North Dakota is rolling out a large statewide initiative to expand access to home and community-based services (HCBS) by leveraging their Money Follows the Person (MFP) program and No Wrong Door System (known in North Dakota as the Aging and Disability Resource Link – ADRL).The Informed Choice Initiative, hereinafter referred to as the “initiative”, is the result of a settlement agreement between the state and the United States Department of Justice (U.S. DOJ) to ensure that the state will meet the requirements of Title II of the Americans with Disabilities Act (ADA) (see plan here).

The initiative addresses three primary goals: 1) expand awareness of and access to community-based care; 2) allow individuals to make an informed choice about how and where they want to live and receive necessary services; and 3) build upon legislative investments and a shared goal to improve services to North Dakotans.

Effective January 2022, nursing facility residents who express interest in HCBS are referred to the ADRL and assigned a HCBS case manager. In addition to the ADRL, MFP and Centers for Independent Living staff play a key role in contacting and providing education to nursing facility residents about HCBS.  State staff conduct follow up visits to build relationships with residents, including those who may have initially refused a visit, to continue the education process about HCBS. The goal is to ensure that residents are fully aware of their options to make an informed decision about HCBS as they consider transitioning back to the community.

ADRLs also provide person-centered counseling to individuals and their families in hospitals to support informed decision-making in anticipation of transitioning back home or to the community. This work is supported through a funding mix that includes COVID-19 relief funds.  North Dakota plans to sustain this work through Medicaid Administrative Claiming. See here for more information on claiming for NWD Systems.  

The ADRL service offering includes  a statewide 1-800 call center, web-based referral capability, and a resource database. ADRL staff offer information and assistance, person-centered counseling, and facilitation of the intake process for public and private long-term services and supports.

North Dakota’s MFP program started in May 2007.  Most recent Centers for Medicare & Medicaid Services data reported that as of December 1, 2020, the MFP program transitioned 490 individuals from institutions to the community. The state Medicaid office offers several demonstration services to support transitions including housing support assistance and resource development, one-time transition costs, transition adjustment support, and workforce development.

See attached flyer and fact sheet for more information on North Dakota’s initiative.