Medicaid in North Dakota is a critical healthcare program providing medical coverage to various eligible groups, including low-income families, pregnant women, individuals with disabilities, and elderly citizens. It offers comprehensive services, from routine check-ups and preventive care to more specialized treatments like dental care, mental health services, and long-term care. The program ensures that vulnerable populations have access to necessary medical services, improving overall public health and well-being. Eligibility for Medicaid in North Dakota is determined based on income, family size, and specific health needs, ensuring that the program serves those who need it most.

North Dakota's Medicaid program offers a wide range of services, subject to certain limitations or restrictions.

Here's a summary of the covered services:

1. Breast and Cervical Cancer Early Detection Program: Medicaid funds screenings and diagnostic tools for breast and cervical cancer, specifically assisting uninsured women needing care for these conditions. More information is available on the Women's Way webpage.
2. Hospital Services:
3. Inpatient: Includes room and board, nursing services, supplies and equipment, operating and delivery room, X-rays, lab, and therapy.
4. Outpatient: Covers emergency room services, lab, X-ray, therapies, drugs, biologicals, and outpatient surgery.
5. Nursing Facility: Covers room and board, nursing care, therapies, medical supplies, wheelchairs, and durable medical equipment.
6. Clinics, Rural Health Clinics: Offers outpatient medical services under a doctor's direction.
7. Hospice: Provides care and support for terminally ill individuals and their families.
8. Physicians: Includes medical and surgical services, supplies and drugs in the doctor's office, X-rays, and lab tests.
9. Extended Post-Partum Coverage: Offers health care for new mothers for 12 months post-birth without reapplying.
10. Prescription Drugs: Covers a range of prescription drugs, insulin, family planning prescriptions, and related supplies, subject to a doctor's prescription.
11. Chiropractor: Funds X-rays and spinal manipulation for specific diagnoses.
12. Health Tracks: Provides screening and diagnostic services for children under 21, including orthodontia and vaccinations.
13. Home Health: Includes nursing care, therapy, and medical supplies provided at home, as ordered by a physician.
14. Durable Medical Equipment and Supplies: Covers supplies like oxygen, catheters, and reusable medical equipment.
15. Dental: Offers comprehensive dental care for children and adults, including cleanings, extractions, dentures, X-rays, and more.
16. Family Planning: Encompasses a range of services for individuals of childbearing age.
17. Sterilization: Available under specific conditions, including age, competence, and informed consent.
18. Podiatry: Covers office visits, supplies, X-rays, and surgical procedures.
19. Medicare Savings Programs: Helps with Medicare costs for low-income individuals with Medicare Part A and B.
20. Behavioral Health: Offers various psychiatric and psychological services, including therapy and substance use disorder treatment.
21. Ambulance: Covers medically necessary ground and air ambulance transportation.
22. Transportation: Provides non-emergency transportation to medical appointments.
23. Vision: Covers exams, glasses, frames, and specific contact lenses, with restrictions on replacements.
24. Therapies: Includes physical, occupational therapy, and speech-language pathology.
25. Waivered Services - Home and Community-Based Services, Traumatic Brain Injury: Provides personal care and other services to individuals at risk of institutionalization.
26. Out-of-State Services: Covers medically necessary services outside North Dakota if not available within the state or in emergencies, subject to prior approval.

Medicaid eligibility in North Dakota encompasses various groups based on several factors, including income, age, disability status, and family circumstances. Here is a summary of the key eligibility requirements:

Eligible Groups

• Individuals within specific income limitsChildren in foster care or subsidized adoption
• Former foster care children up to 26 under specific conditions
• Children with disabilities (birth to 19)
• Pregnant women
• Individuals with breast or cervical cancer
• Workers with disabilities
• Other blind and disabled individuals
• Low-income Medicare beneficiaries (Medicare Savings Programs)

Residency and Citizenship

• Must be a North Dakota resident
• U.S. citizens or lawfully admitted aliens (with some restrictions based on the date of admission to the U.S.)

Asset Limits

• No asset limit for children, families, or pregnant women in certain groups
• Blind, disabled, or individuals aged 65 or older: up to $3,000 in countable assets ($6,000 for couples)
• Additional asset allowances for Workers with Disabilities and those under the Medicare Savings Program

Spousal Impoverishment Prevention Coverage

Applies to couples where one partner needs nursing care. There are specific allowances for the spouse receiving care and the one in the community.

Exempt Assets

Includes home, one automobile, irrevocable burial plans, self-employment property, personal effects, and certain Indian trust assets.

Income Considerations

• Eligibility may be for full Medicaid or with a Client Share based on net income
• MAGI (Modified Adjusted Gross Income) rules apply to certain groups, impacting household size and income treatment
• Specific expenses like taxes, health insurance premiums, and dependent care are considered for aged and disabled individuals
• View monthly income levels here

Income Allowances for Nursing Home Residents

Individuals in nursing homes or Intermediate Care Facilities can keep a portion of their income for personal needs and other specified expenses.

These requirements provide a general outline of Medicaid eligibility in North Dakota. For detailed information and to understand personal eligibility, it's recommended to contact North Dakota Medicaid or visit their official website.

Applying for Medicaid in North Dakota can be done online or manually, and the process varies slightly depending on the applicant's age, disability status, and the type of assistance needed. Here's a summary of the application methods:

Apply Online

Complete and submit an Application for Assistance for healthcare coverage through the North Dakota state website. The application will be directed to the relevant human service zone office.

Manual Application

1. Under Age 65 and Not Disabled (For Medical Coverage Only): Complete the fillable Application for Health Care Coverage and Help Paying Costs form (SFN 1909) and return it to a human service zone office.
2. Applying for Health Care Coverage and Additional Assistance: If you need help with food, cash assistance, or child care along with healthcare coverage, fill out the Application for Assistance form (SFN 405) and submit it to a human service zone office.
3. Aged, Blind, or Disabled (For Medicaid Only): If you only require Medicaid coverage, Medicare Savings Programs, or coverage in a basic care facility, complete the Health Care Application for the Elderly and Disabled form (SFN 958).

By Mail

Contact a human service zone office to request an application be sent by mail.

For free application assistance, either in person or virtually, contact a North Dakota Navigator at 800-233-1737 or visit their website.

Choosing the correct form based on your specific needs and eligibility criteria is important. Contact the human service zone office or a North Dakota Navigator for more detailed information or assistance.

Renewing your North Dakota Medicaid coverage involves a few key steps to ensure your information is up-to-date and verify your continued eligibility. Here's a summarized guide to the renewal process:

Update Your Information

If you've recently moved or your contact details have changed, update this information through the Self-Service Portal (SSP). This can help ensure you receive all necessary communication regarding your Medicaid coverage.

Check Your Mail

ND Medicaid may send you a letter concerning your coverage. This letter will include instructions on the steps you need to take to maintain your coverage, assuming you still qualify.

Complete the Renewal Process

If the letter you receive includes a renewal form, fill it out and return it to the Customer Support Center promptly. This form is crucial for determining whether you still qualify for Medicaid coverage.