North Dakota - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

North Dakota Health and Human Services (ND HHS) administers tenancy support and retention services under the 1915(i) State Plan Amendment, officially designated as 1915(i) Housing Support. Agencies seeking to bill for these pre-tenancy and tenancy sustaining services must enroll as a 1915(i) group provider through the ND Medicaid MMIS Portal.

Approval requires the applicant agency to secure formal membership in the North Dakota Continuum of Care (CoC) before Medicaid enrollment is granted. Providers must also establish documented 24/7 emergency availability protocols to prevent inappropriate institutional placements or incarcerations for members experiencing housing crises.

1. Service Definition and Scope

1915(i) Housing Support assists ND Medicaid members in accessing and maintaining stable community housing. Providers are mandated to offer both pre-tenancy and tenancy sustaining services.

Services must be delivered in a Home and Community-Based setting. While the member must generally be present during service delivery, exceptions exist for specific, time-sensitive administrative tasks.

• Pre-Tenancy Services: Assisting with housing applications, searching for housing, and submitting related paperwork.
• Tenancy Sustaining Services: Landlord mediation, retention planning, and resolving lease violations.
• Setting Requirement: Services must be rendered in a Home and Community-Based setting, not an institutional setting.
• Member Presence: Members must be present, except for time-sensitive landlord meetings or paperwork submission if documented in case notes.
• Release of Information: Required for all entities housing support staff engage with on the member's behalf.

2. Regulatory and Oversight Agencies

ND HHS Medical Services Division oversees the 1915(i) State Plan Amendment and manages provider enrollment. The North Dakota Continuum of Care acts as the coordinating body for homelessness services and holds the membership prerequisite for this Medicaid enrollment.

Background checks and HCBS compliance are managed by ND HHS program administrators during the enrollment phase.

• North Dakota Health and Human Services (ND HHS): Administers the 1915(i) program and Medicaid enrollment (https://www.hhs.nd.gov).
• ND Medicaid MMIS Portal: The system used for provider enrollment and member eligibility verification (https://www.hhs.nd.gov/healthcare/medicaid/provider).
• North Dakota Continuum of Care (CoC): The regional planning body requiring membership for 1915(i) Housing Support providers (https://ndcontinuumofcare.org).
• ND HHS Aging Services Division: Oversees specific HCBS waiver compliance and incident reporting (https://www.hhs.nd.gov/aging).

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota restricts 1915(i) Housing Support enrollment to agencies integrated into the state's existing homelessness response network. Standalone agencies cannot simply apply for Medicaid enrollment without first achieving specific network designations.

Agencies must prove structural capacity to handle housing emergencies around the clock before an application is accepted.

• Continuum of Care Membership: The agency must be a verified member of the North Dakota Continuum of Care (CoC).
• 24/7 Emergency Availability: The agency, or a contracted resource, must be available 24 hours a day, 7 days a week for individuals in need of emergency services.
• Group Provider Status: Agencies must enroll specifically as a 1915(i) group provider of housing support services.
• Pre-Tenancy and Tenancy Mandate: Providers cannot offer only one phase of service; they must be structured to offer both pre-tenancy and tenancy services.

4. Licensure and Certification Requirements

North Dakota does not issue a distinct "Housing Stabilization License" through its health facilities division. Instead, agencies are certified through the 1915(i) provider enrollment process by demonstrating compliance with HCBS standards and CoC membership.

Providers must maintain specific written policies regarding member rights and emergency diversion to maintain their 1915(i) certification status.

• Facility Licensure Exemption: No standard health facility license is required for housing support, as it is a community-based service.
• 1915(i) Certification: Agencies must adhere to all 1915(i) standards, policies, and procedures as verified by ND HHS.
• Emergency Policy Certification: Must have a written policy providing alternatives to prevent inappropriate use of emergency rooms, psychiatric placement, or incarceration.
• Rights and Restraints Policies: Must maintain written procedures for participant rights, abuse, neglect, exploitation, and use of restraints available for ND Medicaid review.

5. Medicaid Provider Enrollment

Enrollment is processed through the ND Medicaid MMIS Portal. The effective date of enrollment cannot precede the completion date of all required verification screenings.

Agencies must enroll as a group provider and ensure all individual staff meet qualifications before billing.

• NPI Requirement: The servicing and billing provider must obtain and register a National Provider Identifier (NPI).
• Group Enrollment: Agencies must submit enrollment applications as a 1915(i) group provider.
• Screening Completion: All federal and state verification screenings must be complete before an enrollment start and end date are issued.
• Retroactive Billing Prohibition: The enrollment effective date cannot be prior to the required verification screening date; retroactive dates are not granted.

6. Staffing, Training and Background Checks

Individual housing support staff must meet specific educational and experiential thresholds before delivering services. ND HHS conducts comprehensive background checks on all HCBS providers prior to enrollment finalization.

Staff must hold specific mental health certifications to operate under this 1915(i) service.

• Education/Experience: Staff must have a high school diploma/GED PLUS either two years of experience providing direct services to individuals experiencing homelessness OR an Associate degree.
• Required Certification: Staff must be certified in Mental Health First Aid Training for Youth and/or Adults, depending on the target population.
• Competency: Staff must be knowledgeable and competent in person-centered plan implementation.
• Background Inquiries: ND HHS verifies against the Child Abuse and Neglect Background Inquiry, ND Sex Offender Site, and National Sex Offender Site.
• Federal Exclusions: Staff and agencies are checked against the OIG List of Excluded Individuals and Entities (LEIE) and SAMS (formerly EPLS).

7. Documentation, Policies and Records

Providers must maintain rigorous documentation to justify billing, especially when the member is not present during the service. Policies must explicitly address emergency diversion and incident reporting.

Releases of information are strictly enforced for any third-party housing negotiations.

• Absence Justification: Case notes must document a specific reason the member could not be present during time-sensitive tasks (e.g., submitting paperwork).
• Releases of Information: Must be signed and on file for all landlords or housing entities the staff engages with on the member's behalf.
• Emergency Diversion Policy: Written policy detailing how the agency meets the 24/7 availability requirement to keep members in their homes.
• Incident Reporting: Must comply with NDCC 50-25.1 for child abuse and neglect, and report incidents to the Aging Services Program Administrator.

8. Billing, Rates and Claims

Claims are submitted through the ND Medicaid MMIS Portal for 1915(i) Housing Support. Services must be medically necessary and have an approved service authorization prior to delivery.

Providers are responsible for verifying eligibility on the exact date of service.

• Eligibility Verification: Providers must verify member eligibility on the date of service via the MMIS Portal or the Automated Voice Response System (1-877-328-7098).
• Service Authorization: Services cannot be billed without an approved service authorization on file.
• Medically Necessary: All billed housing support services must meet ND Medicaid's definition of medical necessity.
• Travel/Distance Billing: If applicable, Rural Differential (RD) rates require using the physical address listed on the Qualified Service Provider (QSP) list.

9. Approval Sequence and Timeline

The approval sequence begins with securing CoC membership and developing required 1915(i) policies. Once submitted to ND HHS, the state conducts background verifications before issuing an active enrollment date.

Providers cannot begin billing until the final enrollment date is issued by the state.

• Step 1: Obtain membership in the North Dakota Continuum of Care.
• Step 2: Develop 24/7 emergency response protocols and 1915(i) compliance policies.
• Step 3: Submit the 1915(i) group provider enrollment application via the ND Medicaid MMIS Portal.
• Step 4: ND HHS Program Administrator conducts LEIE, SAMS, and state background verifications.
• Step 5: ND HHS issues the final enrollment start date (no retroactive approval).

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing prerequisites, such as lacking CoC membership or failing to provide 24/7 emergency coverage policies. During audits, missing documentation for member absences during billed time is a primary recoupment risk.

Failure to maintain current staff certifications also leads to claim denials.

• Missing CoC Membership: Applications rejected outright if the agency is not a recognized member of the ND Continuum of Care.
• Inadequate Emergency Policy: Denials for failing to document how the agency provides 24/7 emergency availability to prevent institutionalization.
• Unjustified Member Absence: Recoupment of funds if case notes fail to document the specific, time-sensitive reason a member was not present during a billed housing task.
• Missing Releases: Audit findings for engaging with landlords without a documented Release of Information on file.
• Unqualified Staff: Billing for services rendered by staff lacking the required Mental Health First Aid certification or experience.

11. Key Contacts and Resources

Providers utilize ND HHS resources for policy manuals, enrollment, and claims guidance. The Medical Services Division is the primary contact for 1915(i) Medicaid inquiries.

The MMIS portal and CoC websites are essential daily tools for active providers.

• ND HHS Medical Services Division: 600 E. Boulevard Ave., Dept. 325, Bismarck, ND 58505-0250; Phone: (701) 328-7068 (https://www.hhs.nd.gov/healthcare/medicaid/provider).
• ND Medicaid Provider Enrollment: [email protected] for enrollment inquiries.
• Automated Voice Response System: 1-877-328-7098 for member eligibility verification.
• North Dakota Continuum of Care: Required network for provider eligibility (https://ndcontinuumofcare.org).

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