AN ACT to amend and reenact sections 50-24.1-02.6 and 50-24.1-26 of the North Dakota Century Code, relating to medical assistance benefits and Medicaid waivers; and to provide an effective date.
Summary
HB 1067 makes targeted changes to North Dakota’s medical assistance and Medicaid waiver statutes. It directs the Department of Health and Human Services to continue providing medical assistance to medically needy individuals whose countable income is below a department-set threshold that must meet federal minimums, and it clarifies eligibility rules for children and families coverage groups and pregnant women by removing asset consideration. The bill also requires coverage for otherwise eligible pregnant women who are lawfully present in the United States.
The bill further allows the department to require individuals eligible for Medicare Part A, B, or D to apply for that coverage as a condition of Medicaid eligibility, and it directs the department to disregard certain income sources—Social Security survivor income and court-ordered child support—for children under 18 enrolled in a Section 1915(c) Medicaid waiver. In addition, it updates the state’s Medicaid waiver authority for in-home services, requiring waivers for children with extraordinary medical needs and for children with autism spectrum disorder who are under 21 and would otherwise meet an institutional level of care, while allowing the department to prioritize applicants with greater need. The effective date for the eligibility changes in Section 1 is July 1, 2026.
Impact
HB 1067 amends North Dakota Century Code sections 50-24.1-02.6 and 50-24.1-26, affecting Medicaid eligibility rules and waiver administration. It expands and clarifies who may qualify for medical assistance, adjusts how certain income is counted for children in Medicaid waivers, and reinforces the state’s authority to administer in-home waiver services for medically complex children and children with autism. The bill primarily affects the Department of Health and Human Services, Medicaid applicants, pregnant women, children with disabilities or extraordinary medical needs, and families receiving waiver-based services.
Sentiment
The bill appears to have broad bipartisan support and little visible opposition. It passed the House 89-2 and the Senate 47-0, indicating strong agreement across both chambers. The lack of committee transcript material suggests no major public controversy was recorded in the available materials, and the vote totals point to a generally favorable view of the bill’s Medicaid and waiver-related provisions.
Contention
The main policy questions raised by the bill are likely to center on eligibility and administrative discretion. One area of potential contention is the requirement that some Medicare-eligible individuals apply for Medicare as a condition of Medicaid eligibility, which can be viewed as a cost-containment or coordination measure but may be burdensome for some applicants. Another possible point of debate is the department’s authority to prioritize waiver applicants by degree of need, which gives HHS discretion in allocating limited in-home services. However, the recorded votes suggest these issues did not generate significant opposition in the Legislature.