Apply Online
Complete and submit an Application for Assistance for Medicaid (health care) coverage using our self-service portal.
On Paper
Complete the appropriate form below and return to a human service zone office. Find your local zone office. All applications are fillable .pdfs.
- If you are under age 65, not disabled, and you want Medicaid ONLY
- Application for Health Care Coverage and Help Paying Costs form (SFN 1909)
- español SFN 1909
- If you want to apply for Medicaid and also want to apply for help with food, cash assistance, or child care
- Application for Assistance form (SFN 405) and return it to a human service zone office.
- español SFN 405
- If you are aged, blind, or disabled, and you ONLY want Medicaid coverage, the Medicare Savings Programs, or coverage in a basic care facility
- Health Care Application for the Elderly and Disabled form (SFN 958).
- español SFN 958
By Mail
Contact the Customer Support Center at (866) 614-6005 or 701-328-1000; 711 (TTY), or a human service zone office and request an application by mail.
Application Assistance
NOTE: For free application assistance in person or virtually, call a ND Navigator at 800-233-1737 or visit their website. ND Navigators are a federally-funded enrollment assistance grant program and are not part of North Dakota Medicaid.
Additional Information
For information about public assistance programs, view the Application for Assistance Guidebook - Which contains IMPORTANT information about programs and client rights.