Written by a parent, not a doctor. Nothing here is medical advice.

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North Dakota program

Free health insurance for your child (North Dakota Medicaid)

North Dakota’s free Medicaid plan for children under 19. It can sit behind insurance you already have.

What it is

North Dakota’s free Medicaid plan for children under 19. It can sit behind insurance you already have.

A drop in pay can open this door even if your child has work insurance. The zone office checks your child’s household and current monthly income. Your child does not need a disability decision for ordinary Medicaid.

Eligibility rules
  • Children qualify through age 18 and must live in North Dakota. Citizenship or qualified noncitizen rules apply.
  • The state decides who belongs in your child’s tax household and which income counts. Dividing yearly income by 12 gives only an estimate.
  • From April 1, 2026, the monthly child Medicaid limits for a household of three are $3,461 at ages 0–5 and $3,142 at ages 6–18; for four they are $4,180 and $3,795. These amounts already include the five-point allowance. The zone checks the child’s actual Medicaid household and countable income.
What you get
  • No premium or child copays for covered hospital care, cancer treatment and medicines.
  • Dental, vision and help getting to covered appointments.
  • Earlier eligible bills can be covered.
What the help includes
  • Home nursing needs its own assessment and approval. EPSDT covers medically necessary care within federal Medicaid benefit categories for children under 21.
  • For a Medicaid-covered, properly authorized service from an enrolled provider, work insurance pays first. The provider cannot bill you its remaining deductible, copay or coinsurance just because Medicaid pays less or pays $0. A client share specifically assigned by Medicaid can still be owed. Noncovered care is different: advance written notice and agreement to pay may be required, and billing or authorization mistakes do not automatically become your bill.
  • Worked example: the work plan allows $8,000, pays $5,000 and leaves $3,000 to your deductible. Medicaid's own rate is $4,000, so it pays nothing extra. The hospital writes off the $3,000 and you owe $0.
If you decide to apply
  1. Discuss child Medicaid with your hospital social worker. If you decide to pursue it, they can help with the next step.
  2. Have your child’s ID, Social Security number, address, current pay, insurance cards and earlier bills ready.

Human service zone or North Dakota HHS, 866-614-6005 · Official page ↗

After you ask
  • The usual decision standard is 45 days, or 90 days when a disability decision is pending, with unusual-circumstance exceptions.
  • Bills from up to three months before you apply can be covered through 2026, and two months from January 2027, for months your child was eligible.
  • Children under 19 generally receive 12 months of continuous Medicaid or CHIP eligibility. An income increase alone does not end that period. Limited exceptions include moving out of state, turning 19, voluntary withdrawal, death, or an erroneous eligibility decision involving agency error or fraud. The zone confirms the child’s coverage dates and any exception.
  • If you decide to proceed, ask the hospital financial counselor to help with the Self-Service Portal or a human service zone application.
Good to know

Work insurance pays first. Having both plans can help with treatment costs, but each plan’s care and billing rules still matter.

Other details
  • A qualified hospital’s trained worker can assess temporary hospital presumptive eligibility for a child who is not already on Medicaid or other minimum essential coverage. It begins on the determination date, not retroactively. Without a timely full application it ends on the last day of the next month; with one, it continues until the full Medicaid decision.
  • Keeping both plans costs the work premium and means managing two insurers. The hospital can check both plans against the cancer team before any coverage change.

Federal background: Medicaid. · Medicaid with another insurer.

Official sources
Ask your social worker

“Could adding Medicaid reduce our child’s bills, and what would managing two plans involve? If you think it would help, could you help us apply?”

Why I’m asking: I want treatment covered without losing access to our child’s cancer team.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on the portal, report this month’s income and any insurance, and name the months that already have bills.

Your social worker

The oncology social worker or hospital financial counsellor helps you file and chases the 45-day decision.

The care team

Nothing for ordinary child Medicaid. Medical records matter only for the disability routes.

Who decides
Your human service zone office checks income and North Dakota Health and Human Services runs the cover.
Ask your social worker
“Can you help me file for ND Medicaid today, list the bills from the last three months, and ask whether this hospital can open temporary Medicaid while we wait?”

How to apply

First step: Apply on the Self-Service Portal at dhsbenefits.dhs.nd.gov this week, or call 866-614-6005.

  1. Apply on the Self-Service Portal this week, or call 866-614-6005.
  2. List the months that already have bills, so the look-back covers the admission.
  3. Ask the hospital financial counsellor whether they can open temporary Medicaid for your child now.

Official application / program page ↗

Where it starts: Apply on the Self-Service Portal, or call 866-614-6005, or take the form to your human service zone office. Ask the hospital’s financial counsellor the same week whether they can open temporary Medicaid for your child.

What to gather

  • Your child’s birth certificate or ID and Social Security number
  • A North Dakota address
  • This month’s pay for each parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: The rules give the zone office 45 days, or 90 if a disability decision is pending. Once approved, cover reaches back up to three months before the month you applied.

What a yes looks like

A notice with the dates the cover starts and ends, and a card for your child. Cover then runs up to 12 months.

What a no looks like, and the next move

Read whether the no was about income, a missing document or the wrong category. If it was income, ask about CHIP and about the Children with Disabilities buy-in by name, and appeal by the date on the notice.

Watch out

  • North Dakota counts the tax household and this month’s income, not last year’s return or everyone under the roof.
  • Do not cancel a work plan to apply. Medicaid pays after it and both can run at once.
  • The line is different for a child under 6 and a child of 6 or older, so a birthday can change the answer.

Dates that change this

2026-04-01: The income table is the one North Dakota published as effective April 1, 2026. The state did not publish when the next one lands, so check the eligibility page before relying on a figure near the line.

2027-01-01: Coverage reaches back up to three months before the month you apply now. North Dakota says that becomes two months for applications made on or after January 1, 2027.

2026-09-11: The rules let a hospital open temporary Medicaid for a child, and the child does not have to be admitted. Which North Dakota hospitals do it was not published, so ask your hospital’s financial counsellor by name. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full North Dakota Medicaid with no premium. For four people the line is $4,180 a month from birth through age 5 and $3,795 from age 6 through 18.

  • $4,180/month — Birth through age 5, household of 4, published line (152% of poverty, allowance included)
  • $3,795/month — Ages 6 through 18, household of 4, published line (138% of poverty, allowance included)
  • $3,142/month — Ages 6 through 18, household of 3, published line
  • $3,461/month — Birth through age 5, household of 3, published line

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Medically necessary care for a child under 21 within federal Medicaid benefit categories, even if the state does not cover that service for adults · Private duty nursing and home health when approved · Rides, and meals and lodging for overnight travel · Dental and vision

Legal protection: Children under 19 generally have 12 months of continuous eligibility; an income increase alone does not end that period. Limited exceptions include leaving the state, turning 19, voluntary withdrawal, death, and an erroneous decision involving agency error or fraud.

What it costs the family: No premium and no enrolment fee for a child.

The eligibility facts, as published

Age
birth through age 18, including the nineteenth-birthday month under the application guide
Age max exclusive
19
Income
MAGI budget group; published lines of 152% of poverty birth to 5 and 138% ages 6 to 18, both with the five-point allowance already inside the printed dollars (NDAC 75-02-02.1-40, 75-02-02.1-39.1)
Insurance status condition
none: other insurance can stay and Medicaid pays after it
Residency
North Dakota; the child must be a United States citizen or a qualified noncitizen
Continuous eligibility
12 months for children under 19, subject to limited exceptions; income increases alone do not end that period
Retroactive months
3 now; North Dakota says 2 from 2027-01-01
Processing standard
45 days, or 90 days with a disability decision pending, except in unusual circumstances (NDAC 75-02-02.1-03)

Decisions this site cannot make: Human service zone MAGI decision · Hospital presumptive eligibility for a child

Expect friction on: Rural human service zone offices are small and the file often moves by phone

The trap: North Dakota counts the tax household and this month’s income. Do not cancel a work plan to apply: Medicaid pays after that plan and both can run together.

Where I read this

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