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

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North Dakota program

Medicaid with a monthly share of medical costs (client share)

Medicaid with a monthly amount your family owes toward covered medical costs.

What it is

Medicaid with a monthly amount your family owes toward covered medical costs.

If income is over the ordinary line, a child under 21 can still get Medicaid with a monthly share: the amount by which your income tops $2,049 a month for three people. Medical bills you already owe can count toward it, so you do not pay it in cash first.

Eligibility rules
  • This medically needy route includes children under 21.
  • From April 1, 2026, the monthly standard is $2,475 for four, $2,049 for three and $1,623 for two. It is 90% of poverty.
  • There is no savings test for a child under 21 on this route. Part of a parent's income is counted as the child's; the zone works out the exact share.
What you get
  • Medicaid coverage with an assigned monthly share; eligible bills can meet it without cash payment first.
What the help includes
  • Income above the standard determines the share after the program’s calculation. It is not a simple maximum-income cutoff.
  • Older unpaid bills can offset at most $15 monthly, with conditions.
  • Work-plan premiums are deducted before the share is set. New bills count as soon as they arrive; old unpaid bills count only $15 a month. Coverage for the month starts once the share is met, so send bills to the zone promptly.
If you decide to apply
  1. Ask the human service zone to compare the client-share route with other Medicaid options.
  2. Have current income and itemized medical bills ready. If approved, send the medical-expense proof each month.

866-614-6005 — Your human service zone office · Official page ↗

After you ask
  • The zone’s notice states the share and who receives payment. Hospital billing can help send itemized bills to the zone.
Good to know

The notice names the doctors or hospitals you pay. The share is not a payment to the state.

Other details
  • Ordinary Medicaid and CHIP may avoid a monthly share. The comparison depends on age, income, disability and other coverage.

Federal background: Medically needy Medicaid.

Official sources
Ask your social worker

“Could our child get Medicaid through a monthly share, and how much would we still owe? Could you help us compare it with other routes and apply if it makes sense?”

Why I’m asking: I want to understand our real monthly cost before relying on this coverage.

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

Send the bills in each month and pay the share to the providers named.

Your social worker

The hospital billing office can send the itemised bills straight to the zone.

The care team

Records and letters when the application asks for them.

Who decides
Your human service zone office sets the monthly share and the notice names who to pay.
Ask the agency
“Please look at this application for the client-share route, and tell me what my share is and who I pay it to.”

How to apply

First step: Apply for Medicaid and ask for the client-share route by name, then send this month’s bills to your human service zone.

  1. Apply for Medicaid and say you want the client-share route looked at.
  2. Send the month’s medical bills to the zone office as they arrive.
  3. Pay the share to the providers the notice names, and keep the receipts.

Official application / program page ↗

Where it starts: Apply for Medicaid, then send the medical-expense proof to your human service zone.

What to gather

  • Itemised bills for the month
  • Insurance explanation-of-benefits letters
  • This month’s income

How long: The same 45-day Medicaid decision standard; the share is then worked out month by month.

What a yes looks like

A notice giving your monthly share and naming the providers to pay it to.

What a no looks like, and the next move

Ask which month was budgeted and which bills were counted; a heavy month can change the answer.

Watch out

  • The share is paid to the providers named on the notice, not to the state.
  • Older unpaid bills count only a little: up to $15 a month, with conditions.

The numbers and the rules

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

What it is worth

A monthly Medicaid client-share calculation uses a $2,475 standard for four people, effective April 1, 2026; eligible incurred bills and deductions matter.

  • $2,475/month — Client-share standard, household of 4 (90% of poverty)
  • $2,049/month — Client-share standard, household of 3
  • $1,623/month — Client-share standard, household of 2
  • $15/month — Maximum monthly offset for older unpaid medical bills

Covers: Full North Dakota Medicaid for the months the share is met

What it costs the family: The notice assigns a monthly share to medical bills. That liability can still be owed, but prepaying every bill is not a condition for recognizing the eligible month.

The eligibility facts, as published

Age
under 21
Income
the client-share standard is 90% of poverty; income above it sets the share rather than barring the route
Assets
The separate under-21 medically needy child category does not use the ABD $3,000/$6,000 resource test. ABD adds $25 for each additional unit member after exclusions. The zone identifies the coverage category and living arrangement; general parental-income responsibility can reach under 21, while ABD parental-asset rules concern disabled children under 18 and exclude stepparents.
Statute
NDAC 75-02-02.1-26, 75-02-02.1-41.1

The trap: You pay the client share to the providers named on the notice, not to the state. Only a limited amount of older unpaid bills counts: up to $15 a month, and only when you still owe it, have not used it before and nobody else paid it.

Where I read this

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