North Dakota Cross - Disability Advisory Council
North Dakota Cross - Disability Advisory Council
Cross - Disability Waiver Public Comments
April 16, 2026
Good afternoon, members of the North Dakota Cross-Disability Advisory Council. I am Carlotta McCleary, Executive Director of Mental Health America of North Dakota and Executive Director of the North Dakota Federation of Families for Children’s Mental Health. Today I speak on behalf of the Mental Health Advocacy Network (MHAN). MHAN advocates for a consumer/family driven mental health system of care that provides an array of service choices that are timely, responsive, and effective. Our vision is for every North Dakotan to have access to the right service—whether it be preventative, treatment, or recovery; at the right time—when the service is needed; and at the right place—as near his or her home as possible.
MHAN is supporting the establishment of a cross-disability waiver and requests that it be truly inclusive of children with mental health needs. As I will detail in my comments today, North Dakota is lacking a full continuum of care for children’s mental health services in both the public and private sectors and across insurance policies. Families who have a child with a mental health challenge are expected to make tremendous sacrifices to get their child access to care. Specifically including children with mental health needs into the cross-disability waiver, without requiring that they first have another disability, will go a long way to address existing service gaps.
One out of ten children in North Dakota has a serious emotional disturbance (SED). That translates to over 18,000 children. These are children with a mental health issue that significantly impacts more than one major area of life and is expected to last at least one year and are at a high risk of out-of-home placement. These are children who are often in need of intense, ongoing services that include wraparound case management services, parent peer support, in-home supports, and respite for their families.
Many families have insurance plans that neither cover many needed services, and if they do, many of those families are faced with paying high deductibles. Some common insurance plans are not deemed in network for most North Dakota mental health providers. This places significant financial barriers to access care for their children.
Children with mental health services do not have the same opportunities to receive services as children with developmental and intellectual disabilities. The services needed by families are in extremely short supply, if available at all. The regional Behavioral Health Clinics are the primary means by which families can gain access to intensive community mental health services. During the 2023-2024 state fiscal year, roughly 1,086 children with SED received case management services through the Behavioral Health Clinics.
In the last decade, there have been tremendous strides in expanding service options for adults. Free Through Recovery provides case management, peer support, and other recovery services for people who have come out of the criminal justice system. Community Connect was established to continue that model, but for the general adult population. Both Free Through Recovery and Community Connect are state funded and are only for adults.
If families cannot receive services through the behavioral health clinics, the only real alternative is the 1915(i) Medicaid State Plan Amendment. Since 2021, the 1915(i) has provided adults and children with a wide range of behavioral health services. For children to qualify for the 1915(i), their parents must have a qualifying income for Medicaid. Whereas since August 2024 between 500 to 900 adults a month have received 1915(i), a record number of 29 children received services in January 2026. What this means is that between the Behavioral Health Clinics and the 1915(i) there is a significant gap between the high demand for services from families and our current options for families to get those services, especially compared to populations served by North Dakota’s existing waivers.
Another significant issue facing children with disabilities is ready access to evaluations. No matter the disability (including mental health diagnoses), there is a meaningful wait for families to have a suspected disability evaluated and diagnosed. Not all diagnosable conditions have similar waitlists to evaluation, however. Children who are likely to have both a mental health condition and a developmental disability like autism are more likely to first be diagnosed with a mental health condition. It is often not because the mental health condition is more apparent than autism, but rather because the wait to receive an autism diagnosis is significantly longer than the mental health condition. As such, if the cross-disability waiver were to support mental health services only for individuals with developmental disabilities like autism, the cross-disability waiver could significantly hamper the ability for families to receive timely and necessary services and supports.
Mental Health Advocacy Network has two core recommendations:
Include mental health conditions as one of the qualifying conditions for the cross-disability waiver, without a pre-requisite of a developmental or intellectual disability.
Address the lengthy waits to get a disability diagnosis by allowing diagnosable conditions.
The cross-disability waiver should be truly representative of children with disabilities in North Dakota by including children with mental health diagnoses, the majority of which do not necessarily have a developmental or intellectual disability. It should also be considerate to the significant challenges families have in receiving evaluations by utilizing diagnosable conditions to qualify for the waiver.
This concludes my comments, and I will be happy to answer any questions you may have.