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

Childhood Cancer Lantern
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North Dakota program

Medicaid for a child with a disability

Medicaid for a child under 19 who meets Social Security’s disability test, with a monthly premium.

What it is

Medicaid for a child under 19 who meets Social Security’s disability test, with a monthly premium.

This route reaches a higher income than ordinary child Medicaid. It still checks parents’ income and needs a disability decision. A cancer diagnosis alone does not settle every part of eligibility.

Eligibility rules
  • The child must meet Social Security’s disability definition. The state may need an SSA or State Review Team disability determination. Acute leukemia can meet the childhood listing without separate proof of severe daily limitations. The rule covers children under 19, including the month of the nineteenth birthday. Financial eligibility remains a separate test.
  • The line is $5,692 a month for three people and $6,875 for four, after the program's deductions from your pay, so a family a little over on gross pay can still fit.
What you get
  • Full Medicaid, with a monthly premium of 5% of the family income the program counts before tax.
  • No savings limit and no enrollment fee.
What the help includes
  • The usual premium is 5% of gross countable income, not 5% of the net amount used for the income test. The state may offset health-insurance premiums you pay for coverage that includes your child. The worker calculates the premium and any offset. Qualifying Indian members are exempt from this cost sharing.
If you decide to apply
  1. Discuss Children with Disabilities coverage with your hospital social worker. If you decide to pursue it, they can help with the next step.
  2. Useful records include current income, work-plan details, and medical records with diagnosis, relapse and transplant dates.

Human service zone, 866-614-6005 · Official page ↗

After you ask
  • A disability decision can take up to 90 days, subject to exceptions. Medical records include diagnosis, relapse and transplant dates. After the listing period, ongoing effects can still support disability.
  • If you decide to proceed, ask your human service zone for Children with Disabilities coverage on the Medicaid application.
Good to know

When a parent’s employer offers child coverage and pays at least half the premium, that coverage must be taken.

Other details
  • This is a higher income ceiling, not a route that ignores parental income. Ordinary free Medicaid is worth comparing first.
Official sources
Ask your social worker

“Could the disability route cover our child, and what premium and extra insurance obligations would we have? Could you help us compare it with free coverage before applying?”

Why I’m asking: I want to know whether broader coverage would be worth the monthly premium.

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

Ask for it by name, and hand in the records the oncology team writes about daily function.

Your social worker

The oncology social worker gathers the medical records and follows the disability decision, which can take up to 90 days.

The care team

The team writes what the child cannot do day to day, not just the diagnosis.

Who decides
Your human service zone office on income, and Disability Determination Services on the disability question.
Ask the agency
“Please look at this application for Children with Disabilities Medicaid coverage as well, and tell me what the premium would be.”

How to apply

First step: If you decide to pursue this route, the zone handles the Children with Disabilities request and the oncology team supplies the relevant medical records.

  1. Ask for Children with Disabilities coverage by name on the Medicaid application.
  2. Ask the oncology team for the records that describe what your child cannot do day to day, not only the diagnosis.
  3. Tell the office what you already pay for private cover for your child; it comes off the premium.

Official application / program page ↗

Where it starts: Apply for Medicaid and ask for Children with Disabilities coverage by name. The same portal and phone line as ordinary Medicaid.

What to gather

  • Medical records documenting diagnosis, relapse or transplant dates and current treatment; function records when relevant
  • This month’s household income
  • What you pay now for private cover for your child

How long: Up to 90 days when a disability decision is pending.

What a yes looks like

A notice naming Children with Disabilities coverage, with the monthly premium worked out.

What a no looks like, and the next move

The notice identifies whether the issue is disability, net income or another requirement. The zone or social worker can review missing evidence, appeal dates and other named Medicaid routes.

Watch out

  • This counts parents’ income. It is a higher line, not a way around the line.
  • SSA disability definition, determined by SSA or the State Review Team; documented acute leukemia can meet listing 113.06 without a separate daily-function hurdle
  • If a parent’s employer pays at least half the premium for a plan that covers your child, the state expects that plan to be taken too.

Dates that change this

2026-09-11: Whether North Dakota also runs a Katie Beckett or TEFRA route, which would leave parents’ income out entirely, was not established: the state plan page did not open. Ask your human service zone about Katie Beckett 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

For four people, the April 2026 limit is $6,875 in countable net monthly income. A separate premium calculation uses gross countable income; there is no savings test.

  • $6,875/month — Household of 4, published line (250% of poverty)
  • $5,692/month — Household of 3, published line
  • $4,509/month — Household of 2, published line
  • $5/month — Monthly premium, as a share of the family’s gross countable income
  • $0 — Enrolment fee

Covers: The full North Dakota Medicaid benefit for a child, including EPSDT · Private duty nursing and home health when approved · Rides to treatment

Legal protection: No asset limit for this coverage

What it costs the family: The usual monthly premium is 5% of gross countable family income, with allowed credits for qualifying private coverage and an applicable American Indian cost-sharing exception. The zone confirms which premium payments qualify and the amount due; there is no enrollment fee.

The eligibility facts, as published

Age
under 19, including the nineteenth-birthday month
Age max exclusive
19
Disability standard
SSA disability definition, determined by SSA or the State Review Team; documented acute leukemia can meet listing 113.06 without a separate daily-function hurdle
Income
countable net family income up to 250% of poverty under non-MAGI rules; parents’ income can count, with allowed exclusions and deductions
Assets
no asset limit
Other insurance
if an employer of either parent offers cover for the child and pays at least half the premium, that cover must be taken
Statute
NDAC 75-02-02.1

The trap: Parents’ income can count, but the entry test uses countable net income. The premium uses gross countable family income. These are different calculations. Required employer coverage and allowable premium credits need a separate review.

Where I read this

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