North Dakota Medicaid Work Rules Affect Thousands Next Year

North Dakota Health and Human Services is preparing to roll out federally required changes to the state’s Medicaid program, including new work requirements for some Medicaid Expansion members.

The updates stem from the Working Families Tax Cut Act, signed into law on July 4, 2025. Beginning Jan. 1, 2027, most adults ages 19 to 64 enrolled in Medicaid Expansion must complete at least 80 hours per month of work, job training, education or volunteer service to keep coverage, unless they qualify for an exemption.

Exemptions include Native Americans; parents or caregivers of children 13 and under or individuals with disabilities; people with certain health conditions; pregnant individuals or those recently pregnant; and veterans with a 100% disability rating. Those already meeting work requirements through programs like SNAP or TANF will not have to meet separate Medicaid requirements.

“It’s important for our Medicaid Expansion members to know about these upcoming changes so they can prepare,” said 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.”

State officials say most work requirements will be verified automatically through existing data sources. Members who cannot be verified will be contacted for more information. About half of the state’s roughly 23,000 expansion members are expected to qualify for exemptions, with an estimated 5,000 to 7,000 affected.