North Dakota Self-Directed Services for People with Disabilities
Why Self-Direction Matters in North Dakota
North Dakota's Traditional IID/DD HCBS Waiver offers a self-directed services option that gives individuals with developmental disabilities — or their families — direct control over hiring, scheduling, and managing their own support staff. In a state where licensed provider agencies are concentrated in Fargo, Bismarck, Grand Forks, and Minot, self-direction is often the only realistic path to receiving services in rural and frontier counties.
The model works like this: instead of a provider agency assigning staff, the young adult (or their representative) becomes the employer. They recruit support workers from their own community — neighbors, family friends, qualified relatives — and manage the day-to-day relationship directly. The waiver funding flows through a fiscal intermediary that handles payroll, taxes, and workers' compensation.
Person-Centered Planning and the Overall Service Plan
Every individual enrolled in North Dakota's DD waiver system works with a Developmental Disabilities Program Manager (DDPM) assigned through their regional Human Service Center. The DDPM facilitates the creation of a Person-Centered Service Plan (PCSP), which outlines the individual's goals for housing, employment, community participation, health, and relationships.
The PCSP feeds into the Overall Service Plan (OSP), which is the formal document that authorizes specific services and funding levels. The OSP is where the rubber meets the road — it specifies exactly which waiver services are authorized, how many hours of support the individual receives, and whether those services are delivered through a traditional agency or self-directed.
Both plans must center the individual's own preferences. North Dakota's HCBS settings rules require that services support the person's full access to the community, that the individual controls their personal resources and schedule, and that they have choices about who provides their support. Self-direction is the purest expression of that requirement.
How to Set Up Self-Directed Services
The process begins with DD waiver enrollment through your regional Human Service Center. Once the individual is deemed eligible and has met the ICF/IID level of care, their DDPM helps build the Person-Centered Service Plan. During this planning process, the family should specifically request self-directed services.
From there, the steps are:
Identify a fiscal intermediary — North Dakota contracts with fiscal intermediary organizations that handle the administrative side of self-direction. They manage payroll, withhold taxes, process timesheets, and ensure compliance with employment laws.
Recruit and hire workers — You find your own support staff. In rural North Dakota, this often means hiring from within the community. Qualified family members can serve as paid support workers in many cases, though there are restrictions on spouses serving as paid caregivers.
Train your workers — You're responsible for training staff on the individual's specific needs, communication preferences, and safety protocols. The DDPM can help connect you with training resources.
Manage the schedule — You set the hours and routines. This flexibility is one of self-direction's biggest advantages — support happens when and where the individual needs it, not when an agency has staff available.
Submit documentation — Timesheets go through the fiscal intermediary. The DDPM reviews service delivery periodically to ensure it matches the authorized plan.
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When Self-Direction Makes Sense
Self-directed services are particularly well-suited for families in counties where the nearest licensed provider agency is an hour or more away. Trying to staff regular support shifts from a distant agency leads to turnover, no-shows, and inconsistent care. Hiring locally solves the geography problem.
Self-direction also works well for families who want deep control over how support is provided — particularly around cultural practices, communication styles, and daily routines that a generic provider might not accommodate.
The tradeoff is administrative responsibility. The family manages a small employer relationship, including finding backup workers when someone is sick and handling the interpersonal dynamics of supervising people they may know personally. For families who are already providing informal support, formalizing it through self-direction means getting paid for work they're already doing.
The Connection to Transition Planning
Families should start thinking about self-directed services before the young adult leaves school. If the DD waiver application is submitted at age 17 and eligibility is confirmed by age 18, the PCSP planning process can include self-direction from the start. Waiting until after graduation to explore options creates the exact service gap that transition planning is supposed to prevent.
During IEP transition meetings, ask the school to invite your regional DDPM to discuss adult service options, including self-direction. The school needs your written consent to make that invitation, but having the DDPM at the table while school services are still active gives everyone time to plan the handoff.
The North Dakota IEP Transition to Adulthood Guide includes Human Service Center contact logs and service planning worksheets designed to help families navigate the DD enrollment and self-directed setup process.
Frequently Asked Questions
Can family members be paid as self-directed support workers?
In many cases, yes. Qualified family members can be hired as paid support staff under the self-directed model, though there are restrictions — typically, spouses cannot serve as paid caregivers, and the family member must meet any training or qualification requirements. Check with your DDPM for current rules.
What's the difference between self-directed services and hiring a private caregiver?
Self-directed services are funded through the Medicaid DD waiver, so the individual doesn't pay out of pocket. The fiscal intermediary handles employer responsibilities (payroll, taxes, insurance). A private hire arrangement would use the family's own funds and wouldn't come with the waiver's infrastructure.
How many hours of self-directed support can someone receive?
Hours are determined by the individual's assessed level of need, based on the Supports Intensity Scale (SIS) and ICAP evaluations. The authorized hours are documented in the Overall Service Plan. Higher assessed needs translate to more funded hours.
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