Overview of the Amendment
North Dakota Health and Human Services (HHS) is actively seeking public input on a significant amendment to the state’s Medicaid Traditional Individuals with Intellectual Disabilities/Developmental Disabilities (IID/DD) Home and Community-Based Services (HCBS) waiver. This critical amendment, dated April 1, 2025, represents a major step forward in supporting vulnerable populations across North Dakota.
The public comment period officially runs from August 29 through September 28, 2025, providing residents, advocates, and stakeholders ample opportunity to review and respond to the proposed changes. This collaborative approach ensures that community voices are heard in shaping vital support services for individuals with intellectual and developmental disabilities.
What is the IID/DD Waiver?
The IID/DD waiver serves as a comprehensive framework that offers an extensive range of in-home and community-based services. These services are specifically designed to support people with intellectual and developmental disabilities in the least restrictive setting possible, promoting independence and community integration while maintaining necessary support structures.
This waiver program represents North Dakota’s commitment to person-centered care, ensuring that individuals can receive appropriate services while remaining connected to their families and communities. The program emphasizes dignity, choice, and quality of life for all participants.
Key Changes in the 2025 Amendment
Introduction of Host Homes
The most significant addition to the waiver is the introduction of host homes as a new service option specifically designed for youth with developmental disabilities. This innovative approach addresses a critical gap in crisis intervention services for families throughout North Dakota.
Host homes provide licensed family settings where youth can live temporarily during crisis situations. These specialized environments offer:
- Structured support systems that address individual needs
- Specialized training tailored to each youth’s requirements
- Crisis stabilization services that promote healing and growth
- Family connection maintenance to preserve biological family relationships
- Reunification planning to support successful family restoration
This groundbreaking model helps youth transition from crisis situations to stability while maintaining essential family connections and working systematically toward successful reunification with their biological families.
The 2025 North Dakota Legislature demonstrated strong support for this initiative by approving dedicated funding for host homes. This funding directly supports a key HHS strategic priority: advancing the foundations of well-being through improved access to high-quality services and comprehensive support systems.
Language Updates and Compliance
Beyond the host homes addition, the proposed amendment includes important updates to internal processes and enhanced provider compliance requirements. These changes strengthen incident reporter requirements, ensuring better documentation, tracking, and response to critical incidents within the system.
These compliance improvements reflect North Dakota’s commitment to maintaining the highest standards of care and accountability in its Medicaid waiver programs.
Public Comment Process
How to Submit Comments
North Dakota HHS has established multiple convenient channels for public participation in this important process. The complete waiver amendment application, including all proposed changes, is readily available at hhs.nd.gov/waivers. For those without internet access, physical copies can be requested and mailed directly to interested parties.
Comments can be submitted through three accessible methods:
By Mail: North Dakota Health and Human Services – Developmental Disabilities Section Attn: Heidi Zander 1237 W. Divide Ave., Suite 1A Bismarck, N.D., 58501
By Email: hzander@nd.gov
By Phone: (701) 328-8945 or 711 (TTY)
Timeline and Implementation
Following the conclusion of the public comment period on September 28, 2025, the amended waiver will be submitted to the federal Centers for Medicare and Medicaid Services (CMS) for comprehensive review and approval. Based on established CMS review timeframes and approval processes, the waiver amendment is expected to become effective on January 1, 2026.
This timeline provides adequate opportunity for thorough federal review while ensuring timely implementation of these crucial services for North Dakota families.
Understanding Medicaid Waivers
Medicaid waivers function as formal agreements between CMS and individual state Medicaid agencies. These agreements are designed to serve specific population groups with unique needs and circumstances. Each waiver carefully specifies:
- The total number of people to be served
- Detailed eligibility criteria and requirements
- Available services and any applicable service limitations
- Comprehensive procedures for evaluation and re-evaluation of care levels
- Quality assurance and monitoring protocols
These specifications ensure that waiver programs maintain high standards while providing flexibility to meet diverse community needs.
Conclusion
North Dakota’s proposed Medicaid waiver amendment represents a significant advancement in supporting individuals with intellectual and developmental disabilities and their families. The addition of host homes addresses a critical service gap, while updated compliance measures strengthen program integrity.
Community participation in the public comment process is essential for ensuring these changes effectively serve North Dakota’s most vulnerable residents. Stakeholders are encouraged to review the proposed amendments and provide thoughtful feedback during the comment period.
This amendment reflects North Dakota’s ongoing commitment to providing comprehensive, person-centered services that promote independence, family preservation, and community integration for individuals with intellectual and developmental disabilities.
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