Medicaid eligibility and enrollment 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.

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. This will be an ongoing process that lasts for up to 14 months, so some people will not receive eligibility redetermination packets for several months.

North Dakota began the process of redetermining enrollees’ eligibility in April 2023, with the first round of disenrollments coming at the end of May (people who were no longer eligible as well as those who failed to complete their renewal packets). So June 2023 was the first month that total North Dakota Medicaid enrollment dropped, with enrollment declining by about 4,000 people.

North Dakota’s Medicaid partnered with a communications firm to provide outreach and information about the return to regular eligibility renewals. The state Department of Health and Human Services also has a webpage with information for enrollees about what to expect during the unwinding of the continuous coverage rules.

Enrollees need to make sure that their contact information is updated with the state Medicaid office, and watch their mail for any renewal information. If a renewal packet is sent to them requesting more information, they need to reply promptly, as coverage cannot be renewed if the state cannot verify that the person is still eligible for Medicaid.

People who lose Medicaid will need to transition to other health coverage. Many will be eligible for an employer’s plan, and some will be eligible for Medicare. But for those who need to obtain their own replacement coverage, HealthCare.gov is offering an extended enrollment opportunity, from March 31, 2023 through July 31, 2024, for anyone who loses Medicaid at any time during that window. To avoid a gap in coverage, however, it’s important to sign up for a new plan before the Medicaid coverage ends.

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.

North Dakota Governor Doug Burgum does 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 his hope was that 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.

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.

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.

From the fall of 2013 to early 2023, total Medicaid and CHIP enrollment in North Dakota increased by 90%, from 69,980 to 133,311 enrollees.

The increase was primarily due to Medicaid expansion and the COVID pandemic. During the pandemic, states received additional federal Medicaid funding, but were not allowed to disenroll anyone from Medicaid. But starting in April 2023, states resumed regular Medicaid eligibility redeterminations, disenrolling people who are not eligible. In North Dakota, the first round of disenrollments came at the end of May 2023, and the state will process eligibility redeterminations for all enrollees over a year-long period. After the first month’s disenrollments in North Dakota, total Medicaid enrollment dropped by about 4,000 people.