Agency seeks comments on changes to North Dakota Medicaid waiver services


The North Dakota Department of Human Services is accepting public comments from older adults, adults with physical disabilities, guardians, family members and other interested individuals about proposed amendments to the state’s Medicaid waiver for home and community-based services. The waiver pays for a variety of in-home community-based support services that allow individuals who otherwise qualify for nursing home care to remain living in their homes and communities. Comments will be accepted through Oct. 3, 2019, at 5 p.m. Central Time.

Describing the benefit of this Medicaid waiver, Aging Services Division Director Nancy Nikolas Maier said, “This waiver makes it possible for qualifying individuals to remain living at home and can help delay or prevent institutional care in nursing facilities.”

Maier said the department is seeking federal approval to amend the waiver to reflect recent state legislative changes and to add new services allowing individuals to access more services supporting community living. 

Proposed Changes

The amendment adds residential habilitation as a covered service. Residential habilitation is formal training and supports provided to eligible individuals who need ongoing daily support and can benefit from adaptive skills training, care coordination, community inclusion, assistance with bathing, dressing, eating, and other daily self-care tasks, as well as more complex activities like meal preparation, house work, taking medications correctly, mobility and non-medical transportation help, and other services that help people remain living in the community.

The amended waiver also expands the definition of adult foster care to include agency adult foster care facilities, and adds community support services, and companionship services to reduce social isolation and its related negative impact on physical and mental health and well-being. It also requests a waiver of the conflict-free case management rules for tribal nations that want to provide culturally competent case management services to eligible tribal members.

Details about these and other changes contained in the draft amendments to the Medicaid home and community-based services waiver are listed in the public notice posted online at The draft waiver amendment document is online at A copy will be provided upon request.

Submitting Comments

Individuals can submit comments by emailing dhshcbsatnd [dot] gov

, or calling 855-462-5465, or 711 (TTY) or by fax at 701-328-8744. Comments can also be mailed to the North Dakota Department of Human Services - Aging Services Division, Attn: HCBS, 1237 W. Divide Ave., Ste. 6, Bismarck, N.D., 58501.

After the public comment period ends, the waiver will be submitted to the federal Centers for Medicare and Medicaid Services (CMS) for review and approval. The waiver is expected to be effective Jan. 1, 2020.