North Dakota certifies community health workers through four pathways, including training with an internship, IHS Community Health Representative training, supervised experience and qualifying out-of-state credentials. Medicaid participation adds separate enrollment and supervision requirements. Program leaders should verify both workforce status and the organization’s payment arrangements before assigning funded services. [1, 3]
North Dakota CHW quick facts
| Topic | North Dakota guidance |
|---|---|
| Certification agency | North Dakota Health and Human Services. [1] |
| Training route | Qualifying training plus a 200-hour internship. [1] |
| Experience route | 1,000 supervised CHW hours in the previous three years, with supervisor recommendation. [1] |
| Other routes | IHS CHR training or approved reciprocity. [1] |
| Renewal cycle | December 31 of even-numbered years, subject to the initial-certification exception in the rule. [1, 2] |
| Continuing education | 12 approved hours, including two in legal and ethical responsibilities. [1] |
| Medicaid enrollment | Individual CHW NPI and servicing-provider enrollment, separate from the billing organization. [3] |
| Last reviewed | November 6, 2026 |
For program leaders
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What is a community health worker in North Dakota?
North Dakota describes CHWs as links between community members and health and social-service systems. Certification is administered by Health and Human Services. A worker’s training route, employment responsibilities and Medicaid participation should remain separate decisions in an organization’s staffing plan. [1, 4]
For example, a team may provide community outreach under a grant and diagnosis-related education under a Medicaid arrangement. A single participant may receive both kinds of assistance, but the organization should identify the purpose and funding of each activity. A clear record helps supervisors understand what was delivered without treating every helpful interaction as a payable service.
North Dakota CHW certification pathways
The state identifies four routes. The training route includes a 200-hour supervised internship after qualifying education. The IHS route recognizes Community Health Representative training. Experienced applicants may qualify with at least 1,000 supervised hours within the previous three years and a supervisor recommendation. Reciprocity requires a current credential in good standing, substantially similar standards and official verification from the other jurisdiction. [1]
The current rule sets age 18 and a $30 initial fee. Training must address seven competency areas, including legal and ethical duties, coordination and documentation, communication and cultural competency, and health promotion. A course’s advertised certificate is not enough without the department’s acceptance of the actual pathway evidence. NDAC 33-03-38-03 to 33-03-38-04.
North Dakota also protects the title “community health worker” for people certified under Chapter 43-66. Reciprocity requires official verification from the other jurisdiction and substantially similar standards at the time of application. The applicant should obtain North Dakota’s actual decision before using the protected title. NDCC 43-66-02, NDAC 33-03-38-06.
How to prepare a certification application
- Select the applicable pathway on the HHS certification page.
- Gather training, internship, experience or credential-verification evidence.
- Check that names and dates are consistent across the supporting documents.
- Submit the current state application and required fee.
- Keep the approval and expiration information in the workforce record.
These are practical preparation steps. The department determines eligibility. For experience-based applications, a supervisor should be able to explain the work performed and verify the time claimed. Avoid estimating hours from a job title alone.
Choosing a training program and internship
Ask a training provider how its curriculum maps to the state’s competencies, who supervises the internship and how completion is verified. Before paying tuition, clarify attendance rules, assessments, accessibility, placement responsibilities and the process if a placement is delayed.
The rule permits students and interns to work within the CHW scope under direct supervision. Qualified supervisors include a department-certified CHW in good standing, CHW training instructor, physician, registered nurse or licensed social worker. Those training-supervision rules are different from the Medicaid benefit’s general-supervision and billing-employer arrangement. NDAC 33-03-38-05.
Employers can make the internship more useful by defining observation, practice and feedback opportunities in advance. A worker who shadows many activities may still need structured opportunities to demonstrate communication, documentation and navigation skills. Keep evidence of completed work separate from a general onboarding checklist.
Renewal and the December 2026 deadline
North Dakota uses an even-year December 31 renewal cycle. The rule includes an exception for initial certification received after July 1 of an even-numbered year: it is automatically recertified for one additional period without another application or fee. Check each worker’s issued dates before placing them in the same renewal batch. The adopted rule lists a $30 recertification fee. [2]
The HHS page calls for approved continuing education, including a legal-and-ethical component. Maintain activity evidence and approval information as the worker completes it. Renewal submission, acceptance and active status should be visible as separate milestones. The rule allows renewal during the first 30 days after expiration but prohibits practice while expired. After that 30-day period, the person must apply for initial certification. A submitted application does not make an expired status current. NDAC 33-03-38-07. [1, 2]
Does North Dakota Medicaid cover CHW services?
Yes, under its CHW policy and applicable requirements. The policy distinguishes diagnosis-related services from general social services. It requires an enrolled billing employer, qualified supervision and a written supervision agreement. A referral must identify the needs, conditions or barriers and recommended duration. More than 12 units requires a practitioner-approved service plan, with ongoing review. [4]
Coverage does not mean every contact qualifies. Confirm the participant, service, setting, referral, authorization and provider status before relying on payment. Use the current policy to resolve a specific claim scenario.
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Who is eligible, and what must the referral show?
The policy identifies chronic conditions, risk of developing a chronic condition and documented health-related barriers as eligibility bases. It gives examples such as measurable increasing risk, a recent emergency or inpatient stay, missed medical appointments and barriers identified through a health-related social-needs screening tool. Document the actual qualifying basis rather than assume every Medicaid member qualifies. CHW policy, page 2.
A physician, dentist, pharmacist or other licensed practitioner must refer the member. The referral identifies the required services, recommended duration and conditions or barriers to address. General supervision can be documented through the written agreement maintained by the billing employer; the practitioner’s physical presence during each service is not required by that definition. CHW policy, pages 1, 3 and 8.
How CHWs enroll with North Dakota Medicaid
The enrollment guide directs CHWs to use their own NPI and the CHW provider classification: provider type 017, specialty 776 and taxonomy 172V00000X. An existing NPI should be updated where necessary rather than obtaining a duplicate. The guide also addresses affiliation with the billing group and submission of certification evidence. [3]
Maintain the worker’s certification, NPI, enrollment approval and affiliation dates separately. An enrollment application in progress does not establish an approved effective date. Before scheduling the first funded visit, the billing team should verify the organization and worker records for that service date.
Service limits and documentation checkpoints
The October 2025 policy uses codes 98960, 98961 and 98962, limits their combined use to four units per day and 104 annually, and requires authorization to exceed limits. It calls for time documentation and excludes documentation time itself from covered service time. Consult its detailed timing and group rules before billing. [4]
The need for a service plan after 12 units is separate from authorization to exceed four daily or 104 annual units. The plan must be drafted by, or reviewed and approved by, the supervising practitioner and finalized before additional services. It identifies the eligibility basis, referral barrier and needed duration, and is reviewed at least every six months for progress and continued medical necessity. CHW policy, pages 3 and 6.
For example, a fictional member has received 12 units under a referral and needs further support. Being below the annual 104-unit limit does not remove the service-plan requirement. Confirm the practitioner-approved plan before further service, and separately check daily use and any service authorization.
What time and setting rules affect a claim?
The policy uses 30-minute education codes and requires at least 16 minutes for one unit, with start and stop times documented. Documentation time itself is not covered service time. The codes distinguish individual service, groups of two to four and groups of five to eight. Claims use CMS-1500 or 837P. CHW work for an encounter-based FQHC, RHC, IHS or Tribal Health Program does not generate an encounter payment; the policy directs CHW fee-for-service payment. CHW policy, pages 5, 7 to 8.
Community-based settings, including the member’s home, may be used. The policy excludes hospitals, intermediate-care facilities, nursing homes, basic-care facilities and carceral settings. It permits telehealth under its definition, which excludes store-and-forward service. Confirm the actual modality and setting before treating a remote contact as covered. CHW policy, pages 4 and 9.
Keep navigation and noncovered work identifiable
The policy includes navigation, coaching and education while excluding specified activities such as transporting a member and duplicative services. Scope and purpose matter. A useful community activity is not automatically payable through the CHW benefit. [4]
For appointment accompaniment, the policy requires that the type of appointment be specified in the service plan and that the member give written consent. Its exclusions also include Medicaid enrollment help, documentation time, discharge planning, food or medication delivery, and services duplicating 1915(i) supports. If a worker separately qualifies to provide non-emergency medical transportation, that requires the distinct enrollment and billing rules for transportation. CHW policy, pages 3 and 5.
For internal reporting, create clear activity categories with definitions staff understand. Record necessary nonbillable work as work, while keeping it outside a payment calculation that does not permit it. That helps program leaders budget realistically and understand the effort required to support participants.
A launch checklist for North Dakota program leads
- Define the population, service area and CHW responsibilities.
- Verify certification pathway, current status and renewal dates.
- Confirm enrollment, affiliation and supervision arrangements for funded work.
- Design intake and referral review before the first service.
- Establish service-plan and authorization review points.
- Test documentation and reports with a de-identified participant example.
- Assign responsibility for policy updates and workforce renewal follow-up.
This checklist supports operations; it does not replace the state’s certification or Medicaid instructions.
What should a useful CHW record show?
A supervisor should be able to reconstruct the participant’s needs, the reason for contact, the action taken and the next step. Keep dates, worker attribution, referral information, participant response and follow-up together. If a service has a clinical or payment requirement, link the relevant evidence rather than copying an unsupported statement into every note.
Consider a participant struggling to attend follow-up appointments. The record should show the barrier identified, what the worker discussed, any resource connection, whether the participant accepted it and who will check back. “Transportation referral completed” should not imply that a ride occurred or that the participant attended an appointment.
Choosing CHW software in North Dakota
Look for a workflow that makes participant follow-up and supervisory review easy to assess. Ask how the platform handles open referrals, incomplete notes, plan-review dates and reports across funding streams. Verify actual supported functions with the vendor.
Credential and enrollment tracking should preserve different identifiers and effective dates. A certification number is not an NPI; an NPI alone is not Medicaid enrollment. During evaluation, ask the vendor to walk through a worker whose certification is active but whose new affiliation has not yet taken effect.
Explore community health workflows to see how Smores Health approaches participant support and program coordination.
A practical software demonstration scenario
Bring one de-identified intake, one referral, a sample contact note and your monthly report. Ask the vendor to show how staff identify the next action, how a manager reviews the contact and how the report connects to the underlying record.
Then introduce an exception: the referral remains unresolved, the participant misses contact or the service needs approval. Assess whether staff can preserve the history and assign follow-up without marking the issue resolved. See the Smores Health platform and use the demonstration to evaluate your actual process.
See it in your program
Build your program around a connected workflow.
Bring your forms and reporting needs. See how Smores Health connects service notes, supervisor review, and program reporting in a walkthrough focused on your team.
A 20-minute walkthrough for your program.
Frequently asked questions
Can an experienced CHW apply without starting a new course?
North Dakota offers a supervised-experience route. The state reviews the required hours and supervisor evidence. Select that application rather than assuming prior employment automatically establishes certification. [1]
Does another state’s credential transfer automatically?
No. Reciprocity is an application route with equivalency and official-verification conditions. Obtain North Dakota’s determination. [1]
Does every newly certified worker renew in December 2026?
The rule has an automatic-recertification exception for qualifying initial certifications issued after July 1 of an even-numbered year. Check the actual credential and rule before assigning a deadline. [2]
Is an NPI enough to bill Medicaid?
No. The enrollment guide requires the applicable enrollment and affiliation process. Certification and the organization’s payment responsibilities remain separate. [3]
What should CHW program management software help a supervisor see?
It should make the participant history, outstanding follow-ups, documentation review and important workforce dates easy to evaluate. Confirm the functions and reporting your organization actually needs.
Plan a stronger North Dakota CHW workflow
Bring your certification tracker, referral process and reporting requirements to Smores Health. Book a program walkthrough to assess the platform with your team, or request pricing for your organization.
Sources
[1] North Dakota HHS, CHW certification pathways and recertification. https://www.hhs.nd.gov/regulation-licensure-and-certification/comm-hlth-worker
[2] North Dakota Administrative Code, current Chapter 33-03-38, effective October 1, 2025. https://ndlegis.gov/information/acdata/pdf/33-03-38.pdf
[3] North Dakota Medicaid, CHW and Community Paramedic Enrollment. https://www.hhs.nd.gov/sites/www/files/documents/chw-and-cp-how-to-enroll.pdf
[4] North Dakota Medicaid, Community Health Worker Services, October 2025. https://www.hhs.nd.gov/sites/www/files/documents/medicaid-policies/community-health-worker.pdf
North Dakota Century Code Chapter 43-66, definitions, protected title and certification authority.