Medicaid agency: HHS
North Dakota Medicaid is administered by the North Dakota Department of Health and Human Services (HHS), a large multi-program agency formed by the 2022 merger of the former Department of Human Services and Department of Health; the Medicaid-specific division is the Medical Services Division. North Dakota runs fee-for-service Medicaid for its base population alongside a single managed care organization, Blue Cross Blue Shield of North Dakota (BCBSND), which covers only the Medicaid Expansion "New Adult Group" statewide under a Section 1915(b) waiver; Primary Care Case Management, which ran alongside fee-for-service Medicaid for years, ended January 1, 2024. Children's coverage runs through the Healthy Steps Children's Health Insurance Program, administered within the same division. Expansion operates under North Dakota Century Code section 50-24.1-37; the statute is nominally subject to a contingent repeal provision, but its current text sets no expiration date, and the program has run continuously since January 2014. Federal work requirements take effect January 1, 2027 for expansion members ages 19-64. North Dakota has no active Section 1115 demonstration (its only prior one, a COVID-era risk-mitigation waiver, expired in 2023) and was newly selected in May 2026 for the federal Certified Community Behavioral Health Clinic Medicaid Demonstration. The state separately received $199 million in first-year federal Rural Health Transformation Program funding in 2026.
CMS's most recent managed care enrollment data (report year 2024) shows North Dakota running a single comprehensive managed care organization, covering only the Medicaid Expansion population statewide, with 24,356 members (down from 36,680 the year before, consistent with the nationwide unwinding of pandemic-era continuous Medicaid enrollment). Primary Care Case Management, present in every earlier report year back to 2016, is absent from the 2024 data, consistent with its January 2024 end. A separate, much smaller Program of All-Inclusive Care for the Elderly serves 190 members, most of them dual-eligible, across a handful of zip codes around Bismarck, Dickinson, and Minot.
Long-term services and supports run outside the Medicaid Expansion managed care contract entirely, delivered fee-for-service through five Section 1915(c) home- and community-based waivers: a waiver for aged and physically disabled adults, a Children's Hospice waiver, a Children with Medically Fragile Needs waiver, an Autism Spectrum Disorder waiver for individuals from birth through age 20, and a Traditional Individual with Intellectual Disabilities and Developmental Disabilities waiver.
Not integrated into managed care
Behavioral health services run within the same fee-for-service and managed care structure as the rest of Medicaid rather than through a separate carve-out vendor. North Dakota was newly selected in May 2026 for the federal Certified Community Behavioral Health Clinic Medicaid Demonstration, with its own demonstration period beginning sometime between July 2026 and July 2027.
Carved in
The Medicaid Expansion adult population has no dental benefit; BCBSND directs those members to FQHC sliding-scale dental care instead. Children's Medicaid dental runs fee-for-service, with no administrator named.
Retail outpatient pharmacy is carved out of the BCBSND contract and administered directly by North Dakota HHS on a fee-for-service basis; no separate pharmacy benefit manager is named.
Non-emergency medical transportation is not brokered through a statewide contract; it runs fee-for-service, arranged regionally through human service zones and tribes.
Conduent operates North Dakota's Medicaid Management Information System, continuing a long-standing role rather than a new vendor relationship established when its current infrastructure-upgrade contract began in December 2021.
104 agency updates tracked for North Dakota. Available with Pro.
See them with ProHelene Neville, an independent candidate for North Dakota's lone U.S. House seat, opposes cuts to Medicaid, Medicare, and Social Security, calling them "earned benefit programs" that need more funding rather than less. Neville, a former travel nurse and public health consultant, finished third in the Democratic-NPL endorsement race before filing as an independent. She also proposes breaking up health insurance and pharmaceutical monopolies to lower healthcare costs. She faces Republican incumbent Julie Fedorchak, Democratic-NPL candidate Trygve Hammer, and independent Charles Tuttle in the general election.
North Dakota's Health and Human Services Department is shifting from directly managing all 500-700 grants under its Rural Health Transformation Program funding to using outside "anchor partners," in-state organizations that will handle grant applications and individual grant management while HHS oversees at a higher level. North Dakota had been the only state managing every grant itself; three anchor partners are being used, including the University of North Dakota Center for Rural Health, with two more still to be finalized. The change comes as more than $161 million of the state's $199 million award remains unawarded ahead of an October 30 deadline, prompting lawmaker concerns about transparency, selection criteria, and further delays. CMS is expected to announce North Dakota's second-year funding amount, estimated near $200 million, in October.
The HHS Office of Inspector General completed its periodic inspection of the North Dakota Medicaid Fraud Control Unit in 2025, examining the unit's compliance with federal certification standards for investigating and prosecuting Medicaid provider fraud and patient abuse cases. The inspection covered staffing, case management, prosecution coordination, and reporting requirements. North Dakota's unit was found to meet federal requirements for continued federal financial participation at the 75 percent match rate. OIG conducts these inspections every three years for all state fraud control units as required by federal law.
CMS has approved funding for North Dakota to launch the Coordinating and Connecting Care Initiative, a program designed to improve care coordination and integration across Medicaid services. The initiative targets beneficiaries with complex medical and behavioral health needs, including those requiring long-term services and supports. Implementation details, effective dates, and specific funding amounts were not provided in the available information. The program aims to reduce fragmentation in care delivery and improve health outcomes for high-needs Medicaid populations.
Gov. Kelly Armstrong appointed Conner Swanson, a longtime senior adviser, as commissioner of North Dakota's Department of Health and Human Services, effective August 29, 2026. Swanson will oversee a $5.7 billion biennial budget, more than 2,000 employees, and agency operations including Medicaid administration and federal grant programs. He succeeds interim commissioner Pat Traynor, who served since June 2025. Swanson previously worked as a policy adviser and communications director for Armstrong in Congress and played a role in the Rural Health Transformation Program deploying federal grants for rural health infrastructure.
11 active waivers tracked for North Dakota. Available with Pro.
See them with ProNo active solicitations currently tracked for North Dakota.
4 managed care contracts tracked for North Dakota. Available with Pro.
See them with Pro6 bills tracked for North Dakota. Available with Pro.
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