North Dakota CHIP Fact Sheet

Key Highlights:

Program type: North Dakota operates a combination CHIP program called Healthy Steps.

Number of children covered: In FFY 2018, 7,417 children were covered by Healthy Steps. (Data from CHIP Annual Report Template System)

State’s enhanced federal match rate*: For FFY 2020, the federal match is 76.54 percent.

Participation Rate: In 2017, 83.7 percent of eligible children in North Dakota participated in either Medicaid or Healthy Steps.  (Urban Institute)

*The Affordable Care Act increased the federal CHIP match rate by 23 percentage points. The HEALTHY KIDS and ACCESS Acts maintained this increase through FFY 2019, and reduced it to 11.5 percentage points in FFY 2020. The federal CHIP match rate returns to states’ regular enhanced match rate in FFY 2021 and beyond.

Premiums and selected cost sharing in Healthy Steps, 2019

Family Income Level Premiums Office Visits Inpatient Services Prescription Drugs
≤160% FPL None None $50 $2-$8

Strategies to Simplify Enrollment and Renewals in North Dakota

Strategy Used
Use of presumptive eligibility No
Use of 12-month continuous eligibility Yes
Use of express lane eligibility No
Premium assistance No

For definitions of strategies in this chart, see the Centers for Medicare & Medicaid Services December 2009 State Health Official letter here.

Other Characteristics of North Dakota’s CHIP Program

Does North Dakota…
Require a waiting period?[1] Yes, 90 days
Offer a buy-in option?[2] No
Cover dependents of public employees? No
Cover lawfully residing children without a five-year waiting period? No

Source: Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey. Kaiser Family Foundation and Georgetown University Center for Children and Families.

Health Services Initiatives

States can develop Health Services Initiatives (HSIs) to improve the health of low-income children and youth by using a portion of their existing CHIP administrative dollars. After covering regular CHIP program administrative costs, states can use any remaining funds – within the 10 percent cap – for an HSI project. The federal share of the HSI project cost is funded at the state’s CHIP match rate. States have used HSIs to support poison control centers, school health services, lead abatement efforts, and other unique prevention and intervention projects. North Dakota currently does not have an HSI.

Quality Measures

States may report on a core set of quality measures for children. North Dakota reported on 1 measure for federal fiscal year 2018. Among the measures is preventive dental services, listed below.

Percentage of eligibles ages 1-20 receiving preventive dental services (FFY 2018)

Ages 1 – 20 who receive preventive dental services
North Dakota 18.4%

Source: Department of Health and Human Services, 2019 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP, September 2019.

[1] States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP.

[2] States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP.

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