What You Should Know About Autism Spectrum Disorder and Medicare/Medicaid Services in North Dakota


Autism Spectrum Disorder (ASD) is a set of developmental and behavioral problems that affect a perosn’s socialization, communication, learning, and play skills. Spectrum alludes that every afflicted child will have an idiosyncratic characteristics and disability levels. The characteristics of autism do not unfold until the child is approximately 3 years of age, and the level of the condition varies from one patient to another. While some may only experience mild impairments, others may suffer from severe disability that affects the daily living of the children suffering from ASD.

Medicaid Home and Community Based Services Waiver (HCBS) for Autism

The Medicaid State Plan of North Dakota provides home and community-based waiver services for families with children diagnosed with ASD. According to the ND’s Medicaid plan, the following can be reimbursed under the waiver services:

  • Hospital services
  • Respite care
  • Assistive technology
  • Special skills training

The level of care must be mentioned as it determines whether the waiver services are required or not. Furthermore, the child diagnosed with ASD must exhibit significant deficits in the behavioral performance and should get a score of 70 or less in all or any one of the assessments:

  • Adaptive behavior
  • Socialization
  • Daily living skills
  • Communication

However, the eligibility criterion does not eliminate the low-scoring applicants above the threshold entirely. You can acquire more information related to the waiver program over here.

North Dakota’s Voucher Program

Those children with ASD who are not availing the waiver services can still qualify for the ND Voucher program. The Voucher Program was initiated by the Human Services Department of North Dakota in 2014 to meet non-therapy related challenges faced by ASD afflicted children and family caregivers. According to the program, families within a certain income level with children between the ages 3 and 17 years who have been diagnosed with ASD can apply for the voucher program, which helps in paying for the assistive technology, support services, transport, registration for workshops, and training.

Through the services provided under the program, the quality of life of the children diagnosed with the condition can be improved and families can meet the distinctive demands of their children. Any household with a gross income of 200% of the poverty level described at the federal level can qualify for the voucher program. The voucher program can pay up to $12,500 annually for supporting ASD afflicted child.

Services Provided Pursuant to EPSD for Treating ASD

In accordance to EPSDT (Early and Periodic Screening, Diagnostic and Treatment), an integral component of Medicaid for child health, the services provided by the state for the treatment will only be granted to those who are below 21 years of age. The services are supposed to be recommended by licensed practitioner and following services can be reimbursed as per Medicaid program:

  • Medical screening prior to the ASD treat to rule out other possibilities
  • Diagnostic evaluation to determine whether a child has ASD and if the services are necessary

Both of these screenings are necessary before ASD treatment services can be provided to the families with children having ASD.