North Dakota Medicaid Income Limits (2026)

North Dakota Medicaid is the state's joint federal-state health coverage program, administered by the North Dakota Department of Health and Human Services (ND HHS). North Dakota adopted the Affordable Care Act's Medicaid expansion in January 2014, making it one of the earlier states to extend coverage to low-income adults without dependent children. The 2026 income thresholds for North Dakota Medicaid are anchored to the 2026 federal poverty level published by HHS ASPE: $15,960 per year for a single person in the 48 contiguous states, with an additional $5,680 per household member. The main adult threshold is 138% of the FPL, which equals $22,025 per year for an individual and $45,540 for a household of four in 2026.

North Dakota Medicaid serves several distinct coverage groups, each with its own income threshold. Working-age adults (ages 19-64) who gained coverage through the 2014 expansion qualify at up to 138% FPL. Children under age 19 qualify under a more generous standard at up to 205% FPL, with coverage available through both Medicaid and the state's Healthy Steps CHIP program for those above the Medicaid threshold. Pregnant women qualify at up to 175% FPL, with extended postpartum coverage continuing for 12 months after delivery, as required by the federal continuous coverage rule effective 2022. Elderly residents (ages 65 and older) and individuals who meet federal disability criteria are covered under SSI-related Medicaid rules, which include an asset test and use SSI income standards rather than the MAGI-based thresholds that apply to other groups.

North Dakota Medicaid is delivered through a managed care organization. Blue Cross Blue Shield of North Dakota (BCBSND) serves as the state's primary Medicaid managed care contractor under the contract brand Medicaid.bcbsnd.com. Most North Dakota Medicaid enrollees receive their covered services through BCBSND-contracted providers. The state updates Medicaid eligibility income thresholds annually on April 1 using newly published HHS ASPE poverty guidelines, which means the 2026 thresholds shown on this page reflect the April 1, 2026 update and remain in effect through March 31, 2027. Residents can apply year-round through the North Dakota Self-Service Portal at applyforhelp.nd.gov, by calling (866) 614-6005, or in person at any North Dakota Human Services Zone office.

North Dakota Medicaid income limits by household size (2026)

North Dakota Medicaid income limits by household size (2026). Adult column = expansion adults ages 19-64 at 138% FPL. Children column = Medicaid and Healthy Steps CHIP at 205% FPL (higher threshold). Pregnant women column = 175% FPL. Figures are annual income limits in dollars. Effective April 1, 2026.

North Dakota Medicaid eligibility requirements (non-income)

North Dakota Medicaid eligibility requires meeting income thresholds AND several non-income criteria. The non-income rules differ slightly by coverage group (MAGI categories vs. SSI-linked categories), but the following requirements apply to most applicants.

• North Dakota residency: The applicant must currently live in North Dakota with the intent to remain. There is no minimum residency duration requirement. Temporary visitors, tourists, or individuals residing primarily in another state do not qualify. Students attending North Dakota schools who maintain a primary residence in another state must document their North Dakota residency intent.
• U.S. citizenship or qualifying immigration status: Most North Dakota Medicaid categories require U.S. citizenship, a qualifying lawful permanent resident status (after the federal 5-year bar for most immigrants who entered after August 22, 1996), or another qualifying immigration status such as refugee, asylee, or special immigrant. Undocumented immigrants generally do not qualify for full-scope North Dakota Medicaid but may receive emergency Medicaid services for life-threatening conditions.
• Social Security Number: Every household member applying for North Dakota Medicaid coverage must provide a valid Social Security Number (SSN) or apply for one. Household members who are not applying for coverage (for example, an undocumented parent filing on behalf of a citizen child) do not need to provide an SSN but must disclose their income.
• Age and population group: Adults ages 19-64 qualify under the Medicaid expansion group. Children under age 19 qualify under children's Medicaid (up to 205% FPL) or the Healthy Steps CHIP program. Pregnant women qualify under the pregnancy group (175% FPL). Individuals ages 65 and older qualify under SSI-linked Medicaid, which has an asset test (countable assets must be below $3,000 for a single person and $6,000 for a couple). Individuals under 65 with a qualifying disability may qualify under the blind/disabled Medicaid category, also subject to the SSI asset test.
• No minimum work requirement: North Dakota Medicaid does not require applicants to be employed, actively seeking work, or enrolled in job training. The Medicaid expansion for adults is not conditioned on work activity. There is also no asset test for MAGI-based Medicaid categories (adults, children, pregnant women) - only SSI-linked categories (elderly, blind, disabled) have an asset test.
• Other coverage coordination: North Dakota Medicaid is payer of last resort. Applicants must report all other insurance coverage they have, including employer-sponsored health insurance, Medicare, VA coverage, TRICARE, or any other private insurance. If an applicant has employer-sponsored insurance, North Dakota Medicaid may require enrollment in that coverage (if it meets minimum value standards) and coordinate payments accordingly. Having Medicare does not disqualify someone from Medicaid; in fact, low-income Medicare beneficiaries may qualify for both programs simultaneously as dual-eligibles, with Medicaid paying Medicare premiums and cost-sharing.

What income counts for North Dakota Medicaid

North Dakota Medicaid uses the federal Modified Adjusted Gross Income (MAGI) methodology to calculate household income for expansion adults, children, and pregnant women. MAGI is based on your federal tax return income concept, meaning it counts the same income you would report on a Form 1040. North Dakota Medicaid does not count all income sources, and some sources are explicitly excluded. The 5% income disregard is automatically applied as part of the federal MAGI calculation, effectively raising the usable threshold slightly above the stated FPL percentage.

Income sources included

• Wages, salaries, and tips reported on a W-2 form from all household members who are counted in the coverage group.
• Net self-employment earnings (gross business income minus allowable business expenses), reported on Schedule C or Schedule F of the federal tax return.
• Social Security Disability Insurance (SSDI) benefits. Note: Supplemental Security Income (SSI) is excluded. SSDI is a disability insurance benefit based on work history and is taxable income; SSI is a needs-based federal supplement and is not counted.
• Social Security retirement and survivor benefits (the taxable portion included on the federal tax return).
• Unemployment compensation benefits received during the year.
• Pensions, annuities, and retirement account distributions (401(k), IRA, etc.) included in federal adjusted gross income.
• Interest income, dividends, and capital gains distributions reportable on the federal tax return.
• Rental income (net of allowable rental expenses) and royalty income.
• Alimony received under divorce agreements executed before January 1, 2019. Alimony from post-2018 agreements is no longer counted as income under the Tax Cuts and Jobs Act.

Income sources excluded

• Supplemental Security Income (SSI) payments. SSI is a federal needs-based supplement and is explicitly excluded from MAGI income for Medicaid purposes.
• Child support received. Amounts received as child support for a dependent child are not counted as household income for North Dakota Medicaid eligibility.
• Veterans' benefits, including VA disability compensation, VA pension, and GI Bill educational benefits. These are non-taxable and excluded from MAGI.
• Workers' compensation payments received for a job-related injury or illness.
• TANF (Temporary Assistance for Needy Families) cash assistance payments.
• Gifts, inheritances, and loan proceeds. Money received as a gift or loan (including family financial assistance) is not income for MAGI purposes.
• Foster care payments and adoption assistance payments made by the state on behalf of a foster or adopted child.

How to apply for North Dakota Medicaid in North Dakota

North Dakota Medicaid applications are processed by the North Dakota Department of Health and Human Services (ND HHS). Applications can be submitted online through the North Dakota Self-Service Portal (SSP) at applyforhelp.nd.gov, by phone at (866) 614-6005, by mail, or in person at any of North Dakota's Human Services Zone offices located across the state. The same application form covers Medicaid, Healthy Steps CHIP, SNAP (food assistance), and other public benefit programs, so applicants only need to complete one intake form for multiple programs.

1. 1. Gather your documents before starting your application. You will need proof of North Dakota residency, Social Security Numbers for all household members applying for coverage, proof of income (recent pay stubs, tax return, or employer letter), and proof of U.S. citizenship or qualifying immigration status for each applicant.
2. 2. Create an account on the North Dakota Self-Service Portal at applyforhelp.nd.gov. If you already have an account from a previous application or renewal, log in with your existing credentials. You can also call (866) 614-6005 for phone assistance or locate your nearest Human Services Zone office at hhs.nd.gov/service-locations.
3. 3. Complete the online application by listing every member of your household, reporting all income from all sources for all household members (including income of household members who are not applying for coverage), and providing the requested documentation.
4. 4. Sign and submit the application. After submission, ND HHS will send an acknowledgment with your case number. Keep this case number for all follow-up contact. For pregnancy Medicaid applications, note the expedited 15-day processing rule - if you are pregnant and your income is clearly within the threshold, request expedited processing when you call or apply.
5. 5. Respond promptly to any requests for additional information from ND HHS. The agency may request clarification or additional documents within 10 days. Failing to respond is one of the most common reasons applications are denied or delayed. If you receive a request, call (866) 614-6005 or respond through the SSP portal.
6. 6. Receive your eligibility determination notice. Standard Medicaid applications in North Dakota are decided within 45 days. Pregnancy applications are expedited and must be decided within 15 days under federal rules. Disability-related applications can take 60-90 days because they require a medical review. If approved, you will receive a Medicaid ID card and information about your managed care enrollment through BCBSND.

Official portal: applyforhelp.nd.gov

Documents needed

• Photo ID for the adult applicant or head of household (North Dakota driver's license, state ID card, or U.S. passport).
• Social Security Numbers for all household members who are applying for Medicaid coverage.
• Proof of North Dakota residency: a recent utility bill, lease agreement, mortgage statement, or official mail addressed to a North Dakota address.
• Proof of U.S. citizenship or qualifying immigration status: birth certificate, U.S. passport, Certificate of Naturalization, or Permanent Resident Card (Green Card) for each person applying for coverage.
• Proof of income for all household members: the most recent four weeks of pay stubs for employees; the most recent federal tax return plus Schedule C/F for self-employed individuals; SSA award letters for Social Security income; employer letters if pay stubs are unavailable.
• For pregnant women: a signed statement from a licensed healthcare provider confirming the pregnancy and estimated due date.

Processing timeline: Standard North Dakota Medicaid applications are processed within 45 days of submission. Pregnancy Medicaid applications are expedited under federal rules and must be decided within 15 days. Applications for elderly, blind, or disabled individuals that require a medical determination can take 60-90 days. If you submit your application and do not receive a notice within the applicable timeline, contact ND HHS at (866) 614-6005.

Common reasons applications get denied

• Income above the applicable threshold for the coverage group. This is the most common reason for denial. For expansion adults, the 2026 limit is $22,025 per year for a single person (138% FPL). For children, the 2026 limit is $32,718 per year for a single child (205% FPL). For pregnant women, the 2026 limit is $27,930 per year (175% FPL).
• Failure to respond to a request for additional information within the 10-day window. ND HHS frequently requests additional documentation to verify income, residency, or immigration status. Not responding causes the application to be denied for lack of information.
• Residency not verified. If you cannot document a North Dakota address (for example, you recently moved and don't have a utility bill or lease in your name), the application will be denied until residency is established.
• Immigration status does not qualify. Some immigration statuses are not covered by North Dakota Medicaid full-scope coverage. Applicants who entered the U.S. after August 22, 1996 as lawful permanent residents may face the federal 5-year bar before becoming eligible.
• For SSI-linked categories only: assets exceed the $3,000 limit for a single applicant or $6,000 for a couple. If you are applying for elderly, blind, or disabled Medicaid and have countable assets above these thresholds, you will need to spend down those assets before qualifying. This asset test does NOT apply to expansion adults, children, or pregnant women.

If your child's income is above the North Dakota Medicaid limit for children

North Dakota's Medicaid program for children covers household income up to 205% of the federal poverty level ($67,650 per year for a family of four in 2026). Children in households with income above 205% FPL may qualify for North Dakota's Healthy Steps program, which is the state's Children's Health Insurance Program (CHIP). Healthy Steps covers uninsured children from birth through age 18 whose families earn too much to qualify for Medicaid but cannot afford private insurance. North Dakota Healthy Steps uses a managed care delivery system and is administered by ND HHS. Applications for Healthy Steps are accepted through the same applyforhelp.nd.gov portal used for Medicaid, making it easy to apply for both programs at once. Children who do not qualify for either Medicaid or Healthy Steps may be eligible for coverage through the ACA marketplace at healthcare.gov, where federal premium tax credits are available for families with income from 100% to 400% FPL.

Compare Medicaid and CHIP income limits across all 50 states

If you are 65 or older with limited income: North Dakota Medicare Savings Programs

North Dakota residents who have Medicare can also qualify for Medicaid assistance through Medicare Savings Programs (MSPs), which help pay Medicare premiums, deductibles, and cost-sharing. North Dakota administers three tiers of MSPs. The Qualified Medicare Beneficiary (QMB) program covers Medicare Part A and Part B premiums, deductibles, and co-payments for individuals with income up to 100% FPL ($15,960 per year for a single person in 2026). The Specified Low-Income Medicare Beneficiary (SLMB) program covers the Medicare Part B premium only for individuals with income between 100% and 120% FPL (up to $19,152 per year for an individual in 2026). The Qualifying Individual (QI) program covers the Part B premium for individuals with income between 120% and 135% FPL (up to $21,546 per year for an individual in 2026). All three MSP tiers use the same $3,000 individual/$6,000 couple asset limit as SSI-linked Medicaid in North Dakota. Low-income Medicare beneficiaries who qualify as dual-eligibles (both Medicare and full Medicaid) get additional benefits including Medicaid coverage for long-term care services not covered by Medicare. Apply for North Dakota MSPs through the same applyforhelp.nd.gov portal or call (866) 614-6005.

Read the Medicare eligibility and dual-eligible guide

Frequently Asked Questions