North Dakota program
Home support for a child with medically fragile needs
A Medicaid route and home support for children who need a nursing-home level of care.
What it is
A Medicaid route and home support for children who need a nursing-home level of care.
Some children need extensive skilled care to live safely at home. This waiver checks whether that care meets a nursing-facility standard. Waiver approval and Medicaid approval are separate steps.
Eligibility rules
- The minimum age is three.
- The waiver runs from age 3 to 21; near the end the office confirms the last covered month and what comes next.
- The waiver office decides whether your child needs nursing-home-level care and can be safe at home. Medicaid then decides money separately; in a full month of waiver services, your income over the line is not counted against your child, though part of it can still be. Ask the worker for the child's budget in writing.
What you get
- Home support in place of nursing-facility care.
- A possible route into Medicaid after waiver approval.
What the help includes
- The care team documents skilled needs and equipment. A waiver assessment decides the level of care.
If you decide to apply
- Ask the oncology social worker to discuss your child’s daily care with the children’s waiver office.
- If you decide to pursue it, complete SFN 394 with care records, equipment and nursing needs.
701-328-4630 — The children’s waiver office at North Dakota Health and Human Services · Official page ↗
After you ask
- After waiver approval, a separate Medicaid application is still needed.
- The children’s waiver office reviews SFN 394 and the care assessment. The office confirms funded openings, waiting-list position and assessment timing. Medicaid eligibility is separate: the general decision standard is 45 days, or 90 days when a disability determination is pending, subject to exceptions. Those clocks do not promise a waiver opening or staffed services.
Good to know
Waiver approval does not enroll your child in Medicaid. There is a separate Medicaid application after approval.
Other details
- North Dakota’s children’s waiver office is the starting point for comparing the care your child needs with the waiver’s test.
Federal background: Medicaid home and community-based services waivers.
Official sources
- Centers for Medicare and Medicaid Services: ND Medicaid Waiver for Medically Fragile Children (0568.R04.00)
- Centers for Medicare and Medicaid Services: North Dakota waiver factsheets
- North Dakota Health and Human Services: Children’s Waiver Services
- North Dakota Health and Human Services: SFN 394, Children with Medically Fragile Needs Application
- North Dakota Health and Human Services: Medicaid Eligibility
- North Dakota Legislative Council: Administrative Code chapter 75-02-02.1, Eligibility for Medicaid
- Official source reviewed September 21, 2026 (AQ10)
“Does our child’s care meet this waiver’s nursing-home standard? What would it add, what would the application involve, and could you help if it is worth pursuing?”
Why I’m asking: I want enough support for home to be safe.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Call the waiver office and describe the care at home in plain terms: hours, equipment, who does it.
Your social worker
The oncology social worker says whether the care reaches the level the waiver needs, before you spend weeks on a form.
The care team
The team documents skilled nursing needs and equipment.
- Who decides
- The children’s waiver office, after an assessment of the level of care.
- Ask your social worker
- “Does the care my child needs at home reach the nursing-home level this waiver asks for, and is it worth applying now?”
How to apply
First step: Call the children’s waiver office on 701-328-4630 and ask whether the level of care fits before you file SFN 394.
- Call the children’s waiver office on 701-328-4630 or 800-755-2604 and ask whether your child’s care reaches a nursing-home level.
- Ask for the current wait before you plan around it.
- File form SFN 394 if the office says the level of care fits.
Official application / program page ↗
Where it starts: Start with form SFN 394, then apply for Medicaid separately once the waiver is approved.
What to gather
- A written description of the care at home: hours, equipment, who does it
- Medical records from the oncology team
How long: Not published. Ask the office for the current wait.
What a yes looks like
A waiver approval, followed by a separate Medicaid application for the approved child.
What a no looks like, and the next move
Usually a level-of-care no. Ask what the assessment measured, and ask about Children with Disabilities coverage instead.
Watch out
- Approval for the waiver is not approval for Medicaid. You apply for both.
- The test is a nursing-home level of care, not a leukaemia diagnosis.
- The federal approval says ages 3 to 21 and the state page says 3 through 20. Ask which applies to your child.
Dates that change this
2026-06-01: The federal approval of June 1, 2026 describes ages 3 to 21; the state page still says 3 through 20. Ask the waiver office which applies to your child’s birthday before you count on the last year.
2026-09-11: How many children are waiting and how long they wait was not published. Ask the waiver office for the current wait when you call. (not yet confirmed against the final rule)
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
A route into Medicaid and paid home support for a child who needs a nursing-home level of care at home, aged 3 upward.
Covers: Home and community services in place of nursing-home care · A route to Medicaid for the approved child · The doorway to the Family Paid Caregiver pilot
What it costs the family: Not published for this waiver. Ask the waiver office.
The eligibility facts, as published
- Age
- from age 3; the federal approval says to 21 and the state page says through 20
- Level of care
- nursing facility
- Income
- the state rule excludes some parental excess income during full service months but keeps a further clause; the complete treatment was not established
- Statute
- CMS waiver ND.0568.R04.00; NDAC 75-02-02.1-41(4)
The trap: Waiver approval is not the same as Medicaid. The state says that after a child is approved for waiver services the family still has to apply for Medicaid for that child.
Where I read this
- ND Medicaid Waiver for Medically Fragile Children (0568.R04.00) — Centers for Medicare and Medicaid Services, read September 10, 2026
- North Dakota waiver factsheets — Centers for Medicare and Medicaid Services, read September 10, 2026
- Children’s Waiver Services — North Dakota Health and Human Services, read September 10, 2026
- SFN 394, Children with Medically Fragile Needs Application — North Dakota Health and Human Services, read September 10, 2026
- Medicaid Eligibility — North Dakota Health and Human Services, read September 10, 2026
- Administrative Code chapter 75-02-02.1, Eligibility for Medicaid — North Dakota Legislative Council, read September 10, 2026