North Dakota program
Medicaid paying your work plan’s premium
Help from Medicaid with a private health plan’s premium when keeping that plan saves the state money.
What it is
Help from Medicaid with a private health plan’s premium when keeping that plan saves the state money.
Medicaid can compare the cost of your private plan with what it would otherwise spend on care. If the plan is cost-effective, Medicaid can pay its premium. Having Medicaid alone does not guarantee premium help.
Eligibility rules
- The person must already receive North Dakota Medicaid and be enrolled in a cost-effective plan.
- The comparison includes expected Medicaid payments, the premium, coinsurance and deductibles under NDAC 75-02-02.1-12.1.
What you get
- Payment of a qualifying private health plan’s premium.
What the help includes
- North Dakota can pay a private-plan premium when the person is enrolled in Medicaid and the plan is cost-effective. The Medicaid worker confirms in writing whether the whole family premium or only a portion is approved, who receives payment, when it starts and whether earlier premiums can be repaid.
If you decide to apply
- Discuss premium help with your hospital social worker. If you decide to pursue it, they can help with the next step.
- Have the premium, deductible, insurance card and plan benefits ready for the comparison.
Human service zone Medicaid worker, 866-614-6005 · Official page ↗
After you ask
- Your human service zone Medicaid worker confirms the application process, decision timing and any earlier-premium reimbursement. Useful records include the insurance card, who is covered, employer and family contributions, payroll deductions, benefits, deductible and cost sharing. The Medicaid third-party-liability unit can help route questions.
- If you decide to proceed, ask your human service zone Medicaid worker about cost-effective health insurance coverage.
Good to know
Payment requires Medicaid eligibility. Your social worker can include premium costs in the same coverage discussion.
Other details
- Two insurance plans still have their own care and billing rules. Premium help does not make every private-plan service Medicaid-covered.
Federal background: Medicaid premium assistance.
Official sources
“If our child receives Medicaid, could it pay some of our work premium? What would we need to keep or change, and could you help request the review if worthwhile?”
Why I’m asking: The work premium is another cost we may be able to reduce.
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 by name, with the premium, deductible and plan details to hand.
Your social worker
The Medicaid worker runs the comparison and says what they need.
The care team
Records and letters when the application asks for them.
- Who decides
- North Dakota Health and Human Services, comparing what the plan costs with what Medicaid would pay.
- Ask the agency
- “My child is on Medicaid and we pay a premium for a work plan. Will the state pay that premium under the cost-effective health insurance coverage rule?”
How to apply
First step: Ask your Medicaid worker at the human service zone whether the state will pay your plan premium, and ask them to write down what they need.
- Ask your Medicaid worker whether the state will pay your plan’s premium under the cost-effective coverage rule.
- Have the premium amount, the deductible and the plan name ready.
- Ask them to write down what they need from you and when they will answer.
Official application / program page ↗
Where it starts: Ask your Medicaid worker at the human service zone; no separate published form or line was found.
What to gather
- The plan name and the monthly premium
- The deductible and what the plan pays
- Your child’s Medicaid number
How long: Not published. Ask for a date when you ask the question.
What a yes looks like
The state agrees to pay the premium; ask in writing who it is paid to.
What a no looks like, and the next move
A cost comparison that did not come out in your favour. Ask what figures were used.
Watch out
- North Dakota publishes the power but not the process. There is no form or phone line to point you at.
- Medicaid eligibility and premium-payment approval are separate. Both coverage and premium questions can be discussed while eligibility is being reviewed.
Dates that change this
2026-09-11: The rule gives the department the power to pay a premium, but no form, phone line, decision clock or payment route was published, and "HIPP" is not a name North Dakota uses. Ask your Medicaid worker how to ask for it. (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
North Dakota Medicaid can pay a private plan’s premium for someone already enrolled in Medicaid.
Covers: The state paying a private health plan premium · Keeping a work plan and Medicaid running together
What it costs the family: Unknown; the amounts and the payment route were not published.
The eligibility facts, as published
- Who
- a person already receiving North Dakota Medicaid who is enrolled in a cost-effective health plan
- Test
- expected Medicaid payments for a set of covered services are likely to exceed the premium, coinsurance and deductibles
- Statute
- NDAC 75-02-02.1-12.1
The trap: North Dakota does not publish a form, a phone line or a decision time for this, and does not call it HIPP. Ask your Medicaid worker directly, and ask them to write down what they need.
Where I read this
- Administrative Code chapter 75-02-02.1, Eligibility for Medicaid — North Dakota Legislative Council, read September 10, 2026
- Medicaid Eligibility — North Dakota Health and Human Services, read September 10, 2026