North Dakota Medicaid Eligibility and Enrollment

North Dakota's Medicaid program is available to individuals and families who live below the program's income limits. It provides its beneficiaries with access to necessary and preventative health care services that they're unable to afford on their own. Medicaid in North Dakota is administered by the state and receives funding assistance from the federal government. The program must also operate within federal guidelines. While covered services vary from state to state, all Medicaid programs must include coverage for primary and ambulatory care, inpatient hospital care and laboratory testing. In some states, waivers and additional programs are available to expand Medicaid coverage for older adults. This additional coverage typically includes services such as long-term care, transportation services and case management.

Below, we discuss how North Dakota's Medicaid program works and provide information about what's covered, how to apply and who seniors can contact if they have questions.

What Is North Dakota Medicaid?

North Dakota Medicaid is administered by the North Dakota Department of Human Services with support from the Centers for Medicare and Medicaid Services. This program provides health care coverage for low-income individuals and families in North Dakota to ensure they can access quality medical and mental health services. Funding is provided jointly by both agencies.

Primary Care Case Management Program

North Dakota's Primary Care Case Management Program provides care coordination for Medicaid beneficiaries. This program allows its participants to select a primary care physician who is responsible for overseeing their care and providing referrals for specialists whenever necessary. All North Dakota Medicaid beneficiaries are required to participate in the Primary Care Case Management Program, and those who do not select a primary care physician will have one appointed to them.

Personal Care Services

The Personal Care Services program is available to Medicaid participants who require varying levels of care. This program ensures that seniors and disabled individuals have access to a caregiver who can provide help with daily tasks such as bathing, dressing, toileting and housekeeping whenever it's required. This program is available only to those whose care needs are expected to last for 30 days or more. A case manager is provided to oversee care and assign necessary services.

Medicaid Waiver for Home and Community-Based Services

The Medicaid Waiver for Home and Community-Based Services helps eligible individuals access care services that allow them to live independently for as long as possible. If a senior's needs can be met at home instead of in a nursing care facility, they may be eligible to participate. Covered services include:

• Adult daycare
• Lifeline emergency response system
• Limited home modifications
• Homemaker services
• Non-medical transportation
• Residential care in an adult foster home or assisted living facility
• Respite care
• Transitional living services

To qualify for the Home and Community-Based Services waiver, an individual must meet Medicaid eligibility requirements and be screened and determined to require a nursing level of care. They must also be capable of directing their own care and be able to safely reside at home with the services provided by this waiver program.

Program for All-Inclusive Care for the Elderly (PACE)

In North Dakota, PACE can be accessed by Medicaid beneficiaries who are aged 55 and older. This program covers a variety of health care and in-home services to help its participants remain independent for as long as possible. It's designed to meet the needs of individuals who may require a nursing level of care but can safely remain at home if provided services such as home health care and non-medical transportation. Those who participate in PACE must receive all health care services under the oversight of a case manager and within the PACE network.

What Does North Dakota Medicaid Cover? 

In North Dakota, Medicaid covers a broad range of health care services for its beneficiaries. However, it's important to understand that copays can apply to some services, and others might be subject to limitations or restrictions when it comes to what's paid for by Medicaid. These restrictions can include who is eligible for certain services and how often a particular service may be accessed within a coverage period. Before receiving any health care service, it's advisable for beneficiaries to ask their health care provider if the service is being paid for by Medicaid or if they'll be required to pay all or part of the cost out of their own pocket.

Services that are included in North Dakota's regular Medicaid program can include:

• Inpatient and outpatient hospital care
• Primary care
• Room, board and services provided in a nursing facility
• Hospice care
• Home health care
• Chiropractic services
• Screening and diagnostic testing
• Prescription medication
• Dental exams and X-rays
• Podiatry
  
  
• Vision care
• Emergency transportation
• Non-emergency transportation to and from medical appointments 
• Mental health care services
• Physical and occupational therapies

What's Not Covered Under North Dakota's Regular Medicaid Program?

While Medicaid coverage in North Dakota is comprehensive, there are some costs and services that are not covered. This includes, but is not limited to:

• Missed appointment costs
• Custodial care
• Experimental treatments
• Acupuncture
• Autopsies
• Reports that are provided for insurance purposes
• Vocational training
• Private rooms in hospitals or nursing care facilities

Who Is Eligible for Medicaid in North Dakota?

North Dakota Medicaid is available to a variety of residents. That includes:

• Low-income individuals
• Aged, blind or disabled persons
• Children in foster care
• Children with disabilities
• Pregnant women
• Those living with breast or cervical cancer
• Workers with disabilities
• Low-income Medicare beneficiaries

Those who access Medicaid must be a resident of North Dakota and a U.S. citizen or alien with permanent resident status. Older adults who wish to receive Medicaid benefits on the basis of their age must be at least 65 years old and fall within the program's income limitations. Additionally, seniors who participate in Medicaid may not have more than $3,000 in countable assets — this number doubles for couples applying together.

Income Limitations for Aged, Blind and Disabled Families and Individuals

*This information is up-to-date as of April 2023. Income allowances are updated annually.

How Do I Enroll in Medicaid in North Dakota?

There are several ways older adults can enroll in North Dakota's Medicaid program.

Online

Individuals can complete their Medicaid application online. It will then be directed to their county's social services office for review.

In-person

Aged, blind or disabled individuals looking to apply for Medicaid coverage can complete a Health Care Application for the Elderly and Disabled form and deliver it in person to their nearest Human Service Zone office.

By Mail

An Application for Assistance form can be completed and mailed to the individual's nearest Human Service Zone office.

Contact Information for North Dakota Medicaid

Questions about Medicaid in North Dakota can be directed to Human Service Zone offices.