Self-Direction and FMS in North Dakota

All states: self-direction map

North Dakota self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in North Dakota offer self-direction?

North Dakota offers self-direction inside three 1915(c) Medicaid waivers: the Traditional IID/DD waiver, the autism waiver and the medically fragile children's waiver. The state has no single self-direction page, so the rules sit on each program's own page. In all three, the participant or the family hires the worker and must be enrolled with a fiscal agent, which is North Dakota's term for the organization that handles payroll and taxes.

• Traditional Individuals with Intellectual Disabilities and Developmental Disabilities (IID/DD) Home and Community-Based Services Waiver: serves people of any age with intellectual or developmental disabilities who meet the level of care for an intermediate care facility. It is run by the Developmental Disabilities Section of North Dakota Health and Human Services (ND HHS). The state's Individuals and Families page lists these under Self-Directing Services: In-Home Supports (self-directed), Equipment and Supplies, Environmental Modification and Behavioral Consultation. The state's EVV page also lists self-directed respite under this waiver. The participant or family has employer authority. We did not confirm budget authority.
• Autism Spectrum Disorder Birth through Age 20 Waiver: serves children and youth from birth through age 20 with an autism spectrum disorder diagnosis. It is run by the ND HHS Medical Services Division through the Children's Waiver Administrator. The state's children's waivers page says respite can be delivered through an agency or through self-direction. When the family self-directs, it hires the respite worker and must be enrolled with the fiscal agent. We did not confirm budget authority.
• Children with Medically Fragile Needs Home and Community-Based Services Waiver: serves medically fragile children and youth who meet a nursing facility level of care. It is run by the ND HHS Medical Services Division through the Children's Waiver Administrator. The state page says families have access to up to $25,300 for waiver services, not counting case management, and must enroll with a fiscal agent to pay for those services. The page does not use the term budget authority.

Employer authority means the participant or family recruits, hires, schedules and supervises the workers. Budget authority means they also manage a set amount of money. North Dakota once had a separate Self Directed Supports waiver for developmental disabilities, but it has ended, and self-directed services now sit inside the Traditional IID/DD waiver.

Older adults and adults with physical disabilities are served differently. The Medicaid Waiver for Home and Community Based Services and the state's SPED and Ex-SPED programs use enrolled Qualified Service Providers, and we did not find a fiscal agent for those programs. They are covered in the paid caregiver section below because they are a common way family members are paid.

Who handles financial management services (FMS) in North Dakota?

GT Independence handles financial management services for North Dakota's three self-directed waivers, according to GT Independence's own pages and a notice from the former vendor, Veridian Fiscal Solutions. North Dakota calls this role the fiscal agent. The participant or family manages the workers, and the fiscal agent handles the payroll side.

• What the vendors say: Veridian's North Dakota page says the North Dakota Self-Direction Program has moved its financial management services provider to GT Independence, and it sends enrollment and payroll questions to GT Independence at 877-659-4500. GT Independence's North Dakota page lists three programs: the Developmental Disabilities Services Waiver (its name for the Traditional IID/DD waiver), the Medically Fragile Waiver and the North Dakota Autism Waiver.
• What the state has published: the Developmental Disabilities Section issued a request for proposal for Fiscal Agent Services (SRC000217) on April 8, 2026, for people statewide who use self-directed support. Proposals were due May 8, 2026.
• Legal employer: GT Independence says the participant has full employer authority to hire and manage employees. The state's EVV policy also refers to an employer of record for self-directed services. We could not read the approved waiver text, so the exact legal wording is not confirmed from the waiver itself.
• What the fiscal agent does: GT Independence describes its role as handling timesheets, paychecks, payroll taxes, workers' compensation and background screening.
• Choosing a vendor: the sources we read describe one fiscal agent for these three waivers, and we did not find a choice among vendors. GT Independence says the case manager makes the referral for anyone who wants to self-direct.

Who can be a paid caregiver under self-direction in North Dakota?

It depends on the program. On the autism waiver, self-directed workers must live outside the child's home, which rules out a parent or other relative in the household. North Dakota pays legally responsible family members through a separate Family Paid Caregiver Pilot Program, and it pays live-in relatives of older adults through daily-rate programs that do not use a fiscal agent.

• Autism waiver: the state's children's waivers page says a self-directed respite worker must be 18 or older, live outside the child's home and pass criminal and abuse background checks. In-home support workers must also live outside the child's home.
• Traditional IID/DD waiver and medically fragile waiver: we did not find a readable published rule on which relatives can be paid as self-directed workers. Ask the person's case manager or the Developmental Disabilities Section at 701-328-8930 (children's waivers: 701-328-4630).
• Family Paid Caregiver Pilot Program: this state pilot pays family members who are legally responsible individuals and who provide extraordinary care to a child or adult enrolled in the Autism, Medically Fragile, Children's Hospice or Traditional IID/DD waiver. It requires an assessment and a child abuse and neglect inquiry, and it depends on available funding. The caregiver sends half-month payment requests to the state through the Family Paid Caregiver Portal. No fiscal agent is described for the pilot, so it is separate from self-direction.
• Family Personal Care (Medicaid Waiver for Home and Community Based Services): an older adult or adult with a physical disability can choose a spouse or a listed relative who lives with them as a daily-rate provider. Under the state policy, a legally responsible person or a guardian with decision-making authority needs case manager approval and a written best-interest narrative.
• Family Home Care (SPED and Ex-SPED): these state programs pay a daily rate to a spouse or listed relative who lives in the same residence. The list covers a parent, grandparent, adult child, adult sibling, adult grandchild, adult niece or nephew, or the current or former spouse of one of those relatives.

In Family Personal Care and Family Home Care the relative enrolls with the state as a Qualified Service Provider. We did not find weekly hour caps for self-directed workers in the sources we could read.

Does EVV apply to self-directed workers in North Dakota?

Yes. North Dakota's EVV page lists self-directed in-home support and self-directed respite under the Traditional IID/DD, Medically Fragile and Autism waivers as services that require electronic visit verification (EVV). The state's EVV policy applies its non-compliance rules to self-directed providers too, including denial of payment for a claim with no matching EVV record. What we could not confirm is which EVV tool self-directed workers use today.

• Whose system: the state's EVV page still names Veridian Fiscal Solutions, with a web application or a phone line, as the EVV vendor for self-directed services. That page had not been updated for the change of fiscal agent at our last check. GT Independence's North Dakota pages describe a free app and portal for logging and submitting time, but they do not mention EVV. We did not find a state statement on the current tool.
• Does pay depend on it: the state's EVV policy (updated October 2025) says a claim with no matching EVV record can be denied, and that section covers agency, independent and self-directed providers. We did not find a statement on whether a worker's paycheck is held when a visit is not verified.
• Exemptions: daily-rate live-in services, including Family Home Care and Family Personal Care, are exempt from EVV. Live-in care paid by the unit still requires it. We did not find a separate live-in exemption for self-directed workers in the three waivers.

For questions about the current EVV tool for self-directed services, ask the fiscal agent or the Developmental Disabilities Section at 701-328-8930.

What is changing next for self-direction in North Dakota?

We did not find a dated upcoming change to self-direction in North Dakota as of our last check. The main recent change is the move of fiscal agent from Veridian Fiscal Solutions to GT Independence, which the two vendors' pages report as already done. The state's own pages had not been updated to show it.

• Fiscal agent change: the state requested proposals for Fiscal Agent Services in April 2026. We did not find an award notice on a state site, and no page we opened gives the date the transition took effect. Expect the state's EVV page and children's waivers page, which still named Veridian, to be revised.
• Paying relatives in the Traditional IID/DD waiver: a public notice from January 2026 proposed a waiver amendment that would revise the section on paying relatives to align with current practice. The state's developmental disabilities page now links an approved waiver, but we could not read the final wording, so we cannot say what changed. Ask the Developmental Disabilities Section before relying on older rules.
• Family Paid Caregiver Pilot Program: the state says 2025 Senate Bill 2305 extends the pilot for two more years at a higher rate. The state's page says the bill does not specifically authorize new enrollments, and that applications are processed in the order received as funds become available.
• Children's waivers: the autism waiver's upper age limit rose from 17 to 20 under an amendment effective November 1, 2025. Some state link text may still show the older age range.

North Dakota self-direction sources

• ND HHS Developmental Disabilities: Individuals and Families (Self-Directing Services)
• ND HHS: Children's waivers (autism and medically fragile)
• ND HHS: Solicitation notice, Fiscal Agent Services (April 8, 2026)
• ND HHS: Electronic Visit Verification (EVV) system
• ND HHS: Electronic Visit Verification policy (updated October 2025)
• ND HHS: Family Paid Caregiver Pilot Program
• Veridian Fiscal Solutions: North Dakota transition notice
• GT Independence: North Dakota programs
• GT Independence: North Dakota Medically Fragile Waiver

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• North Dakota EVV requirements

Other states with one statewide FMS vendor

Arkansas, Connecticut, District of Columbia, Indiana, Iowa, New Mexico, Oklahoma, South Carolina, Tennessee, Vermont, Washington, West Virginia, Wyoming. See every state on the self-direction map.

Page history

• October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.