Cost and Coverage of Medicaid in North Dakota

How much is Medicaid in North Dakota? North Dakota Medicaid cost estimates is a concern for many interested Medicaid applicants when applying for health care coverage. How much does Medicaid cost in North Dakota depends on different factors. Several types of Medicaid insurance in North Dakota only cover certain health care services.

To find out more about the health care program including what services are covered by Medicaid in North Dakota, read the following topics:

  • How much does Medicaid cost in North Dakota?

  • What services are covered by Medicaid in North Dakota?

  • What does Medicaid not cover in North Dakota?

  • Types of Medicaid insurance in North Dakota

How Much Does Medicaid Cost in North Dakota?

Medicaid cost estimates in North Dakota vary depending on the plan, services sought and eligibility of the individual. Some North Dakota Medicaid coverage provides services free of charge, while others require co-payments. What services are covered by Medicaid free of charge? Free health services include inpatient and outpatient hospital services, Hospice care, family planning services, emergency services and therapies.

How much is Medicaid in ND? ND Medicaid co-payments vary for different services. Majority of co-payments charges are free or only a few dollars. Some health care services require a $100 in co-payment. The Medicaid coverage rates changes annually. Therefore, it is important to confirm costs with your health provider before requesting any service.

What services are covered by Medicaid in North Dakota?

ND Medicaid coverage takes care of specific medical services. However, some Medicaid coverage services have restrictions or limitations. As you go through what is covered by Medicaid, keep in mind that not all services you receive are free of charge. Payment for medical services receive but not covered by Medicaid are the responsibility of the beneficiary. North Dakota Medicaid coverage caters to the following medical services and items:

  • Inpatient and Outpatient hospital services. Inpatient services covered include lab and therapy, X-rays, operating and delivery room, supplies and equipment, regular nursing services.Outpatient services covered include outpatient surgery, drugs, therapies, X-ray, lab, emergency room services and supplies.

  • Nursing facilities. Services covered include durable medical equipment, wheelchairs, general medical supplies, therapies, room and board and nursing care.

  • Rural health clinics. Covers supplies provided under the direction of a physician and outpatient medical services.

  • Physicians. Covers medical and surgical services offered by a doctor, X-ray and laboratory tests needed for diagnosis and treatment, and drugs and supplies given at a physician’s office.

  • Prescription Drugs. Covers many, but not all, prescription drugs, devices, supplies, family planning prescriptions and insulin. Patients need to have a prescription from a doctor. A pharmacist can tell you whether a particular drug is covered by ND Medicaid.

  • Health Tracks (EPDST). Covers diagnostics and screening services to determine mental and physical status of an individual. Also covers vaccinations and orthodontia that are medically necessary for children younger than 21 years of age.

  • Home Health. Covers medical supplies, therapy and nursing care provided at a recipients’ home. A physician must order the care for coverage.

  • Durable Medical Supplies and Equipment. Covers medical equipment and supplies such as catheters, oxygen and reusable equipment. The items covered must be medically necessary.

  • Mental Health. Covers psychological and psychiatric evaluations, residential treatment centers services, inpatient psychiatrist, partial hospitalization services, individual/group/family psychotherapy and inpatient services in a psychiatric unit of a hospital for members that are younger than 21 years of age.

  • Vision. Covers exams, frames, glasses and a number of hard contact lenses for correction of various conditions. Medicaid members only receive replacement glasses after a minimum of one year for children younger than 21 years of age and two years for adults, if a lenses change is medically necessary.

ND Medicaid coverage also applies dental, hospice, family planning, sterilization, ambulance, transportation, therapies and medically necessary out-of-state services. The covered Medicaid services may change from time to time.

What does Medicaid not cover in North Dakota?

What does Medicaid not covered when seeking health care services? Generally, ND Medicaid coverage excludes electoral or non-standard items or services. Services not included in Medicaid coverage except under special circumstances include:

  • Payment for a private room in a basic care facility and nursing facility.

  • Payment to an ICF/MR, swing bed or a bed in a nursing facility, unless specifically provided for by the Department of Human Services (DHS).

  • Biological drugs that have been determined to be less than effective by the federal government (DESI drugs).

  • Experimental drugs, procedures or services.

  • Health services that the recipient has not received in the past.

  • Services in a public institution, state hospital or an institution for mental disease for North Dakota residents that are between 21 and 65 years of age.

  • Alcoholic beverages, vitamins, nutritional items, food supplements, home remedies or over-the-counter drugs, except those that have been prescribed for by a doctor.

  • Services or items provided by members of the recipient’s household or immediate relatives

  • Services or items that the dental consultant, optometric, DHS Medical or the peer review organization deem as not medically necessary.

  • Printers, computers and computer hookups, except those used as assistive communication devices.

Types of Medicaid insurance in North Dakota

There are different types of Medicaid insurance in North Dakota available for beneficiaries. When signing up for North Dakota Medicaid coverage, families with children and pregnant women will have to choose a primary care provider. The provider will take care of all their health needs and make referrals to specialists when necessary. Other recipients do not have to choose a primary care provider.



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