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North Dakota expands eligibility for in-home, community-based behavioral health services

A program in North Dakota to provide in-home and community-based support services for people with addictions and severe mental illness was hampered by strict eligibility criteria, which now have been eased.

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FARGO — North Dakota is making it easier to qualify for a program that provides a wide range of in-home and community-based support services for people with mental illnesses, substance use disorders or brain injuries.

The relaxed eligibility requirements open access to services including educational, employment and housing supports, peer support, care coordination and respite care.

North Dakota human services officials have touted the program as a major step in providing support to help those who are mentally ill remain in their homes and communities, where they have support from their families.

“I think that 10 years from now or maybe 20 years from now, people will (look) back and say that this was the turning point” in providing better care for those with behavioral health illnesses, said Pamela Sagness, director of behavioral health services for the North Dakota Department of Human Services.

To be eligible for assistance, people have to qualify for Medicaid and meet certain disability criteria.


When the program first rolled out early last year, few people qualified for help because of strict eligibility requirements imposed by the federal government. Last summer, the Department of Human Services asked federal officials for permission to ease the eligibility requirements.

Federal officials approved the request, broadening eligibility starting Jan. 1, 2022. Before the standards were eased, only 24 applicants qualified out of an estimated population of 11,500 residents who could benefit from the program.

Under the new eligibility, 44 people have qualified, and other approvals are pending, Sagness said. As word gets out about the program, more and more people will benefit, she said.

Carolotta McCleary, executive director of Mental Health America of North Dakota and head of the North Dakota Mental Health Advocacy Network, applauded the broader eligibility standards.

“This is extremely helpful for those seeking services,” she said. “It should help open it up quite a bit. A lot more people will find themselves eligible to receive services.”

Eligibility was expanded by lowering the World Health Organization Disability Assessment Schedule eligibility score from 50 to 25. The score is an instrument used to measure a person’s function and disability in activities of daily living.

“The enhancements will make it easier for more North Dakotans to qualify for the in-home and community-based services to better support their behavioral health needs,” Sagness said.

Provider qualifications also changed, allowing more providers to extend services. A total of $80,000 in grants were made available, in amounts up to $10,000, to help build a “more robust” service provider network.


“We want to be reaching people a little earlier,” before their illness progresses and they require more intensive treatment, Sagness said. Ideally, treatment should take place in the person’s community, where family and other support is available.

“That’s usually what’s best for individuals,” she said. “It’s also fiscally sound.”

A consultant’s review in 2018 found most of North Dakota’s spending on those with behavioral health illnesses was to provide the highest levels of care. The state aims to provide more preventive care and early intervention, Sagness said.

“This is a huge system change,” she said. Legislators approved the new support program but will reduce funding elsewhere because people will no longer need the other assistance, she added.

As of Dec. 1, there were 40 individual and 25 group providers enrolled in the Medicaid program. A complete list of providers by region is available online at www.behavioralhealth.nd.gov/1915i-providers .

More information about the program to provide in-home and community-based services for the mentally ill can be found at www.behavioralhealth.nd.gov/1915i .

Patrick Springer first joined The Forum in 1985. He covers a wide range of subjects including health care, energy and population trends. Email address: pspringer@forumcomm.com
Phone: 701-367-5294
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