North Dakota is one of the states that expanded Medicaid under the Affordable Care Act, which means more residents have access to affordable health coverage than in non-expansion states. Whether you are a low-income adult, a parent, a pregnant woman, or caring for children, understanding the eligibility rules can help you determine if you or your family can get coverage. This guide covers everything you need to know about North Dakota Medicaid eligibility in 2026, including income limits, how to apply, and what to expect.
Not sure if you qualify? Check your eligibility with our free screening tool to see all the benefits you may be eligible for in just a few minutes.
How North Dakota Medicaid Works
North Dakota Medicaid provides health care coverage to residents who meet certain income and eligibility requirements. The program is administered by the North Dakota Department of Health and Human Services (HHS). Because North Dakota accepted Medicaid expansion in 2014, adults without children can qualify for coverage if their income falls below the limit, which is not the case in every state.
Medicaid expansion in North Dakota is managed by Blue Cross Blue Shield of North Dakota. As of October 2025, approximately 105,481 North Dakotans were enrolled in Medicaid or CHIP, including about 25,187 through ACA Medicaid expansion.
For a broader overview of programs available in the state, visit our North Dakota Benefits Overview.
North Dakota Medicaid Eligibility Groups
North Dakota Medicaid has several coverage groups, each with its own income limits and rules. Here are the main categories:
- Adults ages 19 to 64 (Medicaid expansion): Income up to 138% of the Federal Poverty Level (FPL)
- Children birth through age 5: Income up to 152% FPL
- Children ages 6 through 18: Income up to 138% FPL
- CHIP (Children's Health Insurance Program): Income up to 205% FPL for children birth through 18
- Pregnant women: Income up to 175% FPL (unborn child counts as a family member)
- Individuals who are blind, disabled, or age 65 and older: Income up to 90% FPL with asset limits
- Children with disabilities: Income up to 250% FPL (buy-in program)
- Foster care and adoption: Automatic eligibility for children in foster care, receiving an adoption subsidy, or former foster youth up to age 26
Income Limits for North Dakota Medicaid in 2026
North Dakota updates its Medicaid income limits on April 1 each year based on the latest Federal Poverty Level guidelines. The tables below reflect the most recently published limits from the North Dakota HHS website (effective April 1, 2025). Updated limits for April 2026 will be posted when available.
Adults Ages 19 to 64 (Medicaid Expansion) at 138% FPL
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $1,800 |
| 2 | $2,433 |
| 3 | $3,065 |
| 4 | $3,698 |
| 5 | $4,330 |
| 6 | $4,963 |
| 7 | $5,595 |
| 8 | $6,228 |
| Each additional | +$633 |
Children Birth Through Age 5 at 152% FPL
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $1,983 |
| 2 | $2,679 |
| 3 | $3,376 |
| 4 | $4,073 |
| 5 | $4,769 |
| 6 | $5,466 |
| 7 | $6,163 |
| 8 | $6,859 |
| Each additional | +$697 |
CHIP (Children Birth Through Age 18) at 205% FPL
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $2,674 |
| 2 | $3,614 |
| 3 | $4,553 |
| 4 | $5,493 |
| 5 | $6,432 |
| 6 | $7,372 |
| 7 | $8,312 |
| 8 | $9,251 |
| Each additional | +$940 |
Pregnant Women at 175% FPL
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $2,283 |
| 2 | $3,085 |
| 3 | $3,887 |
| 4 | $4,689 |
| Each additional | +$803 |
Note: The unborn child counts as a family member when determining household size.
Individuals Who Are Blind, Disabled, or Age 65+ at 90% FPL
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $1,174 |
| 2 | $1,587 |
| 3 | $1,999 |
| 4 | $2,412 |
| Each additional | +$413 |
This group also has asset limits: less than $3,000 in countable assets for a single person, or less than $6,000 for a couple. Your home, one vehicle, home furnishings, irrevocable burial plans, and personal items are not counted.
Children With Disabilities (Buy-In) at 250% FPL
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $3,261 |
| 2 | $4,407 |
| 3 | $5,553 |
| 4 | $6,698 |
| Each additional | +$1,146 |
Families pay a monthly premium equal to 5% of gross countable income. There is no asset limit for this coverage.
General Requirements
Beyond income, you must also meet the following criteria to qualify for North Dakota Medicaid:
- Residency: You must be a resident of North Dakota
- Citizenship: You must be a U.S. citizen or a qualified noncitizen
- Application: You must submit a completed application (Medicaid is not automatic)
For most groups, there is no asset test. However, applicants who are blind, disabled, or age 65 and older must meet asset limits as described above.
How to Apply for North Dakota Medicaid
You can apply for North Dakota Medicaid at any time of year. There is no limited enrollment window. Here is how to apply:
Step 1: Gather Your Documents
Before you begin, collect the following:
- Proof of monthly income (pay stubs, tax return if self-employed, pension or disability statements)
- Proof of assets (bank statements, certificates of deposit) if you are blind, disabled, or 65+
- Proof of identity (birth certificate, government-issued ID, passport, or permanent resident card)
- Social Security numbers for all household members
Step 2: Choose Your Application Method
North Dakota offers several ways to apply:
- Online: Apply through the North Dakota HHS online benefits portal
- HealthCare.gov: If you are under 65 and do not have Medicare, you can apply through HealthCare.gov or call 1-800-318-2596
- Paper application: Download and print the application form and submit it to your local Human Services Zone office
- Phone or in person: Contact your local Human Services Zone office for help applying by phone or in person
Step 3: Submit Your Application
Complete and submit your application with all required documentation. Incomplete applications may delay processing.
Step 4: Wait for a Decision
North Dakota will review your application and notify you of the decision. If approved, your coverage can begin as early as the date of your application. If you are found ineligible, you will receive a notice explaining why and how to appeal.
Step 5: Keep Your Coverage Current
Once enrolled, you will need to renew your eligibility periodically. North Dakota will send you a renewal notice when it is time. Respond promptly to avoid a gap in coverage.
What North Dakota Medicaid Covers
North Dakota Medicaid provides comprehensive health care coverage including:
- Doctor visits and hospital stays
- Prescription medications
- Preventive care and wellness visits
- Dental care
- Vision care and eye exams
- Behavioral and mental health services
- Lab tests and X-rays
- Maternity and newborn care
- Emergency services
Children on Medicaid receive additional benefits through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, which includes regular wellness checkups, immunizations, and developmental screenings.
Special Situations
Pregnant Women
Women who are pregnant and enrolled in Medicaid receive coverage for prenatal care, labor, and delivery. After pregnancy, coverage continues for a full 12 months postpartum, including checkups, behavioral health services, preventive care, mammograms, and dental care.
Newborns
A newborn automatically qualifies for North Dakota Medicaid if the birth mother was covered by Medicaid on the day the child was born. Coverage lasts for the first year of life.
Former Foster Youth
Young adults who aged out of foster care qualify for Medicaid until they turn 26, regardless of income.
Over-Income Options
If your income is above the Medicaid limit but you have significant medical needs, North Dakota offers a coverage option with a "client share." This means you may still receive Medicaid benefits but will need to pay a portion of your medical costs.
Frequently Asked Questions
Who qualifies for Medicaid in North Dakota in 2026?
North Dakota Medicaid is available to low-income adults, children, pregnant women, and individuals who are blind, disabled, or age 65 and older. Because North Dakota expanded Medicaid, adults ages 19 to 64 with income up to 138% of the Federal Poverty Level can qualify even if they do not have children.
What is the income limit for North Dakota Medicaid?
Income limits vary by coverage group. For adults ages 19 to 64, the monthly income limit for a single person is approximately $1,800. For a family of four, it is approximately $3,698. These figures are based on the Federal Poverty Level and are updated each April. Visit the North Dakota HHS eligibility page for the most current numbers.
Can I apply for Medicaid at any time?
Yes. Unlike marketplace health insurance, Medicaid enrollment is open year-round in North Dakota. You can apply whenever you need coverage.
How long does it take to get approved?
Processing times vary, but North Dakota typically processes Medicaid applications within 45 days (or 90 days for disability-related applications). Coverage can be effective as early as your application date.
Is there an asset limit for North Dakota Medicaid?
For most coverage groups, there is no asset test. However, individuals who are blind, disabled, or age 65 and older must have less than $3,000 in countable assets (single) or $6,000 (couple). Your home, one car, and personal belongings are generally excluded.
What if I earn too much for Medicaid?
If your income is too high for Medicaid, you may qualify for subsidized health insurance through the ACA marketplace at HealthCare.gov. You may also be eligible for other assistance programs. Use our free screening tool to check all the benefits you might qualify for.
Does North Dakota Medicaid cover dental and vision?
Yes. North Dakota Medicaid includes dental care and vision services for both children and adults.
Additional Resources
- North Dakota HHS Medicaid Eligibility Page
- North Dakota Online Benefits Portal
- Find Your Local Human Services Zone Office
- HealthCare.gov
If you are unsure whether you qualify for Medicaid or other benefits, try our free eligibility screening tool. It takes just a few minutes and checks your eligibility for over 11 programs at once, including SNAP, LIHEAP, WIC, and more.
