North Dakota Medicaid seeks $4.9 million to design cross‑disability children’s waiver; agency outlines costs, risks and program requests

Sarah Acre, executive director of the Division of Medical Services at the North Dakota Department of Health and Human Services, told the Legislative Appropriations Committee that the division is requesting $4,900,000 in ongoing funding to design and implement a new cross‑disability children's Home‑ and Community‑Based Services (HCBS) waiver and to develop an updated level‑of‑care assessment.

Acre said the proposed waiver would combine elements of existing children’s waivers — autism, medically fragile and developmental disabilities — to create a single cross‑disability children’s waiver intended to improve transitions, family navigation and service flexibility for participating children and families. "We're requesting $4,900,000 in ongoing funding to help design and implement this waiver over the next biennium," Acre said during the hearing.

Why it matters: the Division said Medicaid and long‑term care together total about $2.9 billion and make up roughly 45.9% of the department’s budget; changes in waiver design, enrollment or reimbursement could affect care for children with complex needs, older adults and people with disabilities, and have major budget implications.

What the division reported - Program scale and finance: Acre said Medicaid is a federal‑state partnership, noting the program serves about 152,000 individuals over a year, with roughly 61% of funding federal and 37% state general funds. She described Medicaid as an entitlement program with certain places to limit service (for example, HCBS waiver slot limits).

- Waiver design…