Basic Care study group weighs licensure and payment changes; HCBS waiver option debated DHHS work group reviewed basic care and assisted-living differences, payment-method risks (inflation gaps, census drop), and the prospect of moving basic care to a 1915(c) HCBS waiver to expand service options — but members warned about CMS scrutiny under the HCBS settings rule.

North Dakota is at a crossroads with its basic care funding and licensure, as proposed changes could reshape long-term residential options, but risks remain looming from federal scrutiny.

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