Stay Enrolled: Updates on SNAP and Medicaid

Starting Oct. 1, 2026, the definition of a qualified alien no longer includes refugees, asylees and others. 

If you entered under one of these statuses, but have now become a Lawful Permanent Resident, you must report this change to the Customer Service Center or a Human Service Zone office to keep your Medicaid.

Current Medicaid coverage can sometimes be backdated up to three months before the date members apply for coverage. 

Staring Jan. 1, 2027, Medicaid coverage will only be applied to up to one month back for Medicaid Expansion members and up to two months back for traditional Medicaid members. 

Current Medicaid coverage requires an annual redetermination.

Starting Jan. 1, 2027, Medicaid Expansion enrollees will complete a redetermination every six months. Tribal members are excluded from these requirements and will still have an annual redetermination. 

Starting Dec. 31, 2026, Medicaid Expansion adults must work, volunteer or attend educational activities 80 hours/month. 

Most ND Medicaid members will not be impacted by work requirements. The new requirements only apply to Medicaid Expansion members. 

People already meeting work requirements under the Temporary Assistance for Needy Families program (TANF) or the Supplemental Nutrition Assistance Program (SNAP) won’t need to do more. 

These work requirements do not apply to ND Medicaid Expansion members who are:

• Pregnant women
• Members with postpartum coverage
• Medically frail members
• Members who are participating in a substance use disorder or alcohol use disorder treatment program
• Parents/caregivers of children 13 and under
• Parents/caregivers to someone with a disability
• Members who are incarcerated or were released from incarceration within the past 90 days
• Current and former foster youth (under age 26)
• American Indians
• Veterans with total rated disabilities

To meet Medicaid’s work requirement, you must either work or participate in an approved activity:

• Employment
• Community service
• Participation in a work program
• Enrollment in an educational program at least half-time
  • A combination of these activities totaling at least 80 hours
• Members who work at least 80 hours per month, earning at least the federal minimum wage. Seasonal workers may average their income over the past six months

Those who lose coverage due to not meeting work requirements will not be able to get health care coverage through the federal Healthcare Marketplace.

When you help pay for your health care costs it is called “cost sharing.” 

Starting Oct. 1, 2028, some Medicaid Expansion members will need to help pay for their health care costs. 

You may be impacted if you make more than 100% of the Federal Poverty Level. Learn more about Federal Poverty Levels. 

Some services are not included in cost sharing, such as:

• Primary health care
• Prenatal and pediatric care
• Emergency services

Non-emergency ER visits will have cost-sharing.

• The basic SNAP work rule is not changing. You meet it by working or participating in an approved activity such as job training, education or community service.
• What is changing: who must actively show that you are meeting the work requirement.

Exemption Groups

If you are in one of these groups, you do not have to meet the work rule:

• People already working at least 20 hours a week or meeting work requirements for another program (TANF or unemployment compensation)
• People unable to work due to a physical or mental limitation
• People participating regularly in an alcohol or drug treatment program
• People studying in school or a training program at least half-time (but college students are subject to other eligibility rules)
• People who are pregnant
• People who are members of federally recognized American Indian or Alaska Native tribes, including those recognized as California Indians under federal law

Work Proof Groups

Starting Oct. 1, 2025, if you do not fall into one of the exemption groups (above) but still fall into one of these groups (below), you must provide proof of meeting the work rule:

• Adults age 18–64 without dependents
• Parents whose youngest child is 15 or older
• Individuals experiencing homelessness
• Veterans
• Young adults (age 18–24) formerly in foster care
• Residents of Rolette County or the Turtle Mountain Reservation

How to Meet the Work Requirement

To meet SNAP’s work requirement, you must either work or participate in an approved activity.

• Work can include:
  • Paid employment (hourly wages, salary or self-employment)
  • In-kind work (work performed in exchange for goods/services, if documented)
  • Unpaid work experience or on-the-job training (if part of an approved employment/training program)
• Other approved activity includes:
  • Community service
  • Education

Once you have received SNAP assistance for 3 months, and if you are in one of the groups that must meet the work rule, you must provide information to stay eligible for SNAP.

You can do this by giving us:

• Pay stubs, letters or other proof you are working
• Verification from your school, job training, or volunteer program that you are in an approved activity 

• Refugees, asylees and Special Immigrant Visa (SIV) holders will no longer qualify for SNAP.
• If you entered under one of these statuses but have now become a Lawful Permanent Resident, you must report this change to the Customer Service Center or your local Human Service Zone office to keep your benefits.

U.S. Congress passed the One Big Beautiful Bill Act. It was signed into law on July 4, 2025. This law requires changes to North Dakota's Medicaid program. 

If you still qualify for Medicaid after the changes go into effect, you can keep seeing your same doctor and clinic.

You may be able to buy coverage through the federal Health Insurance Marketplace. You may also be able to get coverage through your job. 

In North Dakota, Federally Qualified Health Centers provide care on a sliding-fee scale, so you pay based on your income. Find a Federally Qualified Health Center near you. 

You can also contact the ND Navigators to help you explore affordable health insurance options through the Health Insurance Marketplace. Call 1-800-233-1737 or email NDnavigators@MinotStateU.edu.

You can contact the Customer Support Center toll-free 866-614-6005, 711 (TTY). The person who answers the phone will be able to connect you to translation services at no cost to you. 
 

Your children may still get Medicaid even if you don’t. The rules for children are different than for adults, and many children can stay covered based on your family’s income and their age. You’ll need to reapply or update your information to find out if they still qualify.

North Dakota is well-positioned to respond to the changes outlined in the federal law. At this time, North Dakota does not anticipate a cut to benefits or services for people who remain eligible for ND Medicaid. 
 

HHS anticipates re-using systems we already have to track work requirements and connect people to employment supports where possible.

The new work requirements only apply to individuals eligible through Medicaid Expansion. People with disabilities usually use other coverage programs to apply for Medicaid. 
 

No. The six months redetermination requirements only apply to individuals eligible through Medicaid Expansion.
 

HHS is working to make sure these Medicaid changes are as smooth as possible for the public. This includes:

• Providing clear instructions and guidance for those affected
• Updating forms and online systems to reduce paperwork or errors
• Training staff so they can answer questions and help people submit required documents on time
• Communicating early with providers, partners and community organizations who support people receiving Medicaid

Our goal is to make it as easy as possible for applicants to know what they need to do to show they are still eligible for Medicaid.

We are waiting for federal guidance to fully understand the new law and how it will apply to Medicaid. As we get more guidance, we will update this webpage and communicate with members, providers, partners and community organizations. Check back often for updates.

Congress made changes to SNAP in the federal budget. These changes affect who must meet work requirements to stay eligible.

For SNAP, the basic work rule is not changing. What is changing is who must follow the rule.

To meet SNAP’s work requirement, you must either work or participate in an approved activity 20 hours per week.

This can include:

• Paid employment (hourly wages, salary or self-employment)
• In-kind work (work performed in exchange for goods/services, if documented)
• Unpaid work experience or on-the-job training (if part of an approved employment/training program)

Other approved activity includes:

• Community service
• Education

Certain groups who didn’t have to meet the work rule will now need to meet the work requirements. These new groups include adults age 55–64 without dependents, parents whose youngest child is 15 or older, people experiencing homelessness,  veterans, young adults formerly in foster care and residents of Rolette County and the Turtle Mountain Reservation.

The geographic exemption for Rolette County and the Turtle Mountain Reservation will end.

Previously, residents in these areas were exempt from the Able-Bodied Adults Without Dependents (ABAWD) time limit due to high unemployment rates. However, this exemption no longer applies. Residents in these areas must now meet the same work requirements as other SNAP recipients

If you need to meet the new work requirements and provide the needed documentation, you will not lose your benefits.  If you need to and do not, you will only receive three months of SNAP benefits in a 36 month period.

As a SNAP participant, it is your responsibility to provide accurate and timely proof that you meet the work requirement. This means:

• Submitting pay stubs, letters or other proof if you are working
• Providing verification from your school, job training or volunteer program if you participate in an approved activity
• Keeping records up to date and submitting them to the Customer Service Center or your local Human Service Zone office by the deadline provided.

Providing the correct documentation on time helps ensure your benefits continue without interruption.

If you’re unsure what counts as acceptable proof, contact the Customer Service Center or your local Human Service Zone office for help.

If you employ or supervise someone who receives SNAP, you may need to provide proof of their work or participation. This could include:

• A letter on company or organization letterhead confirming employment or volunteer participation
• Dates, hours and type of work or activity completed
• Contact information for the person who can verify the work or activity

This documentation helps SNAP participants show they meet the work requirement. Keep records accurate and up to date so participants can avoid delays in benefits.

If you have questions about what counts as acceptable proof, you or the participant can contact the Customer Service Center or your local Human Service Zone office for help.

Yes. Refugees, asylees, and Special Immigrant Visa (SIV) holders will no longer qualify for SNAP. These groups may still qualify for WIC if they meet program rules. Undocumented individuals remain ineligible for SNAP.

If you don’t provide the required documentation, your SNAP benefits could be delayed or stopped. Contact the Customer Service Center or your local Human Service Zone office as soon as possible. We can help you submit the information and may be able to prevent a break in benefits.

Eligibility staff will work with you to prevent unnecessary interruptions. Make sure you communicate with the Customer Service Center or local Human Service Zone office and submit any required documents as soon as possible.

Need help meeting the required hours?
You can participate in the SNAP employment and training program to help you learn skills and receive training, gain practical job-related experience and get assistance with job search activities to improve your employment prospects. The program can also help you pay for things like transportation, work clothes, tools, licenses and school materials.

Contact the Customer Support Center at 1-866-614-6005 to request a referral to one of North Dakota's employment and training partners.

Yes. HHS is coordinating with community partners, advocacy organizations and local offices to provide guidance and support. This includes help with completing forms, understanding approved activities and other assistance to maintain benefits.

HHS is working to make sure these SNAP changes are as smooth as possible for the public. This includes:

• Providing clear instructions and guidance for those affected
• Updating forms and online systems to reduce paperwork or errors
• Training staff so they can answer questions and help people submit required documents on time
• Communicating early with partners and community organizations who support people receiving SNAP

Our goal is to make it as easy as possible for applicants to know what they need to do to show they are still eligible for SNAP.

Contact the Customer Service Center or your local Human Service Zone office. They can explain the changes and help you understand what documentation you need.

Learn more about programs available to help you and apply online at hhs.nd.gov/applyforhelp. You may also call 211 to learn about more essential community services.