Federal, exists in every state
Medicaid home-care programs (waivers)
Approved services at home, such as nursing or personal care, depending on the program and the child’s assessed needs.
What it is
Approved services at home, such as nursing or personal care, depending on the program and the child’s assessed needs.
North Dakota’s Medically Fragile waiver can open home services and a route to Medicaid. A care assessment decides whether your child needs a nursing-home level of care. A cancer diagnosis or this questionnaire cannot establish that.
Eligibility rules
- The waiver requires a nursing-facility level of care. CMS’s June 1, 2026 renewal summary says ages 3–21; North Dakota’s family page says 3–20. The waiver office confirms the final covered birthday or month and transition arrangements.
- For a full calendar month of waiver services, NDAC 75-02-02.1-41(4) prevents excess parental or spousal income from being assigned to the recipient’s medical expenses. It retains a rule assigning an eligible parent’s or spouse’s income up to the applicable level for a person ineligible for SSI. Partial months, the child’s income, resources and any family share need a separate calculation. The waiver office confirms the complete resource rules; this provision does not mean all parents’ income and savings are ignored.
What you get
- Approved home services for children who meet a program’s criteria.
Separate routes
- Regular Medicaid private duty nursing has its own request through a nursing agency. A waiver is not a prerequisite for every home service.
If you decide to apply
- Ask whether the discharge or home-care team should assess the actual tasks, their frequency and the skilled-care needs; your answers here cannot settle the care level.
Discharge planner or care manager
If you decide to ask
- Ask the children’s waiver office about form SFN 394, current waiting time and the separate Medicaid application. The number is 701-328-4630 or 800-755-2604.
Good to know
A note of the tasks you do at home and how long they take helps any assessment; it is not a requirement.
Other waivers
- Other North Dakota waivers have different entry tests. The Children’s Hospice waiver requires a qualifying life-limiting prognosis and nursing-facility-level care. Autism and intellectual or developmental disability routes have separate diagnosis and care-level requirements. A cancer diagnosis or relapse alone does not establish any of these tests.
Related North Dakota cards: Medically Fragile waiver and Nursing care at home.
Official sources
- ND Medicaid Waiver for Medically Fragile Children (0568.R04.00)
- North Dakota waiver factsheets
- Children’s Waiver Services
- SFN 394, Children with Medically Fragile Needs Application
- Private Duty Nursing policy, April 2026
- Interoperability and Prior Authorization Final Rule
- Preventive Services and EPSDT policy, April 2026
- Service Authorizations policy, January 2026
“Would an assessment for the Medically Fragile waiver help us, or would ordinary Medicaid nursing fit better? Could you explain the costs and help with the right request?”
Why I’m asking: We want to be ready if home care needs change.
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
Register the child on the list, keep the task log, and answer the assessment call when it comes.
Your social worker
Names the waiver that takes medically fragile children in this state and helps with the registration form.
The care team
Documents the nursing-level tasks and the risk if care stops.
- Who decides
- The state waiver agency after a level-of-care assessment
- Ask your social worker
- “Which home-care program fits my child, and can we register today? Can Medicaid start home-nursing hours while we wait?”
How to apply
First step: Ask the discharge team which state home-care service or waiver fits your child's assessed needs, and how to apply.
- Register on the list this week.
- Ask the Medicaid plan for EPSDT nursing hours while you wait.
- Keep a two-week task log for the assessment.
Where it starts: State application or interest list. Assessment when a slot opens
What to gather
- A two-week log of daily tasks: what, how often, how long
- Doctor's letter naming nursing, equipment or safety needs
- Medicaid ID if the child has one
How long: Application steps, assessment timing and waiting-list availability depend on the specific state program. Ask for its current process.
What a yes looks like
A service plan with approved hours and a case manager's name.
What a no looks like, and the next move
“Does not meet level of care” or “no slot”: ask for Medicaid's rule that a child under 21 gets what is medically needed nursing through the Medicaid plan instead, and stay on the list.
Watch out
- If a suitable waiver has a waiting list, ask how and when to register and how priority is determined.
- For a child already on Medicaid, Medicaid's rule that a child under 21 gets what is medically needed home nursing can start long before a waiver slot opens. Ask for both.
- The assessment considers the child's actual care needs under the specific program's rules. No diagnosis or item of equipment guarantees approval.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 7, 2026.
What it is worth
Nursing hours, respite, personal care, equipment, home changes and a case manager. The value is the approved hours.
Covers: Case management · Respite · Personal care · Nursing (some waivers) · Adaptive equipment · Home and vehicle modifications · Caregiver training
What it costs the family: Medicaid-delivered. Patient liability depends on the state.
The eligibility facts, as published
- State specific
- yes
- Institutional level of care
- yes
- Target population
- medically fragile or technology-dependent children in most states
Decisions this site cannot make: Level of care · Service-plan necessity · Financial eligibility (child-only in institutional-deeming waivers)
Expect friction on: Interest lists · Provider shortages · Reassessment
The trap: Ask which waiver, if any, serves your child's needs and whether it has a waiting list. Request covered Medicaid services separately while any waiver application is reviewed.
What changes by state: Which waiver takes medically fragile children, the list length (Texas runs years), and whether parents' income is ignored.
Where I read this
- Home and Community-Based Services 1915(c) — Centers for Medicare & Medicaid Services, read August 27, 2026
- Full List of Medicaid Waivers and Programs — Kids’ Waivers, read August 27, 2026
- Early and Periodic Screening, Diagnostic, and Treatment — Centers for Medicare & Medicaid Services, read August 27, 2026