Understanding the North Dakota Developmental Disabilities Waiver for ABA Therapy

What Is the North Dakota Developmental Disabilities (DD) Waiver?

The North Dakota Developmental Disabilities (DD) Waiver is a Medicaid Home- and Community-Based Services (HCBS) waiver. It was designed to help people with developmental disabilities receive care in their own homes or community settings rather than in an institution. For families of children with autism, this waiver can be a critical way to access applied behavior analysis (ABA) therapy, as well as other supports like respite care, personal assistance, and behavioral intervention planning.

The waiver is administered by the North Dakota Department of Human Services (DHS) and operates under specific federal guidelines. It allows the state to use Medicaid funds to pay for services that are not typically covered under standard Medicaid. In North Dakota, the DD Waiver is one of several HCBS waivers, but it is the primary one for individuals with developmental disabilities such as autism spectrum disorder (ASD), intellectual disabilities, and related conditions.

One key point for families: the waiver is a benefit that follows the person. Once enrolled, you can choose your provider, and services like ABA therapy can be delivered at home, in a clinic, or in other natural environments. Because Start with ABA is a free referral service, we can help you find BCBA-led providers who are already enrolled as DD Waiver providers or who are willing to work with waiver funding.

🔗 Related reading: 3 Year Old Not Responding to Name: ABA Therapy Guide · Local ABA Therapy

Who Is Eligible for the ND DD Waiver?

Diagnostic and Functional Criteria

To qualify for the North Dakota DD Waiver, an individual must have a diagnosis of a developmental disability. The state defines a developmental disability as a chronic, severe condition that begins before age 22 and results in substantial functional limitations in at least three of these areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency. Autism spectrum disorder typically meets these criteria if it significantly impacts daily functioning.

Age and Financial Requirements

The waiver is available to both children and adults. However, financial eligibility is based on income and assets. North Dakota uses Medicaid income standards, which can be confusing. Generally, applicants must have income at or below 300% of the federal Supplemental Security Income (SSI) benefit rate. But there are also rules about spousal impoverishment and how parental income counts for children. Many families work with a case manager or the Department of Human Services to determine eligibility.

Importantly, the DD Waiver does not require the individual to be poor; there are ways to qualify through medical necessity and disability criteria even if the family has moderate income. Additionally, children may qualify through Medicaid's Children's Health Insurance Program (CHIP) or through a separate autism insurance mandate. The DD Waiver can be used in combination with other insurance to cover copays or deductibles.

How the DD Waiver Covers ABA Therapy

ABA therapy is a scientifically validated treatment for autism that focuses on increasing positive behaviors and decreasing harmful ones. Under the ND DD Waiver, ABA therapy can be included as a behavioral intervention service. The waiver's service list includes:

• Behavioral consultation and intervention
• Personal support and habilitation
• Respite care
• Supported employment
• Therapeutic services (including occupational, speech, and physical therapy)

However, not all waiver providers are certified to deliver ABA. The state requires that behavioral services be provided by a Board Certified Behavior Analyst (BCBA) or under the supervision of a BCBA. This is where Start with ABA's matching service becomes valuable. We can connect you with providers who have the proper credentials and experience with waiver billing.

Prior Authorization and Plans of Care

Getting ABA covered through the waiver involves a person-centered plan. A case manager works with the family to create a plan that outlines goals, frequency, and duration of therapy. That plan is submitted to the DHS for prior authorization. Once approved, the provider can begin services. The waiver pays a set rate per hour for ABA therapy, which is often competitive with private insurance rates.

One word of caution: the DD Waiver has a capped enrollment. There are a limited number of slots, so there may be a waiting list. If you are interested, apply as soon as possible. In the meantime, you can still access ABA through private insurance or state-funded programs like Early Intervention (Part C) for children under age three.

🔗 Related reading: Autism Support Groups for SC Parents: Find Community & Care · Nearby ABA Therapy

Costs and Financial Considerations

One of the biggest concerns for families is cost. ABA therapy can be expensive without insurance-sometimes $50,000 to $100,000 per year. The DD Waiver can reduce that to nearly zero. Because it is a Medicaid waiver, there is no premium for the waiver itself. However, some families may have to pay a share of cost based on income, similar to a deductible. For most, the out-of-pocket expense is minimal.

Additionally, if the child has private insurance, the waiver can act as a secondary payer, covering what insurance does not. This is often called a wrap-around effect. For example, if your insurance covers 80% of ABA, the waiver might pay the remaining 20%, plus any copays. This can be a lifesaver for families who have high deductibles or session limits.

There are no hidden fees when working with Start with ABA. Our service is completely free for families. We simply earn a fee from providers if you choose their services. So you get personalized provider matches without any cost to you.

How to Apply for the North Dakota DD Waiver

The application process begins by contacting your local Human Service Zone (HSZ). North Dakota has eight Human Service Zones covering all 53 counties. You can find the office nearest you on the ND DHS website. They will assign a case manager to help with the paperwork.

You will need to provide documentation of the diagnosis (from a doctor or psychologist), proof of functional limitations, and financial information. The case manager will also conduct an assessment to determine the level of care needed. It is important to be thorough and include reports from therapists, schools, and other providers that show the need for ABA.

After the application is complete, the DHS reviews it. If the waiver slot is available, you'll receive a notification and a plan of care can be developed. If there is a waiting list, you can ask to be placed on it. While you wait, you can still start ABA therapy using other funding sources, and then transition to the waiver once a slot opens.

Mistake to avoid: don't assume that a doctor's referral is enough. The waiver requires an ongoing disability that meets the definition above. Also, be aware that the waiver may require an annual re-determination of eligibility. Keep all records organized.

Common Mistakes to Avoid

Mistake 1: Waiting until you have a diagnosis. You can begin the eligibility process before a formal autism diagnosis if you suspect a developmental disability. Early intervention is crucial.

Mistake 2: Not exploring other coverage options. Even if you get the waiver, check if your child is eligible for CHIP or private insurance through a parent's employer. Combining waivers with other insurance can maximize benefits.

Mistake 3: Assuming all ABA providers accept the waiver. Not every BCBA-led clinic is enrolled as a Medicaid DD Waiver provider. That's why Start with ABA asks about your preferred insurance and matches you with providers who accept it. It saves you hours of phone calls.

Mistake 4: Missing renewal deadlines. The waiver requires annual paperwork. Missing a deadline can lead to temporary loss of benefits. Set calendar reminders.

How Start with ABA Helps You Find Providers

Searching for a BCBA-led ABA provider in North Dakota who accepts the DD Waiver can be overwhelming. You have to verify credentials, check availability, and navigate billing. Start with ABA simplifies all of that.

We are a free matching service. You fill out a short form telling us about your child, your location, and your insurance (including the DD Waiver). Our team then connects you with vetted providers in your area who have experience with the waiver. We do not charge families-ever. We work with providers who meet our quality standards, so you can be confident you're getting excellent care.

To get started, just visit our website and complete the matching request. Within a few days, we'll provide a list of providers that fit your needs. You can then schedule consultations and choose the best fit for your family. Many families tell us this removes a huge burden during an already stressful time.

The DD Waiver is a powerful tool to help your child thrive at home and in the community. Let us help you find the team that will make the most of it.