North Dakota DD Waiver Crisis Stabilization and Host Homes

When the Transition Creates a Crisis

The shift from school-based services to adult systems at 18 isn't always gradual. Some families hit a wall: school therapies end, the waiver is approved but no provider has capacity, behavioral needs escalate without the structure of a school day, and the family caregiver is exhausted. In a state where rural distances mean the nearest regional Human Service Center may be hours away, a care breakdown can escalate quickly.

North Dakota's 2026 waiver amendments added host homes as a new service relevant to families facing these situations.

Crisis Response Through Host Homes

Host homes provide short-term support when a family in crisis needs a temporary, licensed family setting for stabilization, specialized training, and support. The model is intended to support family reunification rather than defaulting to permanent out-of-home placement.

Host-home support can involve:

• Temporary placement in a licensed family setting
• Specialized training and support during stabilization
• A plan for family reunification

Host homes are part of the Traditional IID/DD HCBS Waiver. Access is coordinated through your regional DD unit — the same Human Service Center that manages your waiver enrollment and case management.

The Host Homes Model

Host homes, funded by the legislature effective January 1, 2026, offer a different kind of crisis response. Instead of bringing support into the family home, the waiver participant temporarily moves into a licensed family setting — a host home — for stabilization, training, and respite.

The model serves two purposes:

Crisis placement: When a family can no longer safely provide care at the current intensity level, the host home provides a structured alternative while the DD team reassesses the individual's support needs and develops a sustainable care plan. The goal is family reunification, not permanent out-of-home placement.

Training and skill-building: The host home setting can provide specialized training and support during stabilization, with the goal of helping the family reunify rather than creating a permanent placement.

Host homes use a licensed family setting with specialized training and support for individuals with intellectual and developmental disabilities. They're part of the waiver service array, meaning costs are covered through the waiver's funding allocation rather than paid out of pocket by the family.

Who Should Know About These Services

Two groups of families benefit most from understanding crisis stabilization and host homes:

Families in the 17-to-18 transition window: The first year after the 18th birthday carries the highest risk of service gaps. School services end, adult waiver services ramp up slowly (especially with provider shortages in Cass and Burleigh counties), and the young adult is adjusting to a fundamentally different daily structure. Knowing that host homes exist — and how to ask your regional DD unit about referrals — means you have a backup plan before things escalate.

Families where the Family Paid Caregiver arrangement is unsustainable: The caregiver pilot compensates families for extraordinary care, but compensation doesn't solve burnout. If a parent has been providing daily care that exceeds what's sustainable long-term, host homes offer a structured transition period while the family works toward a sustainable plan.

How to Access Host-Home Support

Host-home referrals are coordinated through the waiver system. You can prepare:

1. Know your regional DD unit contact: The eight regional Human Service Centers coordinate DD waiver services and host-home referrals. Have your DDPM's (Developmental Disabilities Program Manager) direct contact information saved — not just a general office number
2. Document behavioral patterns: If your young adult has recurring behavioral crises, keep a log of triggers, frequency, and interventions that work. This documentation speeds up the crisis response when you need it
3. Ask about host homes during waiver intake: When your young adult is enrolling in the DD waiver, ask your case manager specifically how host-home referrals work in your region

The North Dakota Adult Guardianship & Alternatives Guide includes a section on coordinating waiver services with the legal transition — making sure guardianship or SDM arrangements are in place so you know who can communicate with the DD unit and health-care providers when urgent decisions arise.

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