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

Childhood Cancer Lantern
Search Saved

Federal, exists in every state

Other Medicaid routes when income is higher

Routes that consider disability, medical bills or assessed care needs when income-based coverage does not fit.

What it is

Routes that consider disability, medical bills or assessed care needs when income-based coverage does not fit.

North Dakota has Children with Disabilities coverage, a monthly client-share route and a Medically Fragile waiver. Each uses a different test. The disability buy-in counts parents’ income, while the waiver also requires a nursing-home level of care.

Different routes, different tests
  • Children with Disabilities coverage uses Social Security’s disability definition; documented acute leukemia can meet the childhood leukemia listing without a separate showing that ordinary daily activities are already severely limited. The state may still need medical records and an SSA or State Review Team disability determination. This route is for children under 19, counts parents’ income against a net-income standard of 250% of poverty and has no savings test; the administrative rule includes the month the child turns 19. Meeting the disability test does not by itself establish Medicaid financial eligibility or the waiver’s nursing-facility care level.
  • The usual premium is 5% of gross countable income, distinct from the net-income eligibility test. The state may offset health-insurance premiums the family pays for coverage that includes the child. The worker calculates the premium and offset; qualifying Indian members are exempt from this cost sharing. If an employer pays at least half the premium for coverage of the child, that coverage must also be taken.
  • Client share is available for children under 21. The zone calculates the share monthly against a standard of 90% of poverty.
  • The Medically Fragile waiver requires a nursing-facility level of care. Waiver approval and the Medicaid application are separate.
What you get
  • Other paths to Medicaid when your child meets their income, disability or care rules.
What the assessments mean
  • Social Security’s disability test and the waiver’s care-level test are different. A cancer diagnosis alone does not establish the waiver’s care level.
If you decide to apply
  1. Ask your human service zone or the hospital enrollment specialist to compare these routes with ordinary child coverage.
  2. Bring current income, medical bills and the care team’s records of your child’s daily needs.

Human service zone or hospital enrollment specialist, 866-614-6005 · Official page ↗

If you decide to ask
  • Ask the zone to name the coverage category, the costs and any missing medical evidence in writing.
Good to know

Do not assume a disability route ignores parents’ income; some do, some do not.

Questions about the waiver
  • The federal waiver approval says ages 3 to 21; the state page says 3 through 20. The waiver office can explain the final year and current waiting list.

Related North Dakota cards: Children with Disabilities coverage, client share and the Medically Fragile waiver.

Official sources
Ask your social worker

“If ordinary Medicaid or CHIP does not fit, which other route is worth considering, and could you help compare costs and paperwork?”

Why I’m asking: We want to know the fallbacks.

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 which state option fits, confirm its application requirements and gather the requested financial and medical records.

Your social worker

Names the state's option and its phone number, and sends the medical application paperwork to the clinician who writes it.

The care team

Writes the medical application paperwork: diagnosis, treatment plan, daily care.

Who decides
The state Medicaid agency's disability unit
Ask your social worker
“Which option does this state have for a child with leukemia whose family is over the income limit: Katie Beckett, a buy-in, or SSI? Who on the team writes the medical application paperwork, and how soon can we file?”

How to apply

First step: Ask the hospital enrollment specialist which actual state Medicaid route fits and when to submit the required application.

  1. Ask which option the state runs for a child over income.
  2. File within two weeks while the medical evidence is fresh.
  3. Never drop a plan a buy-in requires.

Where it starts: The state's TEFRA, buy-in or SSI-linked application

What to gather

  • Pathology report and the oncologist's letter with the diagnosis date
  • The child's own accounts (most options test the child's money, not yours)
  • Pay stubs if the option charges a premium by income

How long: Up to 90 days by federal rule for a disability-based application. The state item says what is typical.

What a yes looks like

Medicaid behind your plan with a card, sometimes a premium notice, and a review date (often near the end of treatment).

What a no looks like, and the next move

“Over the child's savings”, “level of care not met” or “no such option here”. The letter names the test that failed, and each has its own appeal.

Watch out

  • The agency checks documented disability, the program's financial rules and any required care assessment separately. Do not assume a diagnosis satisfies every requirement.
  • The buy-in states (Colorado, Iowa, Louisiana, North Dakota, Texas) can require you to take an employer plan when the employer pays half the premium. Then the buy-in premium is often lower.
  • Spend-down (medically needy) is the last resort, not the first option.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 7, 2026.

What it is worth

Full Medicaid behind your plan, sometimes for a premium, in a family whose income is far above the ordinary line.

Covers: Full Medicaid benefit package · Home services through EPSDT and waivers once Medicaid is in place

Legal protection: Buy-in premiums and cost-sharing capped at 5% of income up to 200% FPL and 7.5% at 200–300%

What it costs the family: $0 in TEFRA states (Nevada excepted). A premium by income in buy-in states (Texas up to $230. Louisiana $0 to $35).

The eligibility facts, as published

State specific
yes
Non magi
yes
Disability standard
Where the route uses the SSI medical standard, documented acute leukemia is considered disabling for at least 24 months from diagnosis or relapse, or at least 12 months after transplant, whichever is later; financial and other program requirements still apply
Buy in ceiling
up to 300% FPL, state-selected
Employer plan rule
buy-in states may require enrollment in an employer plan that pays 50% or more of the dependent premium

Decisions this site cannot make: Child disability · Child's own finances (most options) · Level of care where the option requires it

Expect friction on: Medical packet · Separate agency desks

The trap: Separate requirements can include documented disability, financial eligibility and an assessment of care needs. Some routes count parental finances. Meeting one requirement does not establish eligibility.

What changes by state: Which option exists, whether there is a premium (buy-ins charge by income. Nevada charges for TEFRA), and the level-of-care standard.

Where I read this

← Back to your options