American Indian Medicare Savings and Medicaid Exemptions in North Dakota

Asset Exemptions for Tribal Members

North Dakota's five federally recognized tribes — Standing Rock Sioux, Turtle Mountain Band of Chippewa, Spirit Lake Nation, Mandan Hidatsa and Arikara (MHA) Nation, and Sisseton Wahpeton Oyate — include thousands of Medicare-eligible elders who may qualify for the state's Medicare Savings Programs.

The same baseline income and resource limits apply to everyone (QMB: countable income at or below $1,330/month single after the $20 general unearned-income disregard, countable resources at or below $9,950). Applicable exclusions can change what counts for a tribal household:

• Trust or restricted Indian lands are fully excluded from countable resources. This includes allotted trust land, tribal trust land, and any land held in trust by the Bureau of Indian Affairs.
• Per capita and trust payments are treated differently depending on their source. Judgment funds and payments from natural resources or leases tied to federally protected Indian property may be excluded under state rules. Locally distributed per capita payments from tribal gaming revenues that are not held in trust are counted as income.
• Indian Claims Commission judgment funds held in trust are excluded under federal statute.

These exclusions can make a significant difference for families who assume that land allotments or qualifying trust payments put them over the $9,950 resource limit.

Appendix B — Form SFN 1620

When a household includes an American Indian or Alaska Native member and applies using Form SFN 1909 (Application for Health Coverage and Help Paying Costs), include Appendix B (SFN 1620). The form's instructions say to submit it with SFN 1909. If applying with SFN 958, ask ND HHS whether this appendix is needed.

SFN 1620 asks whether a family member belongs to a federally recognized tribe, has used or is eligible to use IHS or tribal health services, and receives certain income from natural resources, farming, ranching, fishing, leases, royalties, or culturally significant items. It does not request a tribal enrollment number or list assets. HHS determines which exclusions apply.

SFN 1620 is available in North Dakota's online forms catalog.

IHS and MSP Work Together

Indian Health Service facilities and tribal health clinics (538/638 facilities) provide direct medical care and pharmacy services at no cost to eligible Native Americans. Prescriptions filled at IHS or tribal pharmacies carry zero copays regardless of Medicare or Medicaid status.

MSP enrollment adds a separate layer of coverage. QMB pays the Medicare Part B premium, the Part A hospital deductible, and all Medicare cost-sharing — coverage that applies at any Medicare-enrolled provider, not just IHS facilities. If your parent sees a specialist in Bismarck or Fargo outside the IHS system, QMB covers the cost-sharing that IHS does not.

Additionally, MSP enrollment triggers automatic Extra Help, capping Part D copays at $4.90 (generic) and $12.15 (brand-name) in 2026. For Part D-covered medications not available at an IHS pharmacy — or when distance makes IHS access impractical — Extra Help can help with costs at a participating pharmacy.

Applying From Tribal Communities

Human Service Zone offices serve all residents within their geographic boundaries, including those on reservation land. The Standing Rock reservation spans both North Dakota and South Dakota — applicants on the North Dakota side file with ND HHS, while those on the South Dakota side file with South Dakota DSS. The two states have different income methodologies, so which side of the border your parent lives on determines the rules.

Turtle Mountain and Spirit Lake are served by the Mountain Lakes Human Service Zone, which covers Rolette, Benson, Ramsey, and Towner counties. MHA Nation members near New Town are served by the Mountrail-McKenzie Human Service Zone.

Phone and online filing are available for applicants who face long drives to a zone office. The ND HHS Customer Support Center (1-866-614-6005) can take the application over the phone. The online portal at hhs.nd.gov accepts applications and document uploads from anywhere with internet access.

The North Dakota Medicare Savings Programs & Extra Help Guide covers the full application process — including where and how to file SFN 1620, which tribal assets are excluded, and how to coordinate IHS care with Medicare cost-sharing benefits.

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