Do you need health coverage?
North Dakota Navigators can help you find and enroll in health insurance. Our assisters are local, unbiased, and helping to break down barriers to care. We are trained to understand the details so that you don’t have to, making the enrollment process easier and teaching you how health insurance works. We want all North Dakotans to have better access to healthcare.
What if I am low-income and can’t afford health insurance?
When you fill out an application on the Marketplace, if it looks like you might qualify for North Dakota Medicaid, your application will be sent to ND Medicaid for further review by an eligibility worker. Within a few weeks, you may be sent a letter asking for additional information, or stating that you are approved or denied Medicaid coverage, including a reason for denial.
If you have questions about your letter, Navigators can help you interpret the letter. However, we do not have access to your Medicaid account and can not provide any further information that what is in your letter. If you need additional information, contact ND Medicaid Customer Support Center at 1-866-614-6005 or applyforhelp@nd.gov.
If you are denied Medicaid, we can review your options on the Marketplace including Advanced Premium Tax Credits, which can help make the monthly cost of plans more affordable.
What are Medicaid and CHIP?
Traditional Medicaid, Medicaid Expansion, and the Children’s Health Insurance Program (CHIP} provide free or low-cost health coverage to those who are eligible.
Medicaid Expansion
Families and children with low incomes may be eligible for Medicaid Expansion. ND Navigators can assist with the enrollment application for Medicaid Expansion, including helping you gather additional information or appealing coverage denials. Navigators do not have access to your Medicaid account information and can not see the status of your Medicaid application. If you are approved, you will receive two insurance cards. Health insurance is managed through Blue Cross Blue Shield, and prescription coverage is managed through (Traditional/State) ND Medicaid.
Children’s Health Insurance Coverage
Eligibility for children’s coverage has higher income limits. Sometimes when your family applies for Medicaid, the adults in the household may be denied and the children (up to age 18) are approved. This is called the Children’s Health Insurance Program (CHIP). https://www.hhs.nd.gov/healthcare/CHIP Adults who are denied could look into plans through an employer. If plans aren’t available, adults could look on the Marketplace.
Traditional ND Medicaid
ND Medicaid provides additional income-based coverage for pregnant women, the elderly, and people with disabilities. Eligibility for traditional Medicaid includes submitting in-depth income and asset information. These applications need to be done through an eligibility worker at your local Human Service Zone. ND Navigators are not trained to assist with these enrollments.
You can apply for Medicaid and CHIP any time of year. More details for the ND Medicaid program can be found here.
What can North Dakota Navigators do if I need help with a Medicaid application?
ND Navigators can assist with applications for enrollment in Medicaid Expansion and CHIP. We can help you understand your household situation and what documents you will need to submit with your application. If you are denied Medicaid, we can also assist you with appealing the decision or finding other health coverage.
Note: Navigators are not fully trained in Medicaid eligibility. Traditional (State) Medicaid applications must still be processed with your local Human Service Zone or case worker.
What are the different types of North Dakota Medicaid coverage?
Medicaid Expansion
Medicaid Expansion was enacted in 2014. The program increased the number of people who are eligible for Medicaid financial assistance.Eligibility for Medicaid Expansion is income-based.Families that fall below 138% of the current Federal Poverty Level (FPL) for their tax household size are usually eligible for Medicaid Expansion (see chart below). Members don’t need to meet any age or disability requirements and do not need to claim assets.
Your family may be qualified for Medicaid Expansion if:
- You have qualifying incomes
- Are North Dakota residents
- Are U.S. citizens or qualified aliens
- Do not have other health insurance coverage (IHS is not health insurance)
Blue Cross Blue Shield
Medicaid Expansion
Traditional Medicaid
Traditional Medicaid provides coverage to qualifying individuals in the following groups:
- Individuals within income limits
- Children in foster care or subsidized adoption
- Former foster care children up to age 26, under certain circumstances
- Children with disabilities (birth to 19)
- Pregnant women
- Individuals with breast or cervical cancer
- Workers with disabilities
- Other blind and disabled individuals
- Low-income Medicare beneficiaries (Medicare Savings Programs)
Traditional Medicaid recipients must also meet asset limits. Enrollment in Traditional Medicaid should be done directly with an eligibility worker at your local Human Service Zone or online at
www.applyforhelp.gov.
Navigators may be able to answer some questions, but are not fully trained on Traditional Medicaid eligibility and asset limits.
Find your local Human
Service Zone here
Children’s Health Insurance Program (CHIP)
CHIP is intended to meet the needs of working families, who cannot afford health insurance coverage for their children, yet earn too much to qualify for Medicaid. CHIP is for children who do not have health insurance coverage. Household income levels are higher for CHIP than for Medicaid (210% of FPL).
Children may qualify for CHIP if they:
- Live in families with qualifying incomes
- Are North Dakota residents
- Are U.S. citizens or qualified aliens
- Do not have other health insurance coverage (IHS is not health insurance)
- Are 18 years of age or younger (Single 18-year-olds with eligible incomes may also apply)
CHIP coverage is for children only. The application is the same as for Medicaid. Parents who need health insurance coverage can contact ND Navigators to discuss other coverage options, such as plans on the Health Insurance Marketplace.
MORE INFO ABOUT CHIP
Medicaid (Expansion and Traditional) and CHIP Income Levels
Effective April 1, 2024 -Amounts listed in the table below are MONTHLY income levels for each category
| Family Size | Medicaid Expansion | Full Coverage for Entire Family | Medically Needy* | Children Ages 0-6 | Pregnant Women | Children Ages 6-19 |
|---|---|---|---|---|---|---|
| 1 | $1,732 | $517 | $1,130 | $1,908 | $2,197 | $2,573 |
| 2 | $2,351 | $694 | $1,533 | $2,590 | $2,981 | $3,492 |
| 3 | $2,970 | $871 | $1,937 | $3,271 | $3,766 | $4,411 |
| 4 | $3,588 | $1,048 | $2,340 | $3,952 | $4,550 | $5,330 |
| 5 | $4,207 | $1,226 | $2,744 | $4,634 | $5,335 | $6,250 |
*Aged, blind, disabled, and families who may be responsible for a portion of their medical bills
For additional eligibility details, visit https://www.hhs.nd.gov/healthcare
Where can I sign up for Medicaid and CHIP?
Looking for Medicare?
Medicare is health insurance coverage that is mostly for those 65 or older or people with disabilities. It isn’t part of the Health Insurance Marketplace. Medicare’s annual Open Enrollment Period is October 15 – December 7.
For questions or local help applying for Medicare, visit:
Contact information for North Dakota Medicaid and CHIP
Medicaid Member Case Information and Updates
Contact a Human Service Zone worker to change your case information, update contact info, or find ride options for medical appointments:
Call: 1-866-614-6005 711 (TTY)
Email: applyforhelp@nd.gov
Medicaid Member Questions about Billing and Coverage
For existing Medicaid members, if you have questions about covered services or claims:
Call: (Toll free): 1-877-328-7098
Email: mmisinfo@nd.gov
To fill out an application for ND Medicaid, start by making an account on the Self-Service Portal login here: https://www.hhs.nd.gov/applyforhelp/ssp-help
For questions or help filling out Medicaid Expansion applications, contact us through any of the options shown below.
For help with Traditional (State) Medicaid, contact 1-866-614-6005 or visit your local Human Service Zone
For more information about affordable healthcare plans or to request enrollment assistance, call us at 1-800-233-1737
or locally at 701-858-3580.
You can also email us at: NDNavigators@MinotStateU.edu
Health Insurance Marketplace
This grant is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,049,340 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS or the U.S. Government.