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June 1, 2007
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North Dakota is the first state to implement the federal Family Opportunity Act

In April, North Dakota became the first state to implement the federal Family Opportunity Act (FOA), which allows families of children with special healthcare needs/disabilities to purchase supplemental Medicaid coverage. Children with special healthcare needs are defined as having or at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.

Under North Dakota SB 2326, families at 200% of the federal poverty level will pay 5% of their monthly income as a premium for the additional coverage. The state will use a family's net income instead of gross income to determine eligibility, thus taking into account certain factors, such as child care costs, medical expenses, taxes withheld, etc., when determining Medicaid buy-in eligibility. A family of four at 200% of the federal poverty level would have a net income of $41,300. The premium or buy-in cost is anticipated to average $117/month. A family will need a healthcare benefits analysis to determine whether current out-of-pocket expenses outweigh the cost of buying into Medicaid.

The bill's sponsors were state Sens. Tim Mathern, Tom Fischer, and Judy Lee, and Reps. Clara Sue Price and Jasper Schneider. Advocates had hoped that the legislation would use 300% of the federal poverty level as the benchmark, but 200% is a great beginning.

North dakota gov. john hoeven signed sb 2326 on april 11. he was accompanied by donene feist, director of family voices of north dakota, and state sens. tim mathern (in blue suit) and dick dever (in green suit). mathern was holding elizabeth romanick, whose mother, roxanne, was involved in the legislation and was present at the ceremony

North Dakota Gov. John Hoeven signed SB 2326 on April 11. He was accompanied by Donene Feist, director of Family Voices of North Dakota, and state Sens. Tim Mathern (in blue suit) and Dick Dever (in green suit). Mathern is holding Elizabeth Romanick, whose mother, Roxanne, was involved in the legislation and was present at the ceremony.

Photography by Shannon Wirrenga.

Families in North Dakota who earned too much to qualify for Medicaid had few options for help until the passage of this legislation. Some families have been forced to relinquish custody of their children to the state so they could receive intensive services. Families with private insurance have run into lifetime limits on coverage.

In testimony before the legislature, advocates and families described how this bill would affect them. The Federation of Families for Children's Mental Health provided testimony on behalf of families who deal with mental and behavioral health issues. Family Voices of North Dakota gathered many stories as well, and provided data and information. This grassroots effort also included the Arc of Bismarck, Arc of North Dakota, North Dakota Protection and Advocacy Project, and the North Dakota Disabilities Advocacy Consortium (NDDAC), along with providers, advocates, policy makers, and families.

Additionally, SB 2326 authorizes the state to implement a federal waiver for children with extraordinary medical conditions (including dual diagnoses). The waiver allows the use of Medicaid funds to provide in-home supports and care versus institutional- or hospital-based care.

In some respects, there was no magic about what North Dakota advocates did to get SB 2326 passed. We were very involved in a legislative interim study on children with special healthcare needs and gaps in services, and information on FOA was provided at the study's meetings. Additionally, it was very important to get NDDAC involved, as it is made up of many of the disability agencies and groups in the state. Information was sent to families and providers through newsletters and outreach to solicit their input in the process. Family Voices of North Dakota compiled a booklet on how families were being affected. Thus, together we made a difference.


This article was adapted from a version that appeared in The Edgeley Mail (North Dakota).

Donene Feist is the Director at Family Voices of North Dakota.