75-03-23.2-03. Diversion eligibility criteria.

1. To be considered eligible for the diversion program, an applicant, of any age must: a. Be receiving Medicaid and have a significant disability; b. Be receiving Medicaid expansion, have a significant disability, and have a verifiable monthly income at or below one hundred thirty-eight percent of the current monthly poverty level; or

1. c. Be receiving or have been determined eligible by the department for any of the following services, waivers, or programs:
2. (1) Developmental disabilities program management;
3. (2) Developmental disabilities waiver;
4. (3) North Dakota Medicaid state plan personal care;
5. (4) Services payments for the elderly and disabled program;
6. (5) Expanded service payments for the elderly and disabled program;
7. (6) Medicaid waiver for home and community-based services;
8. (7) Children's hospice waiver;
9. (8) Autism spectrum disorder waiver; or
10. (9) Medically fragile children's waiver.
11. 1. To be considered eligible, an applicant must:
12. a. Live in a community residence and be in direct threat of being placed into a provider-operated residential facility;
13. b. If receiving developmental disability program management, be transitioning from a shared family home or other community residence into an independent or shared living situation with chosen roommates with support services provided under the developmental disabilities waiver and be considered at risk of admission to a provider-operated residential facility; or
14. c. Be unable to remain in the individual's current community residence due to:
    1. (1) A significant change in physical health or the onset or worsening of a physical disability that requires relocation to an accessible housing unit; or
    2. (2) An individual's current living environment having been deemed uninhabitable or unsafe by a local housing authority or inspector, and continued residence at that community residence would pose a danger to the individual's health or safety.
15. 1. An applicant shall submit an application in the form and manner prescribed by the department.
16. 1. An applicant with presumptive eligibility or a pending Medicaid application is not eligible for the diversion program.
17. 1. An individual is not eligible to reapply if the individual having been denied participation in the diversion program within the past twelve months, unless the individual has had a significant change in condition or living arrangement.

History: Effective January 1, 2026.

General Authority: NDCC 50-06-05.1, 50-06-16

Law Implemented: NDCC 50-06-05.1