Workforce Challenges & DDS Waiver Services Analysis
Projecting North Dakota's Costs
A&M projected costs of the recommendations where possible, but the ultimate cost of DD and ASD service modernization efforts depends on State policy decisions.
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Understanding Current Costs
Current costs provide a directionally correct understanding of how
North Dakota's DD and ASD program expenses are structured.
The total Medicaid cost of a Waiver slot includes both the
HCBS Waiver Services, as well as the cost of State
Medicaid Plan services that an individual accesses
A&M utilized Medicaid claims data from a random, 400-
person sample from 2018-2021 to help estimate both total
Medicaid cost of a Waiver participant, as well as costs
before and after Waiver enrollment (if applicable).
In some cases, provider shortages can suppress utilization.
This means that individuals may have a need for greater
services (spending) than is reflected in current data.
To control for under-utilization, and to reduce any sampling
error, A&M also included the State's projected Waiver
expenditures in the cost ranges for current spending.
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Calculating Future Costs ☑÷
The cost of modernizing North Dakota's DD and ASD programs is
composed of both ongoing and one-time expenses.
Ongoing service-delivery fees: These ongoing expenses
include the cost of broadening the DD Waiver LOC, the cost of
expanding services for kids 3-5, and the cost of clearing the
waiting lists. These costs will be heavily influenced by the
State's policy decisions including caps, services, and slots.
The State will need to make these decisions to begin zeroing in
on a reliable cost estimate for the total ongoing expenses.
One-time system innovation costs: North Dakota will need to
invest heavily in the process of redesigning their system
thoughtfully over several years, likely seeking help from national
experts along the way. A&M recommends that the State looks to
leverage federal innovation money currently available to States
through ARPA funding.
ALVAREZ & MARSAL
LEADERSHIP ACTION. RESULTS.View entire presentation