North Dakota DD Waiver: How to Apply for the Traditional IID/DD HCBS Waiver

What the Traditional IID/DD Waiver Covers

The Traditional IID/DD Home and Community-Based Services (HCBS) Waiver is North Dakota's primary funding source for long-term adult disability supports. Federally designated under ID 0273.R06.00, this waiver covers services that help individuals remain in their homes or community settings rather than institutions.

Core services include:

• Residential habilitation and shared living — daily living skills training, meal preparation, and personal care support in a home setting
• Day habilitation — structured daytime community integration and socialization programs
• Supported employment — on-the-job coaching and employment supports for competitive integrated work
• Family support — financial assistance for families providing direct care
• Environmental modifications — home accessibility modifications and adaptive equipment

Eligibility Requirements

Three layers of eligibility must be met:

Developmental disability criteria. Under NDAC Chapter 75-04-06, the applicant must have an intellectual disability or a related condition — such as autism, cerebral palsy, or epilepsy — that manifested before age 22 and results in substantial functional limitations in three or more areas of major life activity.

ICF/IID level of care. To qualify for waiver-funded services (as opposed to just DD case management), the individual must meet the Intermediate Care Facility for Individuals with Intellectual Disabilities level of care. This is verified annually using standardized assessment tools, primarily the Supports Intensity Scale (SIS) and the Inventory for Client and Agency Planning (ICAP). These assessments generate a Level of Service score that determines the funding tier and authorized service hours.

Medicaid eligibility. The applicant must be enrolled in North Dakota Medicaid. For adults 18 and older, parental income is typically disregarded for this eligibility determination — the individual qualifies based on their own resources. North Dakota is a 209(b) state, so SSI approval does not automatically confer Medicaid; a separate application through North Dakota Health and Human Services is required, with a countable asset limit of $3,000.

The Application Process

The intake pipeline runs through North Dakota's eight regional Human Service Centers. Here's what to expect:

Step 1: Contact your regional Human Service Center. Call the DD unit at the center serving your county and request a Developmental Disabilities Eligibility Determination Packet. Each region covers specific counties — if you're unsure which center serves you, the HHS website lists assignments by county.

Step 2: Intake meeting. The regional DD unit arranges an in-person meeting to gather personal history, obtain release authorizations, and explain the eligibility process. For rural families, this may mean significant travel.

Step 3: Eligibility determination. The DD unit reviews medical records, psychological evaluations, and functional assessments to confirm the applicant meets the developmental disability criteria.

Step 4: Level of care screening. If eligible for DD services, a SIS or ICAP assessment determines whether the individual meets the ICF/IID level of care for waiver services.

Step 5: Medicaid coordination. The applicant must establish Medicaid eligibility through their local Human Service Zone office. Do not assume this happens automatically — it requires a separate application.

Step 6: Person-Centered Service Plan. Once waiver eligibility is confirmed, a Developmental Disabilities Program Manager (DDPM) is assigned. The DDPM coordinates referrals to licensed providers and facilitates the creation of a Person-Centered Service Plan (PCSP) outlining residential, day, and employment goals.

The Zero-Waitlist Reality

North Dakota officially reports a near-zero waitlist for its Traditional DD Waiver. This sounds reassuring, but the administrative metric doesn't tell the whole story.

Being approved for waiver funding and actually receiving services are different things. In rural regions, there is a persistent shortage of licensed provider agencies, Qualified Service Providers, and Direct Support Professionals. A student may be approved but face months of delay because no local provider has available staff.

The self-directed services option offers a workaround. Under this arrangement, the individual or their representative directly hires, schedules, and manages support staff — including qualified family members or neighbors. This bypasses traditional agency staffing bottlenecks, which is why rural families frequently choose this model.

When to Start the Process

The intake and eligibility determination process can take months. If your child is still in high school, the school system provides a safety net of transition services. Once the student exits special education, that safety net disappears.

The practical recommendation: begin the DD eligibility process during high school and before the student's expected school exit. This gives time to complete eligibility determinations, functional assessments, and provider matching before school services end.

The North Dakota IEP Transition to Adulthood Guide includes a Human Service Center contact log, assessment preparation worksheets, and a timeline planner for coordinating the waiver application with the student's IEP transition schedule.

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