How to get Medicaid or low-cost care in North Dakota

North Dakota Medicaid in plain words

Medicaid is a program that pays for health care for people with low incomes. In North Dakota the program is run by North Dakota Health and Human Services, which people often call HHS. KFF, a health research group, lists the state's expansion as starting January 1, 2014.

Under expansion, many adults ages 19 to 64 can qualify, and not only pregnant women, people with disabilities or parents. The limit is 138 percent of the federal poverty level. That level is a yearly dollar amount the government uses to measure poverty. The dollar limit goes up each year, so ask the Customer Support Center for the current figure for your household size.

Children and pregnant people can qualify under other rules, and so can older adults and people with disabilities. You can read about each group in plain words in our guide on who qualifies for Medicaid.

Ways to apply

You have several choices for how to apply. You can apply online at applyforhelp.nd.gov, or you can call the Medicaid Customer Support Center at 866-614-6005. The line is open Monday through Friday from 8 a.m. to 5 p.m. Central time. Callers who use a relay service can dial 711. A paper application by mail works too, as does a visit to a human service zone office, which is the local county-level office.

Have a few things ready before you start. The state asks for Social Security numbers and birth dates. It also wants proof of pay, such as pay stubs, W-2 forms or your latest tax return. Applications are accepted at any time of year, and more tips are in the guide to applying for Medicaid.

Once you have coverage, you can manage your case on the state's Self-Service Portal. That is also where you send in proof when the state asks for it.

What the 2027 work rule means here

The state says work rules begin for new applicants on January 1, 2027. For current members, they begin for those whose review is due on February 28, 2027. The rule applies to some members of Medicaid expansion who are ages 19 to 64.

To meet the rule, a member must complete 80 hours of approved activities in a month or earn at least $580 a month. Approved activities are work, job training, school at least half time, and volunteering or community service. You can mix the activities to reach the total. The state also plans to review your case more often.

Most members will not need to do anything extra, because the state first checks the records it already has. If it cannot confirm that you meet the rule, it will send a notice. Proof must reach the Customer Support Center within 30 days of the notice, or you could be denied or lose coverage.

The state says many people are exempt, which means they do not have to meet the rule. These are the groups it names.

• Native Americans and Alaska Natives do not have to meet the rule.
• Parents and caregivers of a child 13 or younger, or of a person with a disability, are on the list.
• Pregnant members are covered by the exemption, and so are members who were pregnant in the last 12 months.
• People who qualify for Medicare are exempt, as are people with special health needs that make work hard.
• Veterans with a total disability rating do not have to meet it either.
• People who are in drug or alcohol treatment are also on the list.
• People released from jail or prison in the last three months are exempt for that time.

For updates, the state keeps a Stay Covered page. Put every letter from the state in one folder, and answer each one before the date it lists. The Medicaid work requirement guide has more detail.

When your income is above the Medicaid limit

Higher earners are sent to the federal Marketplace at HealthCare.gov, and the state's flyer gives the Marketplace phone line as 800-318-2596. A Marketplace plan is private insurance you buy yourself. The site checks whether you can get a tax credit, which is money that lowers the monthly cost. If you lost a job, our guide on what to do after losing insurance explains the sign-up window.

Health centers for people in the Dakotas

The Community HealthCare Association of the Dakotas supports health centers in North Dakota and South Dakota. It says its member health centers offer medical and dental care as well as behavioral health care. They see patients whether or not those patients have insurance. Its website has a Find a Health Center page, and a federal tool with the same name also works. That tool comes from the Health Resources and Services Administration.

Ask the center how its sliding fee works, which is a price scale based on what you earn. Our guide to community health centers lists good questions to ask before a first visit.

Checking a North Dakota doctor

The North Dakota Board of Medicine has a Verify License Status tool on its website. With it, you can see whether a physician is licensed. You can also reach the board by phone at 701-450-4060.

Direct primary care and emergency rights in North Dakota

Some doctors in the state charge a flat monthly fee for primary care, and this is called direct primary care. The doctor does not bill insurance for those visits, and the fee does not cover the emergency room or a hospital stay. You can search our directory of cash-pay doctors.

In an emergency, call 911 or go to the nearest emergency room. The ER cannot turn you away for having no insurance, because a federal law requires it to examine you. If a bill comes later, the guide to hospital financial assistance shows how to ask for help.