Medicaid eligibility and enrollment in North Dakota

Key Takeaways

Who is eligible for Medicaid in North Dakota?
Medicaid expansion in North Dakota
How do I enroll in North Dakota Medicaid?
See frequently asked questions about North Dakota Medicaid
North Dakota Medicaid history and details

Who is eligible for Medicaid in North Dakota?

Because North Dakota has expanded Medicaid under the ACA, low-income adults are eligible for coverage even if they don’t have minor children. Medicaid is available to the following legally present North Dakota residents, contingent on immigration guidelines:

Adults with household income up to 138% of federal poverty level (this is Medicaid expansion under the ACA).
Children age 0 – 18 with household income up to 205% of poverty¹ (depending on the child’s age and the household’s income, coverage will either be via Medicaid or CHIP).² North Dakota’s current income limit for children took effect in 2024, making more kids eligible for coverage.³
Pregnant women with household income up to 162% of poverty; postpartum coverage continues for 12 months.⁴

Enrollment in Medicaid and CHIP continues year-round; there’s no limited enrollment window. North Dakota updates Medicaid eligibility rules on April 1 each year, using the federal poverty level numbers that were published earlier that year, in mid-late January (for the first three months of the year, the prior year’s federal poverty level numbers are used).

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Apply for Medicaid in North Dakota

Online at HealthCare.gov or the North Dakota Department of Human Services website. You can also enroll by phone at 1-800-318-2596, or you can apply in person or by mail at your local County Social Services Office.

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Eligibility: The aged, blind, and disabled. Also, adults are eligible with household incomes up to 138% of poverty, and pregnant women with incomes up to 147% of poverty. Children are eligible for Medicaid or CHIP with with household incomes up to 170% of poverty.

ACA’s Medicaid eligibility expansion in North Dakota

North Dakota opted to accept federal funding to expand Medicaid under the Affordable Care Act. Medicaid expansion was passed by the North Dakota Legislature and signed into law by former Governor Jack Dalrymple in April 2013.⁵ Dalrymple was generally opposed to the Affordable Care Act (ACA), but he was the fourth Republican Governor to throw support behind the expansion of Medicaid in early 2013. Enrollment began in October 2013, with coverage effective January 2014.

Medicaid expansion in North Dakota is managed by Blue Cross Blue Shield of North Dakota (this is as of 2022; prior to that, the managed care contract was with Sanford Health Plan).

The state has also considered the possibility of administering the program itself instead of using the managed care model (as it does for traditional Medicaid), but has not moved forward with this. However, 19- and 20-year-olds have been moved from the managed care Medicaid expansion population to traditional fee-for-service Medicaid in North Dakota. This allows them to be covered by Medicaid expansion but also to have the dental and vision coverage that’s provided to children.⁶

The state has created a helpful brochure to answer questions and provide information about Medicaid expansion. If you have other questions, you can contact the North Dakota Department of Human Services at 855-794-7308.

105,205 – Number of North Dakotans covered by Medicaid/CHIP as of September 2025⁷
25,041 – Number of North Dakotans covered by ACA Medicaid expansion as of March 2025⁸
50% – Increase in total Medicaid/CHIP enrollment in North Dakota since late 2013⁹

North Dakota has accepted federal Medicaid expansion. 105,703 - Number of North Dakotans covered by Medicaid/CHIP as of June 2025. 24,371 - Number of North Dakotans covered by ACA Medicaid expansion as of December 2024. 51% - Increase in total Medicaid/CHIP enrollment in North Dakota since late 2013.

Explore our other comprehensive guides to coverage in North Dakota

Health Insurance Marketplace

Frequently asked questions about North Dakota Medicaid

How do I enroll in Medicaid in North Dakota?

Medicaid enrollment is year-round; you do not need to wait for an open enrollment period to apply for Medicaid.

North Dakota uses the federal health insurance marketplace, so you can enroll through HealthCare.gov or use their call center at 1-800-318-2596 (only use this option if you are under 65 and don’t have Medicare)
You can use the North Dakota Department of Human Services website to enroll online directly through the state.
You can print a paper application and submit it to your local County Social Services Office.
You can call or visit your Human Services Zone office (click on your county to see contact information) for in-person or phone assistance with enrollment.

How does Medicaid provide financial assistance to Medicare beneficiaries in North Dakota?

Many Medicare beneficiaries receive Medicaid’s help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in North Dakota includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

How did North Dakota handle Medicaid renewals after the pandemic?

Throughout the COVID pandemic, the Families First Coronavirus Response Act provided states with additional federal Medicaid funding, but also prevented states from disenrolling anyone from Medicaid. But the continuous coverage requirement ended March 31, 2023, allowing states to begin disenrolling people who are no longer eligible for Medicaid.

Total Medicaid enrollment in North Dakota peaked at about 136,000 in May 2023, and had dropped to about 105,000 by May 2024.¹⁰

Nearly 63,000 people were disenrolled from North Dakota Medicaid during the redetermination process.¹⁰ But other people enrolled during that time, which is why total enrollment only declined by about 31,000 people.

North Dakota Medicaid history and details

Legislation to extend Medicaid expansion

Medicaid expansion in North Dakota was scheduled to expire at the end of July 2017, based on the initial legislation that state lawmakers passed in 2013. But the state enacted legislation (H.B.1012) in 2017 that extended the program through July 2019, and enacted additional legislation (S.B.2012) in 2019 that extended Medicaid expansion through July 2021. North Dakota enacted legislation (H.B.1012) in 2021 that reauthorized Medicaid expansion through June 2023.

Former North Dakota Governor Doug Burgum did not support the ACA, but clarified in November 2016 that he would be open to the possibility of extending Medicaid expansion in North Dakota temporarily, although he hoped a new solution would be devised at the federal level. In late 2017, Burgum and 19 other Republican governors wrote a letter to Congress, urging lawmakers to repeal the ACA. At that point, the replacement bill under consideration (the American Health Care Act, or AHCA) would have resulted in significant federal funding cuts for Medicaid expansion.

Burgum’s first budget proposal, which was unveiled in mid-January 2017, called for continued funding for Medicaid expansion in North Dakota. Democratic-NPL leaders in North Dakota expressed support for Burgum’s inclusion of Medicaid expansion funding in the budget proposal. And lawmakers have continued to renew the state’s Medicaid expansion.

Medicaid expansion benefits provided by Blue Cross Blue Shield of North Dakota since 2022

North Dakota allowed private carriers to bid for the job of using federal Medicaid funds to provide health coverage to the newly eligible population. Two carriers — Sanford Health Plan and Blue Cross Blue Shield of North Dakota — placed bids, and Sanford was initially awarded the state contract. But the contract switched to Blue Cross Blue Shield of North Dakota as of 2022.¹¹

Residents apply for and enroll in Medicaid expansion coverage through the state; BCBSND does not determine eligibility. Once approved for Medicaid, enrollees can contact BCBSND with questions and use the member portal to learn about benefits, get paid for completing a health assessment, and get in touch with a customer service representative.

North Dakota Medicaid enrollment numbers

From the fall of 2013 to mid-2025, total Medicaid and CHIP enrollment in North Dakota increased by 50%, from 69,980 to 105,221 enrollees.⁹

As noted above, enrollment had been quite a bit higher in 2023, before the post-pandemic eligibility redeterminations began.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.