North Dakota Medicaid Beginner’s Guide

The federal Medicaid program provides health insurance for low-income individuals and families. In North Dakota, 25% of the population is low income, but only 12% are covered by Medicaid. Read on to find out if you’re eligible for Medicaid in North Dakota (or Sanford Health Plan Medicaid expansion), what’s covered, and how to apply.

Click below to learn more about ND Medicaid:

• What Does ND Medicaid Cover?
• Healthy Steps, North Dakota CHIP
• Managed Care from Sanford Health Plan
• ND Medicaid Eligibility
• North Dakota Medicaid Application
• How to get Both Medicare and Medicaid in North Dakota

What Does ND Medicaid Cover?

Medicaid covers medically necessary services. There may be some additional limitations, but the North Dakota Medicaid program lists the following as covered benefits: 

• Ambulance travel and some non-emergency medical transportation
• Clinic services (including rural health clinics)
• Dental (exams, X-rays, cleaning, fillings, surgeries, extractions, crowns, root canals, dentures, anesthesia)
• Doctor services, supplies, drugs, tests, and treatment
• Family planning (diagnosis, treatment, drugs, supplies, devices, procedures, counseling)
• Health Tracks (EPDST – early and periodic diagnostics, screenings, and treatment) for those under 21; includes orthodontics and vaccinations)
• Home health (nursing, therapy, supplies)
• Hospice
• Inpatient hospital services (room and board, nursing, supplies, operating/delivery rooms, X-rays and labs, therapy)
• Mental health (evaluations, psychiatric hospital services, psychotherapy, partial hospitalization, residential treatment centers)
• Nursing facilities (room and board, nursing, therapy, supplies, durable medical equipment, wheelchairs)
• Outpatient hospital services (emergency room, supplies, labs and X-rays, therapy, drugs, surgery)
• Physical, occupational, and speech-language therapy services
• Podiatry (office visits, supplies, X-rays, surgeries)
• Prescription drugs
• Spine manipulation and spine X-rays when necessary
• Sterilization (when over 21, legally competent, and between 30 and 180 days of signing a consent form)
• Vision (exams, glasses, frames, some contact lenses; time constraints apply)

FAQ: Will North Dakota Cover Medical Care Out-of-State?

Services that are medically necessary may be covered outside of the state of North Dakota in emergency situations only. It may be possible to receive care in a border state hospital if you need immediate care and the out-of-state hospital is closer. However, it’s always a good idea to visit in-network North Dakota hospitals and facilities for the best coverage.

North Dakota Medicaid Transportation Benefits

North Dakota Medicaid members have coverage for emergency transportation from ambulances that are licensed with ND Medicaid. The transportation must be in response to an emergency call and must truly be a medical emergency.

Non-emergency medical transportation is for members who do not have an adequate means of transportation and need to get to Medicaid-covered medical appointments. Non-handicapped members will receive this in the form of a bus pass, paid taxi fare, or other commercial transportation methods. Handicapped members who cannot use common vehicle transportation will have special transportation arrangements. If you need to be transported to an out-of-state facility, the Medicaid program will have to issue prior approval for you to have coverage. 

Sometimes, when you are required to travel overnight for necessary medical treatments, meals and lodging may be covered. Lodging providers can bill the Medicaid program directly.Back to Top

Healthy Steps, North Dakota CHIP

Kids 18 or younger who are legal North Dakota residents, do not qualify for regular Medicaid, do not have other health insurance coverage, and are within the household income limits, can qualify for the North Dakota Healthy Steps. Kids can qualify for Healthy Steps even if their parents do not qualify for Medicaid. The income limits change every year. In 2019, the annual modified adjusted gross income limit for a family of four was $45,063.

The application process for North Dakota Healthy Steps is the same as ND Medicaid. When you apply, you will receive notice of whether you qualify for Medicaid, Healthy Steps, or another program.Back to Top

Managed Care from Sanford Health Plan

Sanford Health Plan is one of the largest non-profit, rural health systems in the nation. They serve not only North Dakota, but also Minnesota, Iowa, and South Dakota. They are also the second-largest carrier in the Dakotas, and they serve a total of over 180,000 members, 700,000 nationwide providers, and 349 hospitals.

The Sanford Health Plan member portal allows you to do everything starting from replacing your lost ID card and paying your premiums (if applicable) to viewing wellness tips and selecting new doctors. 

The plan also includes comprehensive preventative benefits, like free tests and screenings.

So, how does this affect you?

Sanford Health Plan administers the North Dakota Medicaid expansion program. North Dakota Medicaid expansion is different from the regular state Medicaid program. Eligibility in Sanford Health Plan does not constitute eligibility in North Dakota Medicaid. 

• Click here for the North Dakota Medicaid Expansion drug formulary
• Click here for the ND Medicaid Expansion Member Handbook

There are two versions of the plan depending on your income:

• Click to view the Sanford Health Plan with copays
• Click to view the Sanford Health Plan without copays

You can apply for Sanford Health Plan/North Dakota Medicaid expansion by using the North Dakota Medicaid application.Back to Top

ND Medicaid Eligibility

Generally, the following groups can be eligible for ND Medicaid when couples with low-income:

• Low-income Individuals
• Kids in foster care or subsidized adoption, up to age 26
• Kids and adults with disabilities
• Pregnant women
• Women with breast or cervical cancer
• Low-income Medicare beneficiaries

You also must legally be a North Dakota resident and a U.S. citizen or lawful alien. 

The best way to find out for sure whether or not you are eligible is to go ahead and apply. There is no charge to complete the application.

The following are income limits for qualifying for ND Medicaid. Taxes, work expenses, health insurance premiums, dependent care expenses, child support, and other costs may not be counted.

North Dakota Medicaid Application

To apply for Medicaid in North Dakota, visit www.nd.gov/dhs/eligibility. There, you’ll find the applications for medical assistance, healthcare coverage, food programs (SNAP), cash assistance, and CCAP (Child Care Assistance Program). You can also use that link to check your current benefits, report major changes that affect your eligibility, and find local offices that can help you.

How to get Both Medicare and Medicaid in North Dakota

If you qualify for both programs, you can benefit from both Medicare and Medicaid in North Dakota. You can qualify for Medicare by:

• Turning 65
• Getting diagnosed with ALS
• Getting diagnosed with ESRD
• Entering your 25th month of SSDI

If you qualify for both Medicare and Medicaid, you may be able to enroll in a Medicare Advantage Dual-Eligible Special Needs Plan. These plans generally have very low or no costs and provide benefits for Medicare and Medicaid covered services.

For help with finding plans in your area, call 844-431-1832.