Medical Services Division

The Medical Services Division administers the North Dakota Medicaid and CHIP programs, providing health care coverage to over 130,000 North Dakotans last year, including families and children with low incomes, older adults, and people with disabilities. North Dakota first implemented Medicaid in 1966. Today, ND Medicaid covers 1 in 7 North Dakotans, providing essential healthcare to people and families across North Dakota. 

ND Medicaid’s key priorities include: 

Investing in Value 

• Collaborate with providers to provide high quality care.

• Focus on service delivery strategies that improve outcomes.

• Prioritize reimbursement for high value services that achieve better outcomes, shift the cost curve and improve the care experience.

Services Closer to Home 

• Support community-based services and primary care that reduce the need for institutional care.

• Implement innovative care delivery models and technology that expands care to underserved areas.

Modernizing Infrastructure 

• Pursue automated and self-service technology.

• Invest in Medicaid technology and systems to enhance efficiencies and reduce administrative burden.

• Support investment in care delivery that improve quality and outcomes.

Streamlining Operations 

• Align resources to support our priorities.

• Continuously improve Medicaid coverage, policies, and guidance.

• Address health-related social needs through whole-person care.

Using Data Effectively 

• Data informs and drives Medicaid reimbursement, priorities, and resources. 

• Prioritize evidence-based practices in coverage and care delivery.

• Measure and reward incremental progress towards goals.

Key Functions

The Medical Services Division has two primary functions: to act as a payer and to act as a program administrator. As a payer, the Medical Services Division operates like a health insurance organization. This includes provider enrollment, claim adjudication and payment, clinical management, and program integrity. As a program administrator, the Division designs, implements, and evaluates programs for targeted populations and services.