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Who is eligible?

Medicaid provides coverage to:

  • Low-income individuals from birth
  • Children in foster care or subsidized adoption
  • Former foster care children up to age 26, under certain circumstances
  • Children with disabilities (birth to19)
  • Pregnant women
  • Women with breast or cervical cancer
  • Workers with disabilities
  • Other blind and disabled individuals
  • Low-income Medicare beneficiaries (Medicare Savings Programs).

Most children under age 19 become continuously eligible for Medicaid. That is, once they are determined eligible, they stay eligible for up to 12 months without regard to changes in circumstances. Similarly, most pregnant women who become eligible remain eligible through their pregnancy and for at least 60 days after the pregnancy ends.

Medicaid coverage may begin up to 3 calendar months prior to the month of application.

Medicaid Eligibility Requirements (starting January 2014)

The following is a general outline of Medicaid Program eligibility requirements.

State Residence

You must be a state resident to qualify for Medicaid through North Dakota.

Citizenship

You must be a United States citizen or an alien who is lawfully admitted for permanent residence. Some lawfully admitted aliens may have to wait for five (5) years before full Medicaid benefits are available, however, there is no waiting period for coverage of emergency services.

Asset Limits

There is no asset limit for children, families, or pregnant women in the Children and Families coverage group, the Adult Expansion Group (individuals between the ages of 19 and 65), or the Women's Way program. Generally, a person who is blind, disabled, or age 65 or older can have up to $3000 in countable assets (such as savings accounts, checking accounts, stocks, bonds, or other type of asset) to qualify for Medicaid. The limit for couples is $6000. For each additional person in the household, $25 can be added to the asset limits. Individuals who qualify for the Workers with Disabilities coverage are allowed an additional $10,000. Those requesting eligibility under the Medicare Savings Programs have an asset limit of $7,160 for a one-person unit or $10,750 for a two-person limit.

Spousal Impoverishment Prevention Coverage

This coverage applies to couples where one needs Nursing Care Services in a facility or at home. The spouse receiving the nursing care services is allowed $3000. The spouse who remains in the community is entitled to keep half of the couple's countable assets, but not less than $23,448 and not more than $117,240 for calendar year 2014 (adjusted every January). The spouse receiving the nursing care services may keep up to $65 of their monthly income and may deem income to bring the income of the spouse in community up to $2,267 per month and any dependent household members up to $630 (adjusted every July).

Assets that are not counted:

Your home, one automobile, burial plans (with limits), self-employment property (including tools, equipment and livestock), non-saleable property, personal effects and clothing, household goods and furniture, Indian trust and restricted lands, and per capita and judgment funds. Other miscellaneous assets may also be excluded.

Income:

Depending on the amount of net income, individuals may be eligible for full Medicaid benefits or may be responsible for a portion of their medical bills which is called their recipient liability. Children who are not eligible for full Medicaid benefits may be eligible for Healthy Steps or the Caring for Children Program.

Those eligible under the new Adult Expansion group, families with children, and pregnant women are subject to MAGI (Modified Adjusted Gross Income) rules. MAGI rules differ from traditional Medicaid in that household size is based on tax filing status, and treatment of income is based on Modified Adjusted Gross Income.

The following expenses are allowed for those aged and disabled individuals subject to non-MAGI rules:

Individuals in a nursing home are allowed to keep $65 of their monthly income to meet their personal needs. They also keep enough to cover their health insurance premiums and certain other expenses. If the individual has a family at home with lower income, the individual can give some of his/her money to the family at home.

Individuals residing in an Intermediate Care Facility (ICF) are allowed $100 to meet their personal needs. They also keep enough to cover their health insurance premiums and certain other expenses.

General Medicaid Income Levels, Effective April 1, 2014

Family Size Full Coverage for Entire Family

Medically Needy -
Aged, blind, disabled & families who may be responsible for a portion of their medical bills

Children and Adults Age 6 to 64

Pregnant Women and Children to Age 6
1
$517 $807 $1,342 $1,478
2
$694 $1,088 $1,809 $1,992
3
$871 $1,369 $2,276 $2,507
4
$1,048 $1,650 $2,743 $3,021
5
$1,226 $1,930 $3,210 $3,535

 

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Income levels are revised annually.

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