North Dakota Medicaid Expansion

This webpage and its documents listed below are dedicated to North Dakota’s Medicaid Expansion Program. North Dakota Department of Human Services (ND DHS) chose Sanford Health Plan to provide eligible North Dakota residents with health insurance benefits. ND DHS manages the application process, and eligibility determination. Sanford Health Plan manages the following services: medical management, claims adjudication, customer service, pharmacy network and claims, provider relations and provider network. The State of North Dakota’s Traditional Medicaid program and the program administered by Sanford Health Plan, known as North Dakota Medicaid Expansion (NDME), operate under different systems.

Appeal Rights & Filing Form

Prescription Authorization /Formulary Exception Request Form

Provider FAQ

Provider Enrollment Guidance

Provider & Pharmacy Network: Select the “Individual – ND Medicaid Expansion” network from the dropdown menu

Apply for Coverage: For detailed information on the North Dakota Medicaid Expansion Program, for assistance in guiding members to apply for coverage, visit the North Dakota Medical Services website or call (844) 854-4825 (toll-free).

Member Travel, Lodging and Meal Guide

Summary of Benefits and Coverage (SBC):

  • Click here if for those that have copays.
  • Click here for those that do not have copays.

Transition of Care Form