits "and more," and says plainly that it "does not provide dental or vision care." Before scheduling a dentist, check which group you're in: the coverage letter will say.

Medically frail. If you're on Expansion and have a serious and complex medical condition, a serious mental illness or substance use disorder, or a disability that affects daily living, HHS says you can complete the Medically Frail Questionnaire to get broader coverage. Medically frail members have no asset limit.

Traditional ND Medicaid. The guidebook's services table lists vision exams, dental care (with some age limits and approvals), orthodontia for ages 0 to 20, hearing aids, behavioral health, substance use treatment, hospital care, nursing facility care, pharmacy, durable medical equipment and non-emergency medical transportation. Out-of-state care needs HHS approval each time, except in emergencies.

Costs today. None of the HHS pages Grantsights read list a current member copay for Expansion. Stay Enrolled says cost sharing starts October 1, 2028 for some Expansion members above 100% of poverty, with primary care, prenatal and pediatric care and emergency services excluded, though non-emergency ER visits will carry a charge. HHS also says it isn't cutting benefits or services for people who stay eligible.

How to Apply for North Dakota Medicaid, Step by Step

North Dakota takes applications through 5 routes, all handled by the HHS Customer Support Center and the state's human service zones.

Step 1: Pick a form and a route

Source: ND HHS Apply for Medicaid page, checked November 13, 2026.

Paper filers choose among 3 forms: SFN 1909 for people under 65 and not disabled who want Medicaid only, SFN 405 for Medicaid plus food, cash or child care help, and SFN 958 for aged, blind or disabled applicants. Free translation is available on the phone line.

Step 2: Gather proof

The eligibility page asks for proof of monthly income (pay stubs, a tax return if self-employed, pension or disability payments) and a form of identity such as a birth certificate, government ID, passport or green card. Asset proof is needed only for people who are blind, disabled or 65 and older. The guidebook adds that Expansion and family-only Medicaid applicants don't need to report expenses, and that income proof should cover last month and this month.

Step 3: Watch for the notice

The HHS guidebook says a decision comes within 45 days of the day HHS receives a signed paper or online application, which matches the federal limit in 42 CFR 435.912 (opens in a new tab). If you've also applied for Social Security disability, Social Security may take up to 90 days, and HHS decides after that. Approved households get a notice with each person's Medicaid ID number, and the plastic ID cards follow about 4 to 6 weeks later, so keep the notice to show providers until the card arrives.

Step 4: Report changes within 10 days

After approval, the guidebook says changes in income, address, household members, pregnancy, a new job or health coverage must be reported within 10 days. The Self-Service Portal is the fastest way.

For example, one applicant in Grand Forks, a 28-year-old part-time retail worker living alone who earns $1,600 a month, is under the $1,836 Expansion line. If she applies in February 2027, HHS will look at her January activity, and January pay stubs near $1,600 clear the $580 test with room to spare (an illustration built from ND HHS's 2026 and 2027 figures, not a real case).

Back Coverage and Six-Month Reviews in 2027

ND Medicaid can still reach back up to 3 months before the month HHS receives your application, as long as you saw an enrolled ND Medicaid provider and met every rule in those months, according to the guidebook. That window shrinks on January 1, 2027: the Stay Enrolled page says backdated coverage will go back only 1 month for Expansion members and 2 months for traditional Medicaid members.

If you're an uninsured adult with a hospital bill from October or November 2026, an application HHS receives in December 2026 should still get the 3-month look-back. Waiting into January could cut it to one month.

Renewals. Most ND Medicaid members renew once a year today. Starting January 1, 2027, Expansion enrollees will have a redetermination every 6 months, while tribal members keep an annual review and nursing facility residents aren't affected. HHS asks members to open every letter, keep contact information current in the Self-Service Portal, and return renewal forms to the Customer Support Center.

North Dakota's Medicaid Work Requirements for 2027

The rule covers only Medicaid Expansion members ages 19 to 64, and HHS says most of them won't be affected. Stay Covered ND gives these dates: new applicants from January 1, 2027, and current members whose review is due on February 28, 2027 or later.

What counts each month: 80 hours of paid or unpaid work, internships or self-employment; job training or a work program; school at least half time in college or career and technical education; community service; or a combination. Earning at least $580 a month (80 hours at the federal minimum wage) also meets it. HHS's own example: 60 hours of work plus 20 hours of volunteering equals 80.

Which months HHS checks:

• New applicants: the month before the application. HHS's example says an application dated January 29, 2027 means December 2026 activity is reviewed.
• Current members: at least 1 month in the review period. A renewal due June 30 would look at January through June, and only one of those months has to qualify.

Who's excluded: children, adults 65 and older, Native Americans and Alaska Natives, parents and caregivers of a child 13 or younger or of a person with a disability, former foster youth under 26, veterans with a total VA disability rating, people with special health needs that make work hard, people in drug or alcohol treatment, pregnant women and those pregnant in the last 12 months, people recently released from jail or prison, people who qualify for Medicare, and anyone already meeting SNAP or TANF work rules.

How proof works. HHS plans to check existing data first and send an approval notice when it can verify activity or an exclusion. If it can't, you'll get a notice listing what's needed, and the proof must reach the Customer Support Center within 30 days through the Self-Service Portal, email, mail or a zone office. Pay stubs, an employer letter, a transcript or a letter from a volunteer group all work.

Federal transition option. On November 13, 2026, CMS announced that states may choose a hold harmless period through June 30, 2027, when they check the rule but don't deny or end coverage only for missing it. North Dakota's pages, read the same day, didn't say whether HHS will take it.

What ND HHS Doesn't Tell You

Grantsights analysis of the HHS pages found 6 gaps worth knowing before you apply or renew:

1. The release window for people leaving jail varies by page. Stay Enrolled says 90 days, the Stay Covered ND list says four months, and its FAQ says three months. Ask the Customer Support Center which applies to you.
2. Dental is the dividing line. Expansion has no dental or vision, but the parent and caretaker group does, and the income gap between them is wide. A parent just above $871 a month for three lands in Expansion.
3. The two-card setup confuses pharmacies. BCBSND handles visits, while prescriptions run through the ND Medicaid card. Bring both.
4. The guidebook carries no revision date. It still points to older web addresses in places, so confirm any form number on the current HHS page.
5. Estate recovery reaches Expansion drug costs. The guidebook says Expansion pharmacy services have been subject to estate recovery since January 1, 2020, for members 55 and older.
6. The 3-month back coverage ends in weeks. Applications filed before January 1, 2027 keep the longer look-back; after that, Expansion adults get one month.

Common Mistakes and Red Flags

A common mistake is applying in January 2027 without proof for December. HHS reviews the month before you apply, so a pay stub or school schedule for that month should go in with the application, or you should name your exclusion right away.

Other ways North Dakotans lose or miss coverage:

• Ignoring the six-month review. From 2027, an Expansion member who skips one review can lose coverage halfway through the year.
• Missing the 30-day proof deadline. HHS's notice gives 30 days, and a missed deadline can mean denial.
• Not reporting a pregnancy. It moves you into a group with richer benefits and out of the work rule.
• Underestimating how fast the appeal clock runs. The 30 days start on the mailing date, not the day the letter arrives.
• Skipping the Medically Frail Questionnaire. An Expansion member with a serious condition who never files it stays on the narrower Expansion benefit.

Red flags: HHS never charges to apply, and nobody legitimate needs your Self-Service Portal password. Be wary of calls or texts offering to "keep your Medicaid" for a fee. Your best bet is the Self-Service Portal, 866-614-6005, applyforhelp@nd.gov or a human service zone office.

Appeals: 30 Days From the Mailing Date

North Dakota allows 30 days from the date a notice of action is mailed to request a Medicaid hearing, according to the HHS File an Appeal page. You can also appeal if HHS hasn't acted on your application with reasonable promptness.

How to file:

• By phone, verbally, to the Legal Advisory Unit at (701) 328-2311 or toll-free (800) 472-2622 (TTY 711)
• Online, through the submit-online link on the File an Appeal page
• By email to dhslau@nd.gov
• By fax to (701) 328-2173
• By mail to Appeals Supervisor, Legal Advisory Unit, North Dakota Health and Human Services, 600 E. Boulevard Ave., Dept. 325, Bismarck, ND 58505-0250

Form SFN 162, Request for Hearing, is optional and doesn't have to be signed. If you skip it, give your name, contact information and the decision you're appealing. Language assistance is free.

Other Help in North Dakota

One Application for Assistance can cover Medicaid, food, heating and child care, and a household under Expansion's 138% line often qualifies for more than one of them:

• Food: our North Dakota SNAP guide explains SNAP; meeting SNAP's work rule also satisfies the Medicaid requirement, HHS says.
• Heating bills: see our North Dakota LIHEAP guide for the state's energy help, which uses the same application.
• Pregnancy and young children: North Dakota parents of a baby or toddler can check WIC in the WIC income limits guide.
• Marketplace coverage: if you don't qualify, ND Navigators help with HealthCare.gov plans at 1-833-545-9448, and HHS notes that federally qualified health centers charge on a sliding scale.

North Dakotans looking for other programs can try Grantsights' free eligibility checker, which points to official benefits. Only ND HHS can approve Medicaid.

FAQ: North Dakota Medicaid

How do I apply for Medicaid in North Dakota?

On the HHS Self-Service Portal, at 866-614-6005, at a human service zone office, or by mail, fax or email to the Customer Support Center.

What is the income limit for North Dakota Medicaid Expansion in 2026?

$1,836 a month for one person and $3,142 for three, effective April 1, 2026.

Does North Dakota Medicaid Expansion cover dental and vision?

No; the parent and caretaker group and children's Medicaid do, and medically frail members get broader coverage.

When do North Dakota Medicaid work requirements start?

January 1, 2027 for new Expansion applicants, and reviews due February 28, 2027 or later for current members.

How long does North Dakota take to decide a Medicaid application?

Within 45 days of receipt, longer when a Social Security disability decision is pending; ID cards follow in about 4 to 6 weeks.

How long do I have to appeal a North Dakota Medicaid decision?

30 days from the date the notice was mailed, by phone, online, email, fax or mail.

---

Sources

1. ND HHS: North Dakota Medicaid (opens in a new tab), checked November 13, 2026
2. ND HHS: Medicaid Expansion (opens in a new tab), checked November 13, 2026
3. ND HHS: Medicaid Eligibility (opens in a new tab), checked November 13, 2026
4. ND HHS: Apply for Medicaid (opens in a new tab), checked November 13, 2026
5. ND HHS: File an Appeal (opens in a new tab), checked November 13, 2026
6. ND HHS: Stay Enrolled, updated September 11, 2026 (opens in a new tab)
7. ND HHS: Medicaid Work Requirements, Stay Covered ND (opens in a new tab), checked November 13, 2026
8. ND HHS: Application for Assistance Guidebook (opens in a new tab)
9. CMS: states may choose a hold harmless period through June 30, 2027 (opens in a new tab)
10. eCFR: 42 CFR 435.912 (timeliness standards for Medicaid decisions) (opens in a new tab)