North Dakota has expanded Medicaid under the Affordable Care Act, which means most low-income adults between ages 19 and 64 can qualify for full health coverage without needing to meet disability or parenting requirements. The income cutoff for the expansion program sits at 138% of the Federal Poverty Level (FPL), updated April 1, 2026. For a single person, that is roughly $20,783 per year. For a family of four, it comes to about $43,056 per year.
If you want to check what you qualify for across multiple programs at once, use the free Benefits Navigator screener or read on for North Dakota-specific Medicaid details.
What Is North Dakota Medicaid?
North Dakota runs its Medicaid program through the Department of Health and Human Services (ND HHS). The state expanded Medicaid in 2014 and has kept that coverage in place. The Medicaid Expansion program is administered through Blue Cross Blue Shield of North Dakota (BCBSND), which handles enrollment and covered services for expansion members.
Medicaid in North Dakota covers doctor visits, hospital care, prescriptions, mental health services, and more. Long-term care programs (nursing home and home and community-based services) follow separate income and asset rules, covered further below.
2026 Medicaid Income Limits by Category
Medicaid Expansion (Adults Ages 19 to 64)
This is the broadest category and covers most working-age adults. Income must be at or below 138% FPL.
| Household Size | Annual Income Limit | Monthly Income Limit |
|---|
| 1 | $20,783 | $1,732 |
| 2 | $28,207 | $2,351 |
| 3 | $35,632 | $2,969 |
| 4 | $43,056 | $3,588 |
| 5 | $50,480 | $4,207 |
| 6 | $57,905 | $4,825 |
| 7 | $65,329 | $5,444 |
| 8 | $72,754 | $6,063 |
For each person beyond 8, add approximately $7,424 to the annual limit.
Expansion members do not face asset tests. There is no requirement to have children, a disability, or a specific age (between 19 and 64). Income is the primary determining factor.
Children (Medicaid and CHIP)
Children under age 19 can qualify at higher income levels than adults.
| Age Group | Income Limit |
|---|
| Children under 19 | Up to 205% FPL |
| Infants under 1 | Up to 205% FPL |
At 205% FPL, a family of four can earn approximately $64,090 per year and still have their children covered. Children whose family income falls between 138% and 205% FPL are typically enrolled through the Children's Health Insurance Program (CHIP) rather than traditional Medicaid, though coverage is seamless.
Pregnant Women
Pregnant women qualify for Medicaid at a higher income threshold to ensure prenatal and delivery care.
| Category | Income Limit |
|---|
| Pregnant women | Up to 175% FPL |
At 175% FPL, income limits are approximately $26,250 per year for an individual. Coverage includes prenatal care, labor and delivery, postpartum care, and prescription drugs. Eligibility continues for 60 days after the end of pregnancy.
Aged, Blind, and Disabled (ABD) Medicaid
Adults 65 and older, blind individuals, and people with qualifying disabilities who need regular Medicaid (not long-term care) can qualify under the ABD category.
| Household Size | Monthly Income Limit |
|---|
| Single | $1,197 |
| Couple (both applying) | $1,623 |
| Couple (one applying) | $1,623 |
Asset limits for ABD Medicaid:
- Single: $3,000 in countable assets
- Couple (both applying): $6,000 in countable assets
Long-Term Care Medicaid
North Dakota offers long-term care coverage through nursing home Medicaid and through Home and Community Based Services (HCBS) waivers. These programs have their own rules and differ significantly from standard Medicaid.
Nursing Home Medicaid
| Status | Income Limit | Asset Limit |
|---|
| Single | No income limit (all income goes toward care cost, minus $115/month personal needs) | $3,000 |
| Married (both applying) | No income limit | $6,000 |
| Married (one applying) | No income limit | $3,000 applicant; up to $162,660 for community spouse |
All monthly income must be applied toward nursing home costs, minus a $115 personal needs allowance. The non-applicant spouse can keep up to $162,660 in assets under the Community Spouse Resource Allowance (effective 2026).
Home and Community Based Services (HCBS) Waivers
HCBS programs allow eligible individuals to receive care at home instead of in a nursing facility.
| Status | Monthly Income Limit (effective 4/1/2026) | Asset Limit |
|---|
| Single | $1,197 | $3,000 |
| Couple (both applying) | $1,623 | $6,000 |
| Married (one applying) | $1,197 | $3,000 applicant; up to $162,660 for community spouse |
Important notes on long-term care:
- North Dakota enforces a 60-month (5-year) look-back period for asset transfers. Gifts or asset transfers made within 5 years of applying can result in a penalty period of ineligibility.
- The home equity limit is $752,000 for 2026. The home is generally exempt as long as the applicant intends to return and a spouse or dependent lives there.
- Monthly Maintenance Needs Allowance for a community spouse: $2,644/month (effective July 2025 through June 2026).
Who Does NOT Qualify for North Dakota Medicaid
Certain groups are excluded or face restrictions:
- Income over 138% FPL (adults 19 to 64): Adults whose income exceeds this threshold do not qualify for expansion Medicaid. They may qualify for subsidized Marketplace coverage through HealthCare.gov.
- Undocumented immigrants: Not eligible for full Medicaid. Emergency Medicaid may be available for immediate life-threatening care.
- Non-citizen immigrants with limited status: Some legal residents must wait 5 years before qualifying.
- People with significant assets (long-term care): Those with countable assets above the limits for ABD and long-term care programs must spend down before qualifying.
If your income is too high for Medicaid but below 400% FPL, you likely qualify for ACA premium tax credits. Use the Benefits Navigator screener to check your options.
What Medicaid Covers in North Dakota
Expansion Medicaid covers a broad set of services, including:
- Doctor visits and outpatient care
- Emergency room and hospital stays
- Prescription drugs
- Mental health and substance use disorder treatment
- Lab tests and imaging
- Preventive care and immunizations
- Vision and dental (limited)
- Family planning services
- Behavioral health services
Long-term care programs cover nursing home stays, personal care, home health aides, adult day services, and related supports.
How to Apply for North Dakota Medicaid
Online Application
The fastest way to apply is through the ND HHS self-service portal at dhsbenefits.dhs.nd.gov. You will need to create an account and complete the online application form. The system also screens you for other benefits like SNAP and TANF at the same time.
Step-by-Step Application Process
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Gather documents. You will need proof of identity (state ID, passport), proof of residency in North Dakota, proof of income (pay stubs, tax returns, award letters), and Social Security numbers for all household members applying.
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Create an account. Go to the ND HHS Benefits Portal at dhsbenefits.dhs.nd.gov and register for an account if you do not already have one.
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Complete the application. Fill out the online form. You can also download and mail a paper application if you prefer.
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Submit and wait for a decision. Most Medicaid decisions are processed within 45 days. Disability-based applications may take up to 90 days.
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Respond to any requests. ND HHS may ask for additional documents or verification. Respond promptly to avoid delays.
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Review your eligibility notice. You will receive a written determination explaining whether you were approved, what category you qualify under, and your effective coverage start date.
Other Ways to Apply
- By phone: Call the ND Medicaid Customer Support Center at 1-866-614-6005
- By email: applyforhelp@nd.gov
- In person: Visit your local County Social Services office
- Through HealthCare.gov: Applying on the federal Marketplace can trigger an automatic Medicaid referral if you appear eligible
Renewing Coverage
Medicaid must be renewed annually. ND HHS sends renewal notices by mail before your coverage end date. If your information has not changed, you may be auto-renewed. If anything has changed, complete the renewal form to avoid a coverage gap.
For Medicaid Expansion specifically, renewals go through BCBSND. You can manage your coverage at medicaid.bcbsnd.com or call 1-855-550-7668.
Recent Changes for 2026
- Income limits updated April 1, 2026. FPL-based limits adjust each year. The figures in this article reflect the April 2026 update.
- HCBS income limit update. The monthly limit for single HCBS applicants rose to $1,197, effective April 1, 2026.
- Community Spouse Resource Allowance. The non-applicant spouse protection amount is $162,660 for 2026.
- Redetermination process continues. States completed the pandemic-era continuous enrollment unwinding period. If you received a termination notice but believe you still qualify, you have the right to appeal and can reapply at any time.
North Dakota Medicaid vs. Marketplace Coverage
If you are near the 138% FPL cutoff, it helps to know the difference:
| Factor | Medicaid | ACA Marketplace |
|---|
| Income threshold | Up to 138% FPL | 100% to 400%+ FPL |
| Premium | $0 (no premium) | Subsidized; often $0 at lower incomes |
| Asset test | No (for expansion) | No |
| Coverage start | Can be retroactive | Prospective only |
| Application | ND HHS portal or phone | HealthCare.gov |
| Dental/vision | Limited | Depends on plan |
People right at the 138% FPL line sometimes qualify for either program. If you earn just above Medicaid limits, a Marketplace silver plan with a cost-sharing reduction may cover you for very low or no monthly cost.
Check Your Eligibility
Income limits are one part of the eligibility picture. Household composition, immigration status, age, and other factors also play a role. The fastest way to check your full benefits picture is to use the free Benefits Navigator screener, which checks Medicaid alongside other programs like SNAP, CHIP, and ACA subsidies.
For North Dakota-specific benefits information, visit the North Dakota benefits page on this site.
For official program details, visit:
- ND HHS Medicaid Eligibility: hhs.nd.gov/healthcare/medicaid/eligibility
- Apply for Help Portal: dhsbenefits.dhs.nd.gov
- BCBSND Medicaid Expansion: medicaid.bcbsnd.com
Frequently Asked Questions
What is the income limit for Medicaid in North Dakota in 2026?
For adults between 19 and 64, the income limit is 138% of the Federal Poverty Level. That equals approximately $20,783 per year for a single person, $28,207 for a household of two, and $43,056 for a family of four. Children can qualify up to 205% FPL, and pregnant women up to 175% FPL.
Does North Dakota have expanded Medicaid?
Yes. North Dakota expanded Medicaid under the Affordable Care Act in 2014 and has continued the expansion. This means low-income adults ages 19 to 64 qualify for coverage without needing to have children, a disability, or other categorical requirements.
Is there an asset limit for North Dakota Medicaid?
For Medicaid Expansion (adults 19 to 64), there is no asset test. For ABD Medicaid, the limit is $3,000 for individuals and $6,000 for couples. For long-term care programs, the same $3,000 and $6,000 limits apply, with additional protections for a non-applicant spouse up to $162,660.
How do I apply for Medicaid in North Dakota?
Apply online at the ND HHS Benefits Portal (dhsbenefits.dhs.nd.gov), by phone at 1-866-614-6005, by email at applyforhelp@nd.gov, or in person at your local County Social Services office. You can also apply through HealthCare.gov, which may automatically route you to Medicaid if you are eligible.
How long does it take to get approved for Medicaid in North Dakota?
Most standard Medicaid applications are processed within 45 days. Applications based on disability may take up to 90 days. If you need urgent coverage, let the caseworker know when you apply.
Can I get Medicaid if I am pregnant in North Dakota?
Yes. Pregnant women can qualify for Medicaid at up to 175% FPL, which is higher than the standard adult expansion limit. Coverage begins as soon as eligibility is confirmed and continues for 60 days after delivery.
What if my income is slightly too high for Medicaid?
If your income exceeds 138% FPL, you likely qualify for subsidized health coverage through the ACA Marketplace on HealthCare.gov. Premium tax credits can significantly reduce monthly costs, and cost-sharing reductions are available on silver plans for incomes up to 250% FPL. Use the Benefits Navigator screener to see your options side by side.
Do I need to renew my North Dakota Medicaid coverage?
Yes, Medicaid coverage must be renewed every 12 months. ND HHS will send a renewal notice before your coverage ends. If your income and household have not changed, you may be automatically renewed. If something has changed, you must complete the renewal to maintain coverage.
