North Dakota Medicaid History and Facts

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Initial Medicaid Implementation: North Dakota implemented their Medicaid program in January 1966, among the first states to begin offering coverage. North Dakota participated in the Kerr-Mills program prior to the passage of Medicaid and offered generous benefits in comparison to other states. The state was one of only five states that were determined to have offered comprehensive health care services. The state continued these generous benefits when the program began offering every available service. Despite this existing history with the program, the state saw the lowest enrollment levels of any of the early adopters in Medicaid with only 2.5% of the population enrolling.

Key Medicaid Political Issues: North Dakota, like many states in the area, is largely rural so the issues of access to care for low-income rural populations is a key concern of the state. In recent years the generosity of the benefit has decreased with budget considerations which has caused reductions in reimbursements to providers. The most recent reauthorization of the Medicaid program was passed with a stipulation that the program would work to get the highest reimbursement rates but not to exceed the current rates in an effort to alleviate concerns of providers but maintain budget constraints.

Medicaid Expansion Implementation: North Dakota expanded their Medicaid program with enrollment beginning in October of 2013 and coverage beginning in January of 2014. The state was one of a handful of Republican controlled states that expanded coverage when it was first made available. Governor Jack Dalrymple in 2013 at the signing of the bill said “We try to leave the politics out in the hallway when we make these decisions. In the end, it comes down to are you going to allow your people to have additional Medicaid money that comes at no cost to us, or aren’t you?” he said. “We’re thinking, yes, we should.” The state took advantage of some flexibilities made available to help states speed and increase enrollment in Medicaid expansion. In 2016 the state reauthorized the Medicaid expansion program with little debate. The program is set to expire and need another reauthorization in 2019.

General facts about North Dakota Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthy Steps

Separate or combined CHIP: Combination

Medicaid Enrollment: 92,922 (2018)

Total Medicaid Spending: $1.2 billion (FY 17 Estimate)

Share of total population covered by Medicaid: 12% (estimate)

Share of Children covered by Medicaid: 28.6% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 50% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 21,000 (2018 estimate)

Work Requirement: No


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