The Arc of North Dakota Responds to Proposed Behavioral Health Rehabilitative Services Cuts (BHRS)

The Arc of North Dakota recently submitted public comments on the proposed updates to the Behavioral Health Rehabilitative Services (BHRS) Manual, set to take effect in January 2026. After carefully reviewing the draft, we shared significant concerns about how these changes would affect people with autism and intellectual and developmental disabilities across our state.

The proposed limits would dramatically reduce access to essential behavioral supports. Under the new structure, individuals would be restricted to only 42 hours per year of Skills Training & Integration, 36 hours per year of Behavioral Intervention, and 12 crisis intervention events annually. For many people, this represents less than an hour of support per week. In our comments, we outlined how these limits fall far short of what autistic individuals need to remain stable, safe, and included in their homes and communities. Many require weekly—or even daily—support to manage behaviors, navigate daily routines, develop communication skills, and prevent crises.

While ABA therapy remains untouched under the Autism Services benefit, ABA is not designed to meet every behavioral need. It cannot provide crisis stabilization, emotional regulation coaching, safety planning, or community-based skill practice. It also cannot support many adults who are no longer eligible for autism-specific services. BHRS services have historically filled those crucial gaps. Our comments emphasized that reducing these supports will leave individuals and families without the tools they rely on to maintain stability and quality of life.

We also shared our concern about the ripple effects these changes will create. When community support shrinks, the likelihood of behavioral escalation increases, leading to more emergency room visits, psychiatric hospitalizations, and school disruptions. Providers may be unable to maintain services under such low reimbursable hours, resulting in fewer practitioners available across the state, particularly in rural and tribal communities. These limits will not reduce the need for help; they will shift the pressure onto programs like 1915(i) and HCBS waivers, and onto already overwhelmed families.

One of the most alarming indicators is what is happening already. As of November 18, eighteen youth with autism or developmental disabilities were living at the Life Skills and Transition Center. This rise in institutional placements signals that community supports are already strained, and additional reductions will only widen that gap. Our comments underscored that this trend conflicts with the principles of inclusion and community living protected under Olmstead v. L.C.

We also highlighted the state’s own data showing why robust supports are essential. North Dakota has high rates of disability, especially in rural areas where people face additional barriers to accessing services. Community-based supports cost significantly less than institutional care, and yet the proposed changes push the system toward outcomes that are both more expensive and less aligned with best practices.

In our formal submission, we urged the state to reconsider the proposed limits and instead adopt a structure that reflects evidence-based practice and the diverse needs of individuals with disabilities. We recommended allowing medical necessity to guide service levels, especially for children covered under EPSDT. We also encouraged the expansion of telehealth for BHRS, which is essential for rural access, and asked for clearer guidance on how BHRS and Autism Services should work together to support the whole person. Finally, we encouraged stronger engagement with families, providers, and disability advocates before finalizing any changes.

The Arc of North Dakota remains committed to advocating for behavioral health services that truly support safety, independence, and inclusion. These proposed changes will have lasting impacts on individuals, families, and communities. Our goal is to ensure that every North Dakotan with a disability has access to the services they need—not fewer of them.

If you would like to read our full comments or share how these changes may affect you or someone you know, please get in touch with us at director@thearcofnd.org. We will continue to keep the community informed as this process moves forward.