Medicaid Eligibility in North Dakota: Income Limits & How to Apply

Medicaid Eligibility in North Dakota

Under the ACA's Medicaid expansion, North Dakota residents earning up to 138% FPL can enroll in ND Medicaid. For a single adult, that's roughly $21,597 annually; for a four-person household, the cutoff is about $44,367 in 2026.

The following residents are eligible for ND Medicaid:

• Adults aged 19-64 with income up to 138% FPL
• Children in families with income up to 200-300% FPL (varies by age)
• Pregnant women with income up to 185-200% FPL
• Seniors and people with disabilities who meet income and asset requirements

About ND Medicaid

If you're a North Dakota resident looking for affordable health coverage, you have two main options: ND Medicaid or marketplace subsidies through HealthCare.gov. ND Medicaid has expanded its eligibility, so adults with household incomes up to 138% of the Federal Poverty Level (FPL) can qualify. For a single person, this means an annual income of about $20,783, and for a family of three, around $35,221 (based on 2024 FPL figures, which are typically updated in April). Children can qualify with higher household incomes, up to 205% of the FPL. Pregnant women can also qualify with incomes up to 175% of the FPL, and their coverage continues for 12 months postpartum. Other groups like seniors and individuals with disabilities may also be eligible under different rules, though these groups may have asset limits, unlike the expansion group. As of 2024, approximately 110,000 people in North Dakota are covered by Medicaid, demonstrating it's a significant and active program.

If your income is just above the ND Medicaid cutoff, you might still find affordable coverage through HealthCare.gov. You could qualify for marketplace subsidies, also known as premium tax credits, which significantly lower your monthly health insurance payments. For example, North Dakota's benchmark Silver plan is around $554 per month. With subsidies, your actual payment could be much lower, depending on your income. It's important to remember that changes in your income can shift your eligibility between ND Medicaid and marketplace subsidies, so reporting any income changes promptly is crucial. North Dakota saw a decrease in Medicaid enrollment after the end of continuous coverage requirements that were in place during the pandemic, with nearly 63,000 people disenrolled during redetermination. If you were among those who lost coverage, you can reapply for ND Medicaid at any time.

ND Medicaid provides comprehensive benefits with no premiums or out-of-pocket costs like co-payments, co-insurance, or deductibles for most services. This can include doctor visits, hospital stays, immunizations, pregnancy and newborn care, emergency services, and mental health and substance use treatment. North Dakota also offers several Home and Community-Based Services (HCBS) waivers designed to help elderly and disabled residents receive care in their homes or communities rather than in nursing facilities. A unique benefit under some waivers is "family personal care," which allows a family member, such as a spouse or adult child, to be paid for providing care. Additionally, North Dakota has specific Medicaid programs for children with disabilities, including a buy-in program, and waivers for medically fragile children and those with intellectual or developmental disabilities.

When navigating ND Medicaid, be aware that while there's no limited enrollment window, eligibility rules are updated annually on April 1st. For certain coverage groups, particularly for the aged, blind, and disabled, there are asset limits of $3,000 for an individual and $6,000 for a couple. If you're applying for long-term care, a 60-month "look-back" period for asset transfers is in effect, and transfers for less than fair market value could result in a penalty period. It's always a good idea to provide thorough documentation of your income and assets when applying to avoid processing delays. Your concrete action step is to visit HealthCare.gov or the North Dakota Department of Health and Human Services website to use their eligibility tools or apply.

North Dakota Medicaid Income Limits 2026

The following table shows the key income thresholds for North Dakota in 2026:

If your household income falls below the 138% FPL column, you qualify for ND Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.

North Dakota's average benchmark premium of $554/month is near the national midpoint. For residents earning between 100-400% FPL, premium tax credits offset most of this cost.

Marketplace Insurance in North Dakota

North Dakota residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in North Dakota costs approximately $554/month for a 40-year-old in 2026.

Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in North Dakota might pay after subsidies:

These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.

North Dakota uses the federal marketplace at HealthCare.gov for ACA enrollment. When you apply, the system automatically checks your Medicaid eligibility — if you qualify, your application is forwarded to the state Medicaid agency.

North Dakota adopted Medicaid expansion, bringing ND Medicaid coverage to low-income adults who previously had no affordable option. The transition between Medicaid and marketplace coverage is handled through HealthCare.gov.

How to Apply for ND Medicaid

1. Online application — Start at HealthCare.gov. Your Medicaid eligibility is checked automatically when you enter your income details.
2. State Medicaid office — Apply directly through North Dakota's Medicaid agency at any time during the year. Unlike marketplace insurance, Medicaid has no enrollment deadline.
3. Phone assistance — Call North Dakota's Medicaid helpline for guided help completing your application.
4. In-person help — Visit your county human services office or a local navigator for face-to-face support.

Have the following ready: recent pay stubs or tax returns, proof that you live in North Dakota, Social Security numbers for everyone in your household, and details on any existing health insurance.

Frequently Asked Questions

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