North Dakota DD Provider Moratorium and QSP Shortage

The Moratorium That Makes Provider Shortages Worse

Effective June 11, 2026, North Dakota Medicaid implemented a temporary provider enrollment moratorium covering several provider types in the state's most populated areas. The moratorium freezes new provider enrollment for:

• Non-Emergency Medical Transportation (NEMT) agencies statewide
• Qualified Service Provider (QSP) agencies in Cass and Burleigh counties
• Developmental Disabilities (DD) agencies in Cass and Burleigh counties

Cass County (Fargo-West Fargo metro) and Burleigh County (Bismarck) are where the largest concentration of DD waiver participants live. A moratorium in these two counties hits the population centers hardest — the very places where you'd expect the most provider options.

What This Means Practically

The moratorium doesn't affect your waiver enrollment. If your young adult qualifies for the Traditional IID/DD HCBS Waiver, they can still enroll — North Dakota maintains a zero-person waiting list for clinical eligibility. The problem is what comes after enrollment: finding an agency or individual provider to actually deliver services.

With the moratorium blocking new QSP agencies from enrolling in Cass and Burleigh counties, families are competing for slots with existing providers. And those existing providers are already operating at or near capacity.

The practical consequences:

• Longer waits for in-home services after waiver approval
• Limited choice among available QSP agencies — you may get assigned to whoever has an opening rather than choosing a provider that fits your family's needs
• Geographic mismatch — a provider based in Fargo may not serve families in the outer edges of Cass County without significant travel surcharges or scheduling limitations

The Qualified Service Provider (QSP) Shortage

Even without the moratorium, North Dakota has faced a structural QSP shortage driven by the same workforce pressures affecting direct support professionals nationwide. QSPs provide the hands-on daily support that waiver participants rely on — personal care, community integration, employment support, behavioral intervention.

The shortage is most acute in rural areas, where there may be only one or two QSP agencies serving an entire region. But the Cass/Burleigh moratorium creates a version of the same problem in urban areas, where normally you'd have more options.

For families transitioning a young adult at 18, this means the gap between "waiver approved" and "services actually starting" can stretch for weeks or months. During that gap, you're providing the care yourself — which is why programs like the Family Paid Caregiver pilot matter.

Workarounds That Families Are Using

Self-directed services: North Dakota's DD waiver includes a self-directed option that lets the participant (or their guardian/representative) hire, train, and manage their own support workers directly. Instead of going through an agency, you recruit individuals — neighbors, community members, college students — and the waiver reimburses them. This bypasses the agency moratorium entirely because you're not enrolling a new agency. More on how this works in our self-directed services overview.

Neighboring county providers: The moratorium is county-specific for QSP and DD agencies. Providers enrolled in adjacent counties can sometimes serve Cass or Burleigh residents, though travel distance affects scheduling and availability.

Family Paid Caregiver pilot: Launched April 2024, this program can reimburse an eligible legally responsible individual for providing extraordinary care to an adult waiver participant, at the adult rate of $154.89 per day. It can help fill the gap when agency providers aren't available.

Host homes: The legislature funded host homes as a new service under the Traditional IID/DD waiver, effective January 1, 2026. This model allows families in crisis to temporarily place their family member in a licensed family setting for stabilization and specialized training. It's not a permanent solution, but it provides a temporary setting for stabilization and training while the family and DD team work toward reunification.

Planning Around the Shortage

If your child's 18th birthday is approaching and you're in Cass or Burleigh County, start the waiver enrollment process as early as possible — ideally at 17.5 — so the administrative timeline doesn't stack on top of the provider search. Contact your regional Human Service Center's Developmental Disabilities Program Manager to initiate the eligibility determination, and ask specifically about current provider availability and wait times in your area.

The North Dakota Adult Guardianship & Alternatives Guide includes a coordination timeline showing how to sequence the waiver application, guardianship petition, SSI redetermination, and provider search so they run in parallel instead of sequentially.

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