1915(i) Individual Eligibility

North Dakota’s 1915(i) will serve individuals meeting the following eligibility criteria:

1. The individual is age 0+; and
2. The individual is currently enrolled in ND Medicaid or Medicaid Expansion; and
3. The individual’s household income is at or below 150% of the Federal Poverty Level (see resource here); and
4. The individual’s WHODAS score is 25 or above; and
5. The individual resides in and will receive services in a setting meeting the federal home and community-based setting requirements, and
6. The individual has one or more of the qualifying Diagnoses. Click here for list of diagnoses.

Information on the 1915(i) for Expansion members is available from the Managed Care Organization (MCO) BCBSND:

• Providers will access Availity, submit POCS, pre-certifications (service authorizations) and claims at this website: https://medicaid.bcbsnd.com/
• Telephone

Members: (833) 777-5779

• The member representative will assist with questions about the benefits and pre-certifications (service authorizations).  If the member has additional questions they will be directed to the behavioral health case manager.

Providers: (833) 777-5779

• The provider representative will assist with question about the pre-certification (service authorization) process, benefits and eligibility. If the provider has additional questions they will be directed to the behavioral health utilization management team.