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Health Care Coverage Programs Medicaid



Medicaid helps pay for health care services or insurance premiums for eligible individuals. There are many programs under the Medicaid umbrella. Medicaid determines eligible under two different policies -- Affordable Care Act (ACA) or Non-ACA Medicaid. Any North Dakota resident may be eligible for Medicaid if they met financial guidelines. Income is always consider in determining financial eligibility. Income levels change every year. Assets are also considered for most Non-ACA coverages.

Medicaid is the payer of last resort and all other health insurance coverages will be billed first for health care costs. Children (to age 19), families and pregnant women who are eligible for Medicaid are required to enroll in managed care with a few exceptions. Managed care requires a recipient to select a single medical professional to provide primary care and manage the recipient’s health care needs.
Some people may qualify for full Medicaid benefits while others may be responsible for part of their medical bills. This is called Client Share. Client share is the amount a person must pay each month in medical bills before the Medicaid program will pay for care received. It works like a monthly deductible.

Special programs under Medicaid are:

  1. ACA Medicaid Expansion – coverage for individuals ages 19-64 whose income does not exceed 133% of the Federal Poverty Level. These individuals do not meet guidelines to be eligible as children, parents, caretakers or pregnant women. North Dakota pays a premium to Sanford Health Insurance for recipients.
  2. Non-ACA Coverage for nursing and special services –These services can be provided in the home or in institutional settings. These programs for nursing and special services have an asset test.
    • Waivered services are available for all ages of recipients who meet certain medical criteria. Recipients must be screened as needing these services.
    • Spousal impoverishment rules apply to married couples when one spouse needs nursing services. (http://www.nd.gov/dhs/info/pubs/docs/medicaid/fact-sheet-medicaid-spousal-impoverishment.pdf fact-sheet-medicaid-spousal-impoverishment.pdf) A look-back date of 60 months for income or assets transfers is consider for any individual who needs nursing services. (http://www.nd.gov/dhs/info/pubs/docs/medicaid/fact-sheet-medicaid-disqualifying-transfer.pdf) An asset assessment will need to be completed for spousal cases dating to the first continuous period of receiving nursing care services for more than 30 days. The purpose of the asset assessment is to establish the spousal share, community spouse asset allowance and the amount of assets that must be spent down before Medicaid eligibility will begin.
  3. Non-ACA Workers with Disabilities – This coverage makes it possible for disabled individuals to work and still qualify for health care coverage through Medicaid. Qualifying individuals pay a monthly premium based on their income. Coverage is open to disabled individuals between the ages of 16 and 65 years, who are currently employed. (http://www.nd.gov/dhs/info/pubs/docs/medicaid/fact-sheet-workers-w-disabilities-medicaid.pdf
  4. Non-ACA Children’s with Disabilities – This program allows families with disabled children to pay a monthly premium for Medicaid coverage based on the family’s income. The child must be under age 19.  (http://www.nd.gov/dhs/info/pubs/docs/medicaid/fact-sheet-children-w-disabilities-medicaid-buy-in.pdf)


415 East Rosser Avenue Suite 113
Bismarck ND 58501-4058
OFFICE PHONE: 222-6670
FAX: 221-3384 Administration
FAX: 222-6476 Economic Assistance
FAX: 222-6644 Child & Family Services

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