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- ND SFN 958 2024
MEDICAID APPLICATION FOR THE ELDERLY AND DISABLED DEPARTMENT OF HEALTH AND HUMAN SERVICES SFN 958 (32024)AGENCY USE ONLY Case Number:Date Requested:Date Received:Interview Date:Individual InterviewedIf.
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HHS FAQ
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Medicaid and the Children's Health Insurance Program (CHIP) provide no-cost or low-cost health coverage for eligible children in North Dakota. These programs provide health coverage for children so that they can get routine check-ups, immunizations and dental care to keep them healthy.
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Some individuals may qualify for ND Medicaid benefits at no cost while others may have to pay a portion of their medical bills. This is called Client Share (Recipient Liability). Client Share is the monthly amount an individual must pay in medical bills before the Medicaid program will pay for care received.
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Medicaid provides comprehensive medical, dental and vision coverage to North Dakota children and adults through a variety of coverage programs and waivers, including: Autism Spectrum Disorder Waiver provides services for young children from birth through age 11 who have a diagnosis of an autism spectrum disorder.
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Do You Qualify? Medicaid Expansion is available to individuals between 19-64 with household incomes up to 138% of the federal poverty level (FPL). Individuals eligible for Medicare or Supplemental Security Income (SSI) are not eligible for coverage under Medicaid expansion.
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Covers medical and surgical services performed by a doctor; supplies and drugs given at the doctor's office; and X-rays and laboratory tests needed for diagnosis and treatment.
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Generally, a person who is blind, disabled, or age 65 or older can have up to $3,000 in countable assets (such as savings accounts, checking accounts, stocks, bonds, or other types of assets) to qualify for Medicaid. The limit for couples is $6,000.
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How can this program help me? This program lets you get Medicaid benefits even if your income is higher than Medicaid program guidelines. It works by letting you spend down your income so that you meet Medicaid income limits. The spend-down amount is the amount of income that is over the Medicaid limit.
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Who is eligible for North Dakota Medicaid Program? Household Size*Maximum Income Level (Per Year) 1 $20,030 2 $27,186 3 $34,341 4 $41,4964 more rows
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Related links form
- NC DSS-5238 2004
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