Effective for dates of service on or after January 1, 2026, North Dakota Medicaid will be providing a 3.2% inflationary increase for all Nursing Facility services. In addition, North Dakota is transitioning to a new classification system titled ND PDPM, to more accurately reflects residents’ health and care needs. Medicaid expenditures for these services are expected to increase $20 million for a 12-month period.
Effective for dates of service on or after January 1, 2026, North Dakota Medicaid will be providing a 2.0% inflationary increase for all Psychiatric Residential Treatment Facility services. In addition to the 2.0% inflationary increase and consistent with Medicaid State Plan Authority, rates for Medicaid-eligible individuals residing in instate psychiatric residential treatment facilities will be adjusted, based on cost reports submitted by the facilities within the current rate methodology. Medicaid expenditures for these services are expected to increase $2.3 million for a 12-month period.
Effective January 1, 2026, North Dakota Medicaid will be submitting a State Plan Amendment to allow for reimbursement of reimburse therapeutic leave days for individuals residing in a Psychiatric Residential Treatment Facility. ND Medicaid will reimburse for up to fifteen days per certification of need period. Medicaid expenditures are expected to have a minimal impact for a 12-month period.
Effective January 1, 2026, North Dakota Medicaid will be submitting a State Plan Amendment to update the In-State PPS Hospital Value-Based Program percentage of Medicaid revenue that may be returned to the state from 4% to 5%. Medicaid expenditures are expected to have a minimal impact for a 12-month period.
Effective January 1, 2026, North Dakota Medicaid will be submitting a State Plan Amendment to refine the services provided under Behavioral Health Rehabilitative Services. These refinements will provide enhanced guidelines for services to determine the appropriate level of care for members. North Dakota Medicaid will also set annual limitations on certain services to ensure all services provided are medically necessary. Medicaid expenditures are expected to have a minimal impact for a 12-month period.
Effective January 1, 2026, North Dakota Medicaid will be submitting a State Plan Amendment to add Licensed Master Social Workers (LMSWs) as an Other Licensed Practitioner. Medicaid expenditures are expected to increase $700,000 for a 12-month period.
Effective January 1, 2026, North Dakota Medicaid will be submitting a State Plan Amendment to allow Licensed Practical Nurses (LPNs) to provide Nursing Services provided in a School to Children with Complex Medical Needs. Medicaid expenditures are expected to increase $10,000 for a 12-month period.
Effective for dates of service on or after January 1, 2026, and consistent with approved state plan language, ND Medicaid will update the payment rate for lodging to the amount established for the month of January 2026 by the General Services Administration. Medicaid expenditures for these services are expected to increase $1,000 for a 12-month period.
Effective for dates of service on or after January 1, 2026, ND Medicaid will reimburse unlisted professional service codes at 34% of billed charges. Medicaid expenditures are expected to have a minimal impact for a 12-month period.
The capitated monthly rate for Medicaid Expansion, effective January 1, 2026, is estimated to increase, based on actuarial certification of the rates and Blue Cross Blue Shield of North Dakota acceptance of those rates. Overall, there is expected to be a minimal fiscal impact.
The benefits for ND Medicaid Expansion, as required by the Affordable Care Act and section 1937 of the Social Security Act, are provided through an Alternative Benefit Plan (ABP). Effective for dates of service on or after January 1, 2026, ND Medicaid will be submitting a state plan amendment which will clarify language for existing benefits, specifically as they relate to those under the age of 21. The amendment will align the ABP with the changes to traditional Medicaid described in other sections of this public notice.
To assure compliance with 42 CFR 440.345, ND Medicaid compared the benefits available under the ABP to those available under Traditional Medicaid fee-for-service. The results of this comparison showed that the ABP benefits include Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for those enrolled with ND Medicaid Expansion who are under age 21 that are consistent with the current ND Medicaid state plan regarding the delivery of these services with minimal changes.
Effective January 1, 2026, North Dakota Medicaid will be submitting a State Plan Amendment to the Alternative Benefit Plan (ABP) for the 21-64 year olds to align the ABP with the changes to traditional Medicaid described in other sections of this public notice. Overall, there is expected to be a minimal fiscal impact.
ND Medicaid follows the National Correct Coding Initiative (NCCI) Edits. These edits were developed by the Centers for Medicare and Medicaid Services (CMS) based on coding conventions defined in the American Medical Association’s Correct Procedure Terminology Manual, national and local polices and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. CMS annually updates the National Correct Coding Initiative Coding Policy Manual.
Comments can be sent to and viewed at: Medical Services Division Room 309, ND Department of Health and Human Services, 600 E Boulevard Ave Dept 325, Bismarck, ND 58505-0250. Questions may be directed to human service zone offices, or individuals may contact the ND Medicaid Program at 1-800-755-2604.