North Dakota Medicaid Expansion covers adults ages 19 to 64 with income at or below 138% of the Federal Poverty Level in 2026, and North Dakota Health and Human Services (ND HHS) runs the program. In 2026, coverage loss in the state comes from three sources: routine annual renewals that go unanswered, income or household changes flagged through data matches, and new federal rules from the One Big Beautiful Bill Act (H.R. 1), signed July 4, 2025. Immigrant eligibility restrictions under H.R. 1 took effect October 1, 2026. Work requirements of 80 hours per month start January 1, 2027 for new applicants, and current members face their first reviews under the new rules from February 28, 2027, according to ND HHS. A termination notice in 2026 does not always mean you are ineligible. Many terminations nationwide are procedural, triggered by a missed renewal form or an out-of-date address, and a fast response can restore coverage.
Seven steps below walk you through the first 90 days after losing North Dakota Medicaid: reading the notice, filing an appeal, applying at healthcare.gov before the 90-day Special Enrollment Period closes, choosing a plan, and protecting your children's coverage. The ACA subsidy cliff returned for 2026 after the enhanced premium tax credits expired January 1, 2026, so households above 400% FPL ($63,840 for one person in 2026) receive no premium tax credit. Most people leaving North Dakota Medicaid sit well below that line and still qualify for large subsidies. Check the Medicaid income limits page first to see whether you still qualify for Medicaid, then use the ACA income limits page to estimate your Marketplace subsidy for 2026. Marketplace plans purchased through healthcare.gov arrive with a Form 1095-A each January, which you need to reconcile credits on your tax return. Plan selection also decides whether your doctors stay in network, so confirm each provider in the 2026 directory before you pay the first premium.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
Five mistakes cost North Dakotans the most after a Medicaid termination in 2026:
- Waiting past the 90-day SEP window. Missing it means no Marketplace enrollment until Open Enrollment, and a gap that can last most of 2027.
- Skipping the appeal. Many terminations come from an unreturned renewal form or a data mismatch, and a timely appeal within 30 days of the notice mail date can restore coverage.
- Reporting last year's income on healthcare.gov. Marketplace subsidies use your projected 2026 MAGI, not the figure from your prior tax return.
- Choosing Bronze when 2026 income is under 250% FPL. Cost Sharing Reductions exist only on Silver plans, and a Bronze deductible can run several thousand dollars in 2026.
- Forgetting the children. Healthy Steps (CHIP) and children's Medicaid use higher income limits than adult Medicaid Expansion, so children often stay eligible after a parent loses coverage.
Why North Dakota Medicaid Terminations Rise in 2026 and 2027
North Dakota Medicaid Expansion has run since 2014, and ND HHS reviews eligibility at renewal using income, household, and residency data. Renewal packets that go unanswered close the case even when income still qualifies, which is why a missed form is the most fixable cause of coverage loss. Federal changes add pressure in 2026 and 2027. Immigrant eligibility restrictions under H.R. 1 began October 1, 2026, removing some lawfully present non-citizen groups from Medicaid. Expansion adults will also move to more frequent reviews, with the federal standard set at every six months starting in 2027, which raises the number of chances to miss a notice. Keep your mailing address current in the Self-Service Portal, and check mail from ND HHS and your managed care plan each week. Check the date on every letter, because a mailed renewal can arrive after its due date, and ask ND HHS in writing for more time if that happened to you. Calling the Customer Support Center at 866-614-6005 on the day a notice arrives also creates a record of your contact in 2026.
Work requirements add a second layer starting January 1, 2027. Expansion adults ages 19 to 64 must show 80 hours per month of work, training, education, or volunteering, or earnings of at least $580 per month in 2027, unless exempt. ND HHS lists exemptions for children, adults 65 and older, American Indians and Alaska Natives, parents or caregivers of a child 13 or younger, caregivers of a person with a disability, medically frail members, pregnant or recently pregnant women, people in substance use treatment, and people already meeting SNAP or TANF work rules. New applicants face the rule from January 1, 2027, while current members are reviewed under it from February 28, 2027 onward. A 2026 termination citing work requirements should be appealed, since the rule is not yet in force. Track your hours each month in 2026 even though enforcement has not begun, using pay stubs, school enrollment letters, or volunteer logs, so the proof is ready when your review arrives.
North Dakota Medicaid vs ACA Marketplace: Which Fits Your 2026 Income?
North Dakota Medicaid Expansion provides comprehensive coverage with little or no monthly cost for adults at or below 138% FPL, which is $22,025 for one person and $45,540 for a family of four in 2026. Above that line, the federal Marketplace at healthcare.gov takes over. Premium tax credits apply between 100% and 400% FPL in 2026, and Silver plans carry Cost Sharing Reductions up to 250% FPL ($39,900 for one person in 2026). At 400% FPL ($63,840 for one person in 2026) the subsidy cliff applies, so one extra dollar of income can remove the entire credit. Because the credit is based on projected 2026 income, estimate carefully and update healthcare.gov if your income changes during the year. Per KFF and CMS data, most enrollees at lower incomes pay little after credits. North Dakota has no state-run exchange, so every Marketplace application goes through healthcare.gov, where you see plans from the insurers that sell in your county for 2026.
Documents You Need to Appeal or Enroll After Losing North Dakota Medicaid in 2026
Three documents settle most disputes: the original ND HHS notice (which states the reason and your appeal rights), proof of current income, and proof of North Dakota residency. For the Marketplace, healthcare.gov may ask you to verify the qualifying life event, and the termination notice is the strongest proof of the coverage end date. Pay stubs matter because subsidies use projected 2026 MAGI, and a mismatch between your reported income and employer data can trigger a follow-up request. Gather the items below before you start either application so processing does not stall. Social Security numbers and immigration documents let the Marketplace run its identity and eligibility checks against federal data, and missing items are the most common reason an application sits pending in 2026. Upload clear copies, keep the originals, and respond to any follow-up notice from healthcare.gov within the deadline printed on it. Keep a folder of paper and digital copies for the full 2026 plan year, because Marketplace verification requests and tax reconciliation both draw on the same records.
- Your ND HHS termination notice or notice of action (verifies the qualifying life event at healthcare.gov)
- Recent pay stubs, an unemployment award letter, or self-employment records for 2026 income
- Social Security numbers for everyone applying
Medicaid Income Limits by Household Size in North Dakota, 2026
North Dakota Medicaid Expansion uses 138% of the Federal Poverty Level for adults ages 19 to 64, which equals the 2026 limits in the household size table on this page. Larger households get a higher limit, so a family of four can earn up to $45,540 per year in 2026 and still qualify. Children and pregnant women in North Dakota qualify at higher income levels than adults, and Healthy Steps (CHIP) covers children above the Medicaid line. Verify your exact category and income counting rules at hhs.nd.gov or through the Self-Service Portal at applyforhelp.nd.gov, because aged, blind, and disabled categories use different rules. Households with a member who is aged, blind, or disabled should ask ND HHS about the separate Medicaid categories, because those programs count income and assets differently from Medicaid Expansion in 2026. Self-employed applicants should bring a profit and loss statement for 2026, since net earnings rather than gross receipts drive eligibility.
Frequently Asked Questions
How long do I have to get new coverage after losing North Dakota Medicaid?
You have 90 days from the date your North Dakota Medicaid coverage ends to enroll in an ACA Marketplace plan at healthcare.gov, per the healthcare.gov Special Enrollment Period rules for 2026. That is longer than the standard 60-day window for other coverage losses. If your coverage ends October 31, 2026, the window runs from November 1, 2026 through January 29, 2027. North Dakota Medicaid itself accepts applications year-round, so you can re-apply any time your income qualifies, and children can apply for Healthy Steps (CHIP) year-round.
What is the SEP window for losing North Dakota Medicaid and when does it start?
The Marketplace Special Enrollment Period for loss of Medicaid or CHIP is 90 days, and the clock starts on the day your coverage ends, not the day the notice arrives. You can also apply before your end date to prevent a gap. Plans selected before the end date can start the first of the month after the loss, and plans selected afterward start the first day of the following month. Select the loss-of-Medicaid qualifying life event at healthcare.gov and upload your ND HHS notice if asked. Apply early in 2026 so your first premium is processed on time.
How do I document losing North Dakota Medicaid for a Marketplace application?
Upload your ND HHS termination notice or notice of action, which shows the coverage end date and the reason for loss. Healthcare.gov may ask for it after you report the qualifying life event. Keep proof of North Dakota residency, Social Security numbers, and pay stubs ready, because subsidies use projected 2026 income. If you did not receive a notice, call the ND HHS Customer Support Center at 866-614-6005 and request written confirmation of your end date. Photograph every page of mailed notices, since healthcare.gov asks for legible copies and the envelope date can matter for appeals.
Can I appeal my North Dakota Medicaid termination instead of switching plans?
Yes. State policy sets the appeal limit at 30 days from the mail date on your notice, and you can file through the Self-Service Portal at applyforhelp.nd.gov, by phone at 866-614-6005, or at a human service zone office. An appeal filed before the effective date generally prevents termination until the hearing decision, except when the only issue is a change in federal or state law. Many terminations are procedural, such as an unreturned renewal form, so appeal first and enroll in a Marketplace plan at the same time to protect yourself in 2026.
What if I miss the 90-day SEP window after losing North Dakota Medicaid?
Missing the window means you generally cannot enroll in a Marketplace plan until Open Enrollment. The 2027 Open Enrollment Period runs November 1, 2026 through January 15, 2027, which can overlap with your SEP if your coverage ends this fall. If both windows pass, you wait for Open Enrollment for 2028 coverage unless another qualifying life event applies, such as marriage, birth, or a move. North Dakota Medicaid and Healthy Steps (CHIP) accept applications year-round, and American Indian and Alaska Native members can enroll through a monthly SEP.
Can I get retroactive coverage after losing North Dakota Medicaid?
Marketplace coverage is not retroactive, so a plan starts the first day of the month after you select it. To avoid a gap, apply at healthcare.gov before your Medicaid end date. Medicaid can sometimes cover medical bills from before your application month under federal retroactive coverage rules, up to three months through 2026, and H.R. 1 shortens that period for applications starting in 2027. A successful appeal also reinstates coverage back to the termination date, which can cover bills incurred during the appeal. Ask ND HHS which period applies to your category.
What is the difference between COBRA and Marketplace coverage after losing Medicaid?
COBRA applies only if you also lost job-based coverage and charges 102% of the full group premium, often $500 to $2,000 per month in 2026. Marketplace plans use premium tax credits, so a single adult below 400% FPL ($63,840 in 2026) usually pays far less. COBRA keeps your exact network and any deductible you already met, while a Marketplace plan may change providers. You have 60 days to elect COBRA after the job-based loss, which is separate from the 90-day Medicaid-loss SEP. Losing Medicaid alone does not create COBRA rights.
Do my children still qualify after I lose North Dakota Medicaid?
Often yes. Healthy Steps (CHIP) and children's Medicaid in North Dakota use higher income limits than adult Medicaid Expansion, so a parent can lose coverage while the children stay eligible. Apply for children separately at applyforhelp.nd.gov, since enrollment is year-round and not tied to the 90-day Marketplace SEP. Check current 2026 limits with ND HHS or at medicaid.gov. If the children are not eligible, you can enroll them in a Marketplace plan with your own, and members of North Dakota's tribal nations can also use Indian Health Service care.
