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As first reported by the North Dakota Monitor, North Dakota’s Medicaid program faces changes from new federal requirements, but state officials say the impact will be limited. Between 3,000 to 5,000 people in the Medicaid expansion program – about 3% to 5% of total enrollees – could be affected by new work requirements starting in 2027.
The rules require working-age adults to complete 80 hours monthly of work, volunteering, or education, though many groups are exempt including pregnant women, tribal members, and those with medical conditions.
Patient advocates worry about administrative hurdles causing people to lose coverage unnecessarily. Additionally, Affordable Care tax credits expire this year, and without congressional action, health insurance costs could rise $485 on average for North Dakotans, according to KFF. In 2024, more than 34,000 North Dakotans received Advanced Premium Tax Credits through the ACA marketplace.
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