NORTH DAKOTA
DNorth Dakota's system, honestly. A letter grade is a summary, not a verdict on your family — a low grade doesn't mean nothing is available, it means the path is narrower. What's behind it is below.
Do this first
Contact the regional Human Service Center for your area and ask to be assigned a DD Program Manager — that is a state employee and the person who coordinates everything on the developmental disabilities side. Separately, apply for ND Medicaid through your Human Service Zone, because Medicaid eligibility is decided there rather than by the DDPM and both have to be in place. Those are two different offices and families regularly assume one covers the other. Then be ready for a two-step eligibility judgement: the team must first decide whether the condition is severe enough to constitute a developmental disability under NDCC 25-01.2-01, and then separately whether services can appropriately be provided — the administrative code says explicitly that having a developmental disability does not by itself establish eligibility.
Last verified 2026-07-03
HOW WE GRADE NORTH DAKOTA
Full methodology (v2.1) →North Dakota's strongest area is self-direction index; what pulls the grade down most is institutional vs. community balance.
Waitlist Burden
30% of grade—Not available
Nobody waiting scores 100. 225 per 100,000 scores 0.
- Not scored: North Dakota has no list for its main disability waiver, but 141 children are waiting for its separate autism waiver, and the main waiver's own rules start a date-ordered waiting list as soon as the yearly participant limit is reached.
Source:KFF State Health Facts, People Waiting for HCBS by Target … (FY2025 (KFF Medicaid HCBS Waiver Program Survey, FY 2025))US Census Bureau Vintage 2025 state population estimates (2025-07)
HCBS Spending Per Capita
25% of grade41/100$396 spent per resident
$200 per resident scores 0. $675 scores 100.
Source:CMS / Mathematica — Medicaid LTSS Annual Expenditures and … (CY2023)
Self-Direction Index
20% of grade75/10075 out of 100 on the self-direction index
Scored directly on its own 0–100 scale.
Source:CMS approved 1915(c) waiver application (2026-08-05)CMS approved 1915(c) waiver application (2026-08-05)
Waiver Program Count & Breadth
15% of grade60/10060 out of 100 on program breadth
Scored directly on its own 0–100 scale.
Source:Medicaid.gov State Waivers List, Authority=1915(c), Status… (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 2 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 1 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)
Each factor is scored against a fixed bar, not against the other states, so North Dakota's grade moves when North Dakota moves. Think we have it wrong? Every number above links to its source — email hello@spectrumpathways.ai and we will correct it in public.
WHAT THINGS ARE CALLED IN NORTH DAKOTA
Use these exact words when you search, call, or fill out forms — they're what North Dakota's own offices use.
- Medicaid here is
- ND Medicaid
- The DD agency is
- Developmental Disabilities Section (DHHS)
- You contact
- regional Human Service Center
- The plan is
- Individual Program Plan
- Self-direction is
- Self-Directed Supportscontrolling your own budget and hiring your own people
- A denial arrives as a
- Notice of Decisionthe letter that gives you the right to appeal
WHO TO CONTACT, IN ORDER
Five different offices, and they don't talk to each other. Disability services, health coverage, and income each run through a separate agency — applying to one does not start the others. Ask each office for the name of the person you spoke to and write down the date; if something is later denied, that record is what an appeal is built on.
- 1
Developmental disability services
This is the office that decides whether your child is eligible for disability services. Ask for "intake" or "eligibility determination" by name. In North Dakota, you contact regional Human Service Center.
North Dakota HHS Developmental Disabilities (regional HSC intake)
- 2
Health coverage — ND Medicaid
Almost every waiver and personal-care route requires this first, and it is decided by a different office from the one above. Apply in parallel rather than waiting.
- 3
Help at home, and who can be paid for it
Unless you say otherwise, services come the traditional way: the agency picks and pays the providers. Self-direction — where you get a budget and hire your own people — is opt-in almost everywhere and is not offered automatically. Here it is called Self-Directed Supports. Ask for it by that name.
- 4
Income — SSI
Federal, so it's the same everywhere: 1-800-772-1213 (TTY 1-800-325-0778). There is no minimum age — you can apply for a newborn. Until 18, the parents' income is deemed to the child, so an early denial is usually about that rather than the child's disability. In many states an SSI award also opens Medicaid automatically — ask when you call.
- 5
If you get told no
Every state has a Protection & Advocacy agency by federal law — free legal help on disability services and appeals. Most families never hear of it, and it is the number to have before a deadline, not after. Yours is Protection & Advocacy Project (North Dakota).
Protection & Advocacy Project (North Dakota) · 1-800-472-2670
RUNNING IT YOURSELF
In many states you can control the budget and hire your own people — including, sometimes, family. Most families are never told this is an option. Here's what we've verified for North Dakota; where we haven't verified an answer we say so — it does not mean the answer is no, and it is worth asking.
Can you control the budget?
No — verified: North Dakota offers no self-direction, and its personal care programme has no consumer-directed benefit
Can a family member be paid to provide care?
No — North Dakota has no self-direction, so there is no route to pay a family member
Who is legally the employer of the people you hire?
Not verified yet — ask, don't assume the answer is no.
How freely can money move between services?
Not verified yet — ask, don't assume the answer is no.
Can the budget buy things, not just staff time?
Not verified yet — ask, don't assume the answer is no.
Is your case manager independent of your providers?
Not verified yet — ask, don't assume the answer is no.
Your income does not disqualify your child.
North Dakota determines waiver eligibility on the individual's own income and medical need; parental income is not counted.
Deadlines reflect this state’s rules as researched; they can change — always confirm the current deadline with your state agency or Protection & Advocacy office before relying on it.
HOW TO GET SERVICES & APPEAL IN NORTH DAKOTA
- DD program / fee-for-service Medicaid: request fair hearing within 30 calendar days of the adverse decision notice
- Optional DD informal conference: request within 10 days (does not extend the 30-day appeal deadline)
- Continuation: request hearing within 10 calendar days of the notice date
- Managed care: after MCO Notice of Resolution, request fair hearing within 120 days
KEY AGENCIES & RESOURCES
NOTABLE WAIVERS
Traditional IID/DD HCBS Waiver
SourceChildren and adults with intellectual/developmental disabilities.
Waitlist: North Dakota historically enrolls without long waitlists — apply through regional Human Service Centers.
Autism Spectrum Disorder Birth-through-17 Waiver
SourceChildren with autism.
Waitlist: Capped enrollment; verify openings.
Medically Fragile Children Waiver
SourceChildren with complex medical needs.
Waitlist: Verify with HHS.
Full milestone guide
View the North Dakota Roadmap →
Six age-based stages — state-correct programs, benefits, and milestones from birth through adulthood.
