Income Levels 510-03-85-40

(Revised 4/1/2026 Release 26.3 )

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(N.D.A.C. Sections 75-02-02.1-40, 75-02-02.1-22(7), 75-02-02.1-24.2(8), and 75-02-02.1-24(5))

Following are the Income Levels for the various categories under ACA Medicaid Categorically Needy:

Parents and Caretakers of Deprived Children and their Spouses who are NOT eligible for Medicare, SSI or over age 65 – (ACA Equivalent to 1931 Levels).

The family size is increased for each unborn when determining the appropriate family size.

Income Levels for Parents and Caretakers of Deprived Children and their Spouses who are NOT eligible for Medicare, SSI or over age 65 Household Size Monthly Income Level Yearly Income Level 1 $517 $6,204 2 694 8,328 3 871 10,452 4 1048 12,576 5 1226 14,712 6 1403 16,836 7 1580 18,960 8 1757 21,084 9 1934 23,208 10 2111 25,332 Plus - 1 178 2,136 Effective January 1, 2014

Parents and Caretaker Relatives who ARE Medicare beneficiaries, SSI recipients or over age 65. (Parent and Caretaker Relative fixed dollar level listed in #1 above PLUS the 5% Federal Poverty Level disregard.)

The family size is increased for each unborn when determining the appropriate family size. Income Levels for Parents and Caretaker Relatives who ARE Medicare beneficiaries, SSI recipients or over age 65. Household Size Monthly Income Level Annual Income 1 $566 $6,792 2 760 9,120 3 955 11,460 4 1,149 13,788 5 1,344 16,128 6 1,539 18,468 7 1,733 20,796 8 1,927 23,124 9 2,122 25,464 10 2,316 27,792 Plus - 1 195 2,339 Effective April 1, 2015

Children ages 6 through 18 and Individuals eligible for the Adult Expansion Group - 133% + the 5% disregard or 138%.

The family size is increased for each unborn when determining the appropriate family size. Income Levels for Children ages 6 through 18 and Individuals eligible for the Adult Expansion Group - 133% + the 5% disregard or 138% Household Size Monthly Income Level Annual Income Level 1 $1,836 $22,025 2 $2,489 $29,864 3 $3,142 $37,702 4 $3,795 $45,540 5 $4,449 $53,379 6 $5,102 $61,217 7 $5,755 $69,056 8 $6,408 $76,894 9 $7,061 $84,732 10 $7,715 $92,571 Plus - 1 $654 $7,839 Effective April 1, 2026

Children ages 0 through 6 - 147% + the 5% disregard or 152%.

The family size is increased for each unborn when determining the appropriate family size.

Income Levels for Children ages 0 through 6 - 147% + the 5% disregard or 152% Household Size Monthly Income Level Annual Income Level 1 $2,022 $24,260 2 $2,742 $32,893 3 $3,451 $41,527 4 $4,180 $50,160 5 $4,900 $58,794 6 $5,619 $67,428 7 $6,339 $76,061 8 $7,058 $84,695 9 $7,778 $93,328 10 $8,497 $101,962 +1 $720 $8,634 Effective April 1, 2026

ACA Adults age 19 and 20 and Medically Needy Pregnant Women, Children and Parent/Caretaker relative - 90% of Poverty Level. See Non-ACA Medicaid Policy income considerations, income deductions and income disregards.

The family size is increased for each unborn when determining the appropriate family size. Income Levels for ACA Adults age 19 and 20 and Medically Needy Pregnant Women, Children and Parent/Caretaker relative - 90% of Poverty Level Household Size Monthly Income Level Yearly Income Level 1 $1,197 $14,364 2 $1,623 $19,476 3 $2,049 $24,588 4 $2,475 $29,700 5 $2,901 $34,812 6 $3,327 $39,924 7 $3,753 $45,036 8 $4,179 $50,148 9 $4,605 $55,260 10 $5,031 $60,372 +1 $426 $5,112 Effective April 1, 2026

Pregnant Women - 170% + 5% Disregard or 175% The family size is increased for each unborn when determining the appropriate family size.

Income Levels for Pregnant Women - 170% + 5% Disregard or 175% Household Size Monthly Income Level Yearly Income Level 1 $2,328 $27,930 2 $3,156 $37,870 3 $3,985 $47,810 4 $4,813 $57,750 5 $5,641 $67,690 6 $6,470 $77,630 7 $7,298 $87,570 8 $8,126 $97,510 9 $8,955 $107,450 10 $9,783 $117,390 +1 $829 $9,940 Effective April 1, 2026

Optional Targeted Low-Income Children (CHIP) - 200% + 5% Disregard or 205%. The family size is increased for each unborn when determining the appropriate family size.

Income Levels for 7. Optional Targeted Low-Income Children (CHIP) - 200% + 5% Disregard or 205% Household Size Monthly Income Level Yearly Income Level 1 $2,727 $32,718 2 $3,697 $44,362 3 $4,668 $56,006 4 $5,638 $67,650 5 $6,608 $79,294 6 $7,579 $90,938 7 $8,549 $102,582 8 $9,519 $114,226 9 $10,490 $125,870 10 $11,460 $137,514 +1 $971 $11,644 Effective April 1, 2026

ACA Maintenance of Effort – Medicaid – Children ages 6 through 18.

The family size is increased for each unborn when determining the appropriate family size. Income Levels for ACA Maintenance of Effort – Medicaid – Children ages 6 through 18 Household Size 111% FPL Monthly 111% FPL Annual 133% FPL Monthly 133% FPL Annual 1 $1,477 $17,716 $1,769 $21,227 2 $2,022 $24,021 $2,399 $28,782 3 $2,528 $30,326 $3,028 $36,336 4 $3,053 $36,630 $3,658 $43,890 5 $3,578 $42,935 $4,288 $51,445 6 $4,104 $49,240 $4,917 $58,999 7 $4,629 $55,545 $5,547 $66,554 8 $5,155 $61,850 $6,176 $74,108 9 $5,680 $68,154 $6,806 $81,662 10 $6,205 $74,459 $7,435 $89,217 +1 $526 $6,305 $630 $7,555 Effective April 1, 2026