I/DD Waivers in North Dakota

All states: Medicaid disability services map

North Dakota I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in North Dakota?

North Dakota Health and Human Services (HHS) is both the Medicaid agency and the developmental disabilities agency. Its Developmental Disabilities (DD) Section runs the main I/DD waiver day to day. State employees called DD Program Managers, based at eight regional DD units, decide eligibility, write each person's plan and authorize services.

• Medicaid agency: the Traditional IID/DD waiver says it is administered by the state Medicaid agency, with the DD Section, a section inside that agency, handling daily administration.
• DD Section: licenses private nonprofit and for-profit DD providers, sets the rate matrix and oversees the regional DD units.
• Front door: a referral to one of eight regional Developmental Disabilities offices, located in the Human Service Centers in Williston, Minot, Devils Lake, Grand Forks, Fargo, Jamestown, Bismarck and Dickinson. The June 2026 waiver amendment now calls these offices DD units.
• Case management: DD Program Managers (DDPMs) are state employees, not private agency staff. They determine eligibility, develop the person-centered plan, authorize services and monitor them.
• Autism waiver: run by HHS Medical Services Division children's waiver staff, not the DD Section.

What Medicaid waivers and programs serve people with I/DD in North Dakota?

North Dakota has two 1915(c) waivers that serve people with I/DD. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. The Traditional IID/DD waiver is the main program and serves people of any age. The Autism Spectrum Disorder waiver serves children and youth with autism.

• Traditional Individuals with Intellectual Disabilities and Developmental Disabilities (IID/DD) Home and Community-Based Services Waiver (1915(c), control number ND.0037): serves people of any age with an intellectual disability or a related condition with cognitive impairment who qualify for Medicaid and meet the level of care of an intermediate care facility (ICF/IID). The current amendment, ND.0037.R09.04, was approved effective June 1, 2026, and the waiver it amends took effect April 1, 2024. It plans for 6,980 people in waiver year 1, rising to 7,580 in year 5, with slots reserved for emergencies (15), Infant Development (170) and people moving from Vocational Rehabilitation supported employment (5). Services include Residential Habilitation, Independent Habilitation, Host Home, Adult Foster Care, Family Care Option, Day Habilitation, Prevocational Services, Individual and Small Group Employment Support, In-Home Supports, Respite, Homemaker, Extended Home Health Care, Parenting Supports, Infant Development, Behavioral Consultation, Remote Monitoring, Community Transition Services, Environmental Modifications and Equipment and Supplies. Source: the waiver document.
• Autism Spectrum Disorder Birth through Age 20 Waiver (1915(c), control number ND.0842): serves children and youth from birth through age 20 with an autism diagnosis. The upper age was raised from 17 to 20 by an amendment effective November 1, 2025. Services include agency or self-directed Respite, Service Management, Assistive Technology, Community Connector and Remote Monitoring. Details are on the HHS children's waivers page.

Related programs: the Family Paid Caregiver Pilot Program is a state pilot that pays legally responsible family members who give extraordinary care to someone on the Traditional IID/DD, Autism, Medically Fragile or Children's Hospice waiver. It was extended by 2025 Senate Bill 2305 and takes applications in order as funds allow. The Medically Fragile and Children's Hospice waivers are not counted here because they use a nursing facility or hospice level of care, and North Dakota's 1915(i) program serves behavioral health conditions, not I/DD. Intermediate care facilities for individuals with intellectual disabilities (ICF/IID) are the institutional option; the state licenses them, and HHS runs the Life Skills and Transition Center in Grafton.

Does North Dakota pay for I/DD services through managed care?

No. I/DD waiver services in North Dakota are paid fee-for-service. Providers bill the state claims payment system directly at statewide rates, and a fiscal agent bills for self-directed services. Coordination is done by state DD Program Managers, not by a health plan.

• Who pays claims: ND Medicaid, through its claims system. Claims questions go to ddclaimsupport@nd.gov.
• Who coordinates services: the person's DD Program Manager at the regional DD unit.
• Medicaid Expansion adults: these adults get their medical care through a Blue Cross Blue Shield of North Dakota managed care plan, but the DD waiver documents describe fee-for-service billing for waiver services.

Is there a waiting list for I/DD services in North Dakota?

We could not confirm whether anyone is waiting right now. The Traditional IID/DD waiver describes how a list would work, but no state page we checked publishes a count. Ask the DD Section for current numbers.

• How slots are offered: common waiver slots are offered first come, first served.
• When slots run out: once the cap, including reserved slots, is reached, the state keeps a waiting list by date of request. Emergency cases get priority when slots open.
• Reserved slots: 15 for emergencies, 170 for Infant Development and 5 for people moving from Vocational Rehabilitation supported employment.
• Family Paid Caregiver Pilot: this separate state pilot has its own waitlist, handled in the order applications are received as funds allow.

For current waiting list information, contact the DD Section at 701-328-8930 or dhsddreq@nd.gov.

How do people apply for I/DD services in North Dakota, and how are budgets set?

A family or individual starts with a referral to the regional Developmental Disabilities office that serves their county, sending the applicant's information, diagnoses and records. Eligibility for a DD Program Manager and eligibility for DD services are two separate decisions, and the process can take up to 45 days. Budgets for residential, day and employment services are set from the person's assessment score.

• Eligibility: North Dakota residency, Medicaid citizenship rules (waived for ages birth to 2), ND Medicaid eligibility, the state's DD criteria and, for waiver services, the ICF/IID level of care. The state's process guide describes the steps.
• Level of care: a state evaluation in a web-based system produces an HCBS indicator, which the DD Program Manager reviews.
• Assessment tools: under the SIS and ICAP policy, people 16 and older take the Supports Intensity Scale for Adults (SIS-A), repeated every 36 months. People under 16 take the Inventory for Client and Agency Planning (ICAP), repeated at least every 12 months.
• Budgets: an algorithm turns the SIS-A or ICAP score into average direct care staff hours. The budget is those hours times the hourly rate in the state rate matrix. This applies to Residential Habilitation, Independent Habilitation, Day Habilitation, Prevocational Services and both employment supports.
• Limits: day, prevocational and employment hours together may not exceed 40 a week.

What day and residential services can I/DD providers offer in North Dakota?

The Traditional IID/DD waiver has four day and employment services and five residential options. Most are delivered by DD providers licensed by the DD Section under North Dakota Administrative Code (NDAC) 75-04-01. Day services are billed in 15-minute units, and the research did not find a published staff ratio for Day Habilitation or Prevocational Services.

Day and employment services

• Day Habilitation: scheduled activities, training and staff support, usually in a non-residential setting, to build self-help, social and adaptive skills. It can also cover retirement activities. Three medical acuity tiers apply for people who need ongoing nursing support. Licensed DD provider, 15-minute unit, no published ratio found.
• Prevocational Services: training to prepare for paid work in integrated community settings, reviewed at least every 12 months. Licensed DD provider, 15-minute unit, no published ratio found.
• Individual Employment Support: long-term, one-to-one support to keep a paid community job or self-employment at or above minimum wage. Licensed DD provider, 15-minute unit.
• Small Group Employment Support: long-term support for groups of 2 to 8 employed people in integrated settings. Licensed DD provider, 15-minute unit.

Residential services

• Residential Habilitation: training and daily support for people not living with a primary caregiver, in a provider-controlled home, a community setting or a private home. Paid at a daily rate with three medical acuity tiers, a vacancy factor and up to 30 days a year of retainer payments. Room and board are not included. Licensed DD provider.
• Independent Habilitation: staff support for fewer than 24 hours a day, usually not daily, to build skills for living independently. Billed in 15-minute units and subject to EVV. Licensed DD provider.
• Host Home: new on June 1, 2026. A temporary private family home for a child with intense behavioral needs in crisis, with the goal of returning home. No more than two participants per home, paid $150 a day including transportation. Requires a foster care home license (NDAC 75-03-14) and a child placing agency (NDAC 75-03-36).
• Adult Foster Care: care in a licensed adult foster care home run by an individual Qualified Service Provider, paid a daily rate of up to $150 plus a respite component. Licensed under NDCC 50-11 and NDAC 75-03-21.
• Family Care Option: part- or full-time care for participants under 21 with an active IEP in another family's home that meets family or adult foster care safety standards. Paid a daily rate.

How are I/DD provider rates set and how do agencies enroll in North Dakota?

North Dakota pays statewide, non-negotiable rates set by HHS, and they change only when the Legislature funds a change. The most recent change was a 2 percent inflationary increase for most ND Medicaid providers for dates of service from July 1, 2026. New agencies apply for a DD provider license through the state's DD Licensing Portal.

• Rate method: the April 2018 rate matrix was built from provider ledgers and cost reports, reviewed by the state's actuary in 2019 and 2021, and reviewed again in July 2024 for the 2025 to 2027 budget period. Medical acuity tiers add a nursing component. Other services use cost-based or team-recommended hours, and Host Home and Adult Foster Care use a $150 daily rate.
• Latest change: the 2 percent increase from July 1, 2026 was funded by the 2025 Legislative Assembly, according to the DD Section's current news page. We could not read current rate amounts from the state's rate matrix file.
• Enrollment: new DD providers apply through the DD Licensing Portal (DDLP) after a notice of intent, business plan, orientation and policies. The DD Section lists CARF, CQL, NADD, The Joint Commission and COA as accreditation options. Steps are on the DD licensed provider page. Individual Qualified Service Providers enroll with Medical Services instead.
• EVV: Independent Habilitation, Extended Home Health Care, In-Home Supports, Homemaker and Respite require electronic visit verification (EVV). Therap is the free state system, and providers can use another system that sends data to the Sandata aggregator. Under the state's EVV policy, claims without a matching EVV visit may be denied.

What is changing next for I/DD services in North Dakota?

North Dakota has planned a new children's cross-disability waiver and a new level of care, but no draft or submission has been published. HHS has said it is designing and testing a new level of care for a children's cross-disability waiver (ages 3 to 21 with mild to moderate needs) and for the DD waiver. As of October 23, 2026 we did not find a draft waiver, a CMS submission or a start date, so treat this as a plan, not a final change.

• Planned children's waiver: described in HHS's February 18, 2025 Medicaid advisory committee slides. Watch for public comment notices from HHS.
• Recent changes already in place: the June 1, 2026 waiver amendment added Host Home, revised Extended Home Health Care provider qualifications, updated case manager training on HCBS settings and person-centered planning, and revised the rules on paying relatives. The 2 percent rate increase took effect for dates of service from July 1, 2026.

North Dakota I/DD sources

• ND HHS: Developmental Disabilities Services
• ND HHS: Traditional IID/DD HCBS Waiver ND.0037.R09.04 (effective June 1, 2026)
• ND HHS: DD services for individuals and families
• ND HHS: Information for DD licensed providers
• ND HHS: SIS and ICAP assessment policy
• ND HHS: Children's waivers
• ND HHS: Medicaid waivers
• ND HHS: DD current news
• ND Medicaid: Electronic visit verification policy
• ND HHS: Medicaid advisory committee meeting slides, February 18, 2025

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Developmental Disabilities vs. Mental Health: Key Differences
• I/DD services in every state (map)
• North Dakota EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.