North Dakota Health and Human Services (HHS) is preparing to implement several federally required changes to the state’s Medicaid program over the next two years, including work requirements for some Medicaid Expansion members.
These new requirements are a result of the federal Working Families Tax Cut Act passed by Congress and signed into law on July 4, 2025.
Starting Jan. 1, 2027, adults ages 19 to 64 enrolled in Medicaid Expansion will be required to participate in work, an approved work or training program, volunteer or be enrolled in an education program for at least 80 hours per month to maintain their coverage, unless they qualify for an exclusion.
The new rules exclude certain individuals from having to meet work requirements, including Native Americans; parents, guardians or family caregivers of children ages 13 and under or to someone with a disability; people with special health needs that make it hard to work; pregnant women or members who were pregnant in the last 12 months; and veterans with a 100% disability rating, among others.
People already meeting work requirements under the Temporary Assistance for Needy Families program or the Supplemental Nutrition Assistance Program (SNAP) will not need to meet separate Medicaid work requirements.
“It’s important for our Medicaid Expansion members to know about these upcoming changes so they can prepare,” said HHS Interim Medicaid Director Krista Fremming. “I encourage members to make sure their mailing address, phone number and email address are up to date in our system, so they receive important information about their coverage.”
Most members will have their work requirements verified automatically using federal income data and other approved data sources. Members whose work requirements cannot be verified through these sources will be sent a letter requesting more information. HHS’ preliminary data shows that nearly half of North Dakota’s roughly 23,000 Medicaid Expansion members qualify for an exclusion. The new work requirements are estimated to affect about 5,000 to 7,000 members.
“We are working to make the reporting process as simple as possible for Medicaid Expansion members, as we want all members who qualify to stay covered,” Fremming said.
In the coming months, HHS, in partnership with Blue Cross Blue Shield of North Dakota (BCBSND), will be sending text and email messages to expansion members who have chosen to receive electronic communications, along with mailed letters in late August to raise awareness about the upcoming work requirements. BCBSND is the contracted administrator of the state’s Medicaid Expansion program.
HHS has created a webpage at hhs.nd.gov/StayCoveredND with information about work requirements and how members can update their contact information. This page will be updated regularly, so members, providers, stakeholders and other interested individuals should check it often.
Other upcoming changes
Work requirements are just one of several changes coming to North Dakota Medicaid. Other changes include fewer eligible statuses for Medicaid, shortened retroactive coverage periods, more frequent reviews and cost-sharing requirements for some Medicaid Expansion members. Learn more at hhs.nd.gov/stayenrolled.
About North Dakota Medicaid Expansion
North Dakota expanded Medicaid in January 2014 to provide health coverage to qualifying low-income, uninsured North Dakotans ages 19 to 64. To qualify, individuals must have incomes up to 138% of the federal poverty level, which is $22,025 for a single person and $29,864 for a household of two. Learn more at hhs.nd.gov/healthcare/medicaid-expansion.