North Dakota Medicaid Waivers & Home and Community Based Programs Overview

North Dakota, known as The Peace Garden State, has a well-structured Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.

Administered by the North Dakota Department of Health and Human Services (HHS), Medical Services Division, the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings rather than institutional care.

Key waiver programs include the Aged and Disabled (AD) Waiver, which provides personal care, respite, and assistive technology for seniors and adults with physical disabilities, and the Developmental Disabilities (DD) Waiver, which offers residential, employment, and behavioral health support for individuals with intellectual and developmental disabilities (IDD).

Other major programs include the Technology Dependent (TD) Waiver, which serves individuals who require medical technology for daily living, and the Autism Spectrum Disorder (ASD) Waiver, which provides early intervention and therapy services for children with autism. North Dakota also offers Self-Directed Services, giving participants greater flexibility in choosing and managing their caregivers.

Regulatory oversight in North Dakota is managed through HHS and its Medical Services Division, with additional provider licensing and compliance enforcement handled by the Division of Quality Management (DQM). The state operates under both fee-for-service and managed care models, with HCBS services coordinated through North Dakota Medicaid’s Managed Care Organizations (MCOs) to improve service delivery and cost-effectiveness.

North Dakota has also implemented Electronic Visit Verification (EVV) for personal care services, ensuring compliance and service integrity. Providers must navigate Medicaid enrollment, prior authorization requirements, and stringent quality assurance measures to successfully participate in the state’s HCBS programs. With a strong emphasis on rural healthcare access, person-centered planning, and community-based supports, North Dakota’s Medicaid waiver system ensures that individuals receive high-quality, sustainable long-term care while maintaining independence, dignity, and inclusion in their communities.

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Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.

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