Medicaid Waivers in North Dakota – An Overview

Regina Woodard

By Regina Woodard for Assisted Living Directory

People may not know about the history of North Dakota, with the state possibly known for that movie set in one of its largest cities. But the 39th state has seen a remarkable uplift, despite the US Great Recession, with a boom in oil and natural resources that have helped to drive strong job and population growth.

North Dakota's Medicaid Waivers

The elderly population within the state was at 14.2%, slightly lower than the national average in the US, however that doesn’t mean that those living in the state currently aren’t seeking help in achieving help with Medicaid or Medicare. As of late last year, North Dakota has made changes to their Medicaid waivers, to ensure that all individuals are able to require aid of the waivers.

Service Payments for the Elderly and Disabled (SPED)

SPED helps to provide services for those individuals who are elderly or have physical disabilities and are having difficulty completing tasks that enable them to live within their homes independently. Some of the services included in this waiver are adult family foster care, chore services, emergency response system, family home care, personal care, respite care, and more.

To be eligible for this waiver, individuals need to have liquid assets that are less than $50,000, have an inability to pay for services, be impaired in four activities of daily living (such as bathing, dressing, etc) or five instrumental activities of daily living (such as driving, managing money, etc), and be sixty-four years of age or older.

Expanded Service Payments for the Elderly and Disabled (Ex-SPED)

Similar to the SPED program, the Ex-SPED program pays for in-home and community based services who would be receiving care within a licensed care facility, such as a nursing facility. Services with this also include case management, chore service, environmental modifications, family home care, homemaker, respite care, and more. Eligibility for this wavier includes being able to receive or being eligible for Medicaid, as well as receiving social security income and is not severely impacted by activities of daily living (such as toileting, eating, etc), is not living in an institution or dormitory, has health, welfare, or safety needs, such as supervision, and others.

Technology Dependent Medicaid Waiver

This waiver helps to provide services for individuals who need ventilators for a minimum of 20 hours per day. This helps to keep individuals in their own homes and communities, while helping to delay or divert the option or need for institutional care. Services included with this waiver include required case management, attendant care service, and others based on individual requirements.

Home and Community Based Services Waiver (HBCS)

Most of the waivers above actually fall under this umbrella of home and community based services waiver, including the technology dependent waiver. This waiver helps to provide individuals who would be required to enter nursing home facilities to remain within their home or the community they live in, giving individuals better options if their needs are able to be met at home.

The included services for this waiver are:

  • adult day care – provides up to four hours daily of attended care within a group setting
  • chore services – snow removal, heavy cleaning, and others
  • emergency response services – provides emergency telephone response services in home
  • homemaker services – provides house cleaning, laundry, and/or meal preparation
  • non-medical transportation – transportation services for essential needs like grocery shopping, errand visits, etc
  • residential care – includes 24 hour, on site response staff for scheduled and unpredictable needs
  • respite care – provides temporary relief for full time caregivers
  • specialized equipment – provides special equipment in order to reduce the need for human help
  • transitional living services – helps to train individuals to live with greater independence in their own home, including supervision and assistance with self-care, communication skills, socialization, and others

To be eligible for this waiver, individuals need to be receiving Medicaid, be receptive to being screened at a nursing facility level of care, be capable of directing their own self-care, and be at least 65 years of age or meet the criteria for social security disability.

This is just some of the different waivers that elderly individuals and their families can take advantage of while in North Dakota. Some of the other waivers include the Children’s Hospice waiver for medically fragile or physically disabled individuals (for those 64 years or older) and the Traditional ID DD waiver (also under the HCBS waiver) that helps individuals with no age limit.

The best way to find out more information is to contact the North Dakota Department of Human Services in Bismarck on 600 E Boulevard Ave or to give them a call 701.328.2310 or you can visit their website, at to learn more about their different programs for residents within the state.


Photo by A. Rams


North Dakota facts

ND to End Medicaid Waiver Services that Isolate Individuals



Technology Dependent Medicaid Waiver


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