Healthy Steps North Dakota: Medicaid and CHIP for a Grandchild in Kinship Care

Two Programs, One Application

North Dakota provides children's health coverage through two channels: Child Medicaid (zero-cost for low-income children) and Healthy Steps, which is the state's CHIP program for children in working families who earn too much for Medicaid but still need affordable coverage. Both are managed by the HHS Medical Services Division, and both use the same application.

For kinship caregivers, the critical question is always: whose income counts?

The MAGI Household Rule That Helps Kinship Families

Medicaid and Healthy Steps use Modified Adjusted Gross Income (MAGI) rules. For a child living with a nonparent relative, the rules work differently from SNAP. Even if you claim the child as a tax dependent, North Dakota applies the "non-filer exception" — the child's MAGI household includes resident parents, stepparents, and siblings under 19 who live in the same home, as well as the child's spouse and children under 19 who live there.

The grandparent or aunt or uncle who is actually raising the child is not automatically included in the child's MAGI household just because they claim the child on taxes. That means a grandparent's Social Security, pension, or wages are typically excluded from the child's eligibility calculation.

This is one of the most misunderstood rules in kinship care. Many caregivers assume their own income disqualifies the child. In most cases, it doesn't.

Healthy Steps Income Limits

Healthy Steps covers uninsured children up to age 19 in households with MAGI income up to 205% of the Federal Poverty Level (with a built-in 5% statutory disregard). For reference, a two-person household (one child plus one counted parent or sibling) can earn up to $3,697 per month — $44,364 annually — and the child still qualifies.

For a child with no parents or counted siblings in the home, the income test looks at the child's own income only, which is usually zero. That child qualifies for Child Medicaid with no cost to the caregiver.

What Healthy Steps Covers

Healthy Steps provides comprehensive coverage: doctor visits, dental, vision, prescriptions, mental health services, hospitalizations, and preventive care. There may be small copays for some services depending on household income, but no monthly premium for children who qualify.

Child Medicaid covers the same range of services at zero cost for families at lower income levels.

How to Apply

Use the same unified application process as TANF and SNAP — through the North Dakota HHS Self-Service Portal online or a paper application mailed to the Customer Support Center. Your Human Service Zone processes the eligibility determination.

You'll need the child's birth certificate, Social Security number, proof of residence, and documentation of any income the child receives directly. If a parent lives in the home (which disqualifies Kinship-ND but not Medicaid), their income information is needed too.

Coverage can be approved quickly. As of November 2026, North Dakota allows retroactive Medicaid coverage for up to three months before the application date for months when the child qualified and received services. Starting January 1, 2027, traditional Medicaid coverage can be backdated for up to two months.

For the full breakdown of how health coverage fits alongside TANF child-only cash, SNAP, and Kinship-ND expense reimbursements — with a document checklist for each — see the North Dakota Kinship Financial Help guide.

See more North Dakota guides →