[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6372732,"mediaKeyId","2147274-033dab7a2bf5d9510986b89198643d7d","parentId",2147274,"title","Alzheimer’s Association outlines dementia care contract, says services reduce costs and help caregivers","audioSeconds",1075,"startMs",8717000,"endMs",9792000,"viewUrl","/Search/View?dp=1&key=2147274-033dab7a2bf5d9510986b89198643d7d&start=8717&end=9792","thumbnailUrl","https://assets.pipeline.soar.com/2147274-033dab7a2bf5d9510986b89198643d7d/thumbnail_8717000.jpg","articleUrl","/articles/6372732/North-Dakota/Alzheimers-Association-outlines-dementia-care-contract-says-services-reduce-costs-and-help-caregivers","mediaUrl","https://secure.pipeline.soar.com/6372732-eafef07f560baeacf17cb62e4de0576c/orig.mp4?Expires=1771184353&Signature=TZTU5sUofiDeGpvxtznIukeUQuT1dY271JkHmkWVVKqQe3qGDyEgEKVrBoMKCLGcXr~SGBg0rywfgkn5xIVxUSrxiVK~F1ZgaGBSqusSQCXwPWfcvBNWijssb0qa0E9~2AeVRQ9pyLvUKOPg1BUvGKIAaVmMkz6NuvFhbwato7JYZ~~Mm~wvVwrDADUJ5mDAFyjg6pOpGg1KG-0xNmF~7mv7-iWp2cKp9UsM2MDSQQv8P0ejB8QDw9jDNdKG2sBSWnk~HdZo3YR1hdbAHSGzQWfh4VOPkpoXQ-n7GEU5n5ipd6JILGy~HLO4Fp3PBDMzCuYI13ToGX6w56cKE4uhTw__&Key-Pair-Id=KUT5TJCACFTXG","author","House Appropriations - Human Resources Division, ND","date","2025-01-23T00:00:00Z","article","Melanie Gaby, North Dakota policy director for the Minnesota‑North Dakota chapter of the Alzheimer’s Association, told the committee the association’s statewide contract provides dementia care consultations, education and training and links people and caregivers to services.

Gaby said the dementia care services program began in 2010 as a state‑funded contract and remains a state partner with Adult and Aging Services. \"We have 8 staff who provide programs and support to North Dakota residents impacted by Alzheimer's and other dementia and their caregivers,\" she told the committee.

Why it matters: The association said its services help caregivers plan, obtain legal documents and manage care; the group urged continued funding in House Bill 1012. Gaby said active dementia management can improve quality of life and reduce higher‑cost care demands.

Contract activity the association reported for the current contract cycle (July 1, 2023–Dec. 31, 2024):
- roughly 2,000 care consultations and information referrals delivered; about 1,200 unique caregivers assisted and roughly 700 people living with dementia supported (the testimony highlighted 17 veterans among those served),
- nearly 3,000 community members received education across the state,
- 110 law‑enforcement personnel and 818 healthcare professionals trained (testimony cited both figures),
- 57 people were referred to the Aging and Disability Resource Link for other services.

Gaby said dementia care services support family caregivers and community providers and stressed a workforce gap in geriatrics: the association’s materials the witness supplied show that meeting projected geriatrician demand by 2050 would require large percentage increases in specialists.

Ending: Gaby asked the committee to maintain contract funding for the dementia care services program in the governor’s recommended budget and answered lawmakers’ questions about association fundraising (which the witness said primarily supports research and national programs, while state funds purchase the contract services described to the committee).","mediaType","Video","parentTitle","House Appropriations - Human Resources Division Jan 23, 2025","oneSentenceSummary","Melanie Gaby, North Dakota policy director for the Minnesota‑North Dakota chapter of the Alzheimer’s Association, testified in support of continued funding for the dementia care services contract. The association provided counts of education, care consultations and professional trainings that its staff delivered under the contract period.","taxTitle","Appropriations - Human Resources Division, House of Representatives, Legislative, North Dakota","taxId",28888,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6372737,"Lawmakers hear proposal to raise targeted HCBS provider rates amid workforce, rural access concerns",4894,7276000,12170000,"/Search/View?dp=1&key=2147274-033dab7a2bf5d9510986b89198643d7d&start=7276&end=12170","https://assets.pipeline.soar.com/2147274-033dab7a2bf5d9510986b89198643d7d/thumbnail_7276000.jpg","/articles/6372737/North-Dakota/Lawmakers-hear-proposal-to-raise-targeted-HCBS-provider-rates-amid-workforce-rural-access-concerns","https://secure.pipeline.soar.com/6372737-ad281eda5efbe209864f344e78a62bd0/orig.mp4?Expires=1771184353&Signature=Bq-WlSVh4Ss6772796l-DxsUIrvljWeaJv3dHeRfsnHJfnAdhhOwlNsJ5w9omOXjPs02TICOeHXKetvLnctn3nJtWw1EaiEZcXSbYy01oduPtRWVVZRY6hCL6O3Pa9kmxfC37W5rd83DC-Any0mt5SOEs36wtrsOc~kNuXVfdM1HXaBdofxgO~EQQW5fiMR1XiDafXd5zAZ2EdxU0~uhNQpSaBbE9FTv6FN9F4aY~135KkdHgxiuDRqY9atyNJ7bODIHbX0EcZJIcyNbf3XW9kUvh7kQZs0ey3mKLJ1Wt1jtbOtf9zuatGxxzRdgmnTN8lGB4x2JIGvnBW8z~31ERQ__&Key-Pair-Id=KUT5TJCACFTXG","Nancy Nicholas Meyer and Division of Medical Services director Sarah Achor explained to the Human Resources Appropriations panel that provider wages and agency reimbursement for many in‑home and HCBS services have not kept pace with regional benchmarks and rising demands.

Achor summarized Medicaid obligations and long‑term care policy context before returning the floor to Meyer for HCBS specifics. Sarah Achor noted that Medicaid is an entitlement program that requires federal compliance and federal match; she said states can limit waiver slots but not generally deny eligible individuals access to Medicaid services.

Meyer described several cost drivers and the division’s targeted rate proposal. She told lawmakers that a relatively small subset of waiver clients — about 16% of participants — accounts for roughly 40% of waiver costs because they need 24‑hour or medically complex in‑home services. She also described a rising prevalence of behavioral health and substance use needs among waiver recipients, which increases training and staffing requirements for providers.

Decision package and proposed rate changes (as presented):
- Total targeted rate increase request: about $5.3 million total funds ($3.5M general fund, $1.7M federal match). The package includes agencies and SPED where applicable.
- Proposed new agency 15‑minute unit rates (examples discussed): homemaker/chore/personal care/respite/support services grouped to $9.40 per 15 minutes; companionship and supervision at $9.10 per 15 minutes; nurse‑delivered services (nurse education/extended personal care) elevated to a proposed $19.71 per 15‑minute unit.

Why it matters: Committee members asked how those increases would translate to employee wages and whether they would improve provider recruitment in rural service deserts. Meyer said agency rates do not directly equal worker pay but that agencies reported paying direct caregivers roughly in the mid‑teens per hour; higher agency reimbursement is intended to help agencies offer competitive wages and retain staff.

Committee dialogue and clarifications: Representative Stevens asked how the revised rates would move North Dakota relative to neighboring states; staff said the proposal narrows the gap but a comprehensive regional rate study would better estimate rank. Representative Murphy asked if individuals may provide services as independent contractors; staff confirmed family caregivers and independent QSPs may enroll but noted agency arrangements and required program enrollment procedures.

Ending: Lawmakers acknowledged the complexity of balancing wage competitiveness, provider accountability and program costs. The department emphasized that improved rates for preventive and less‑intensive services could reduce higher‑cost institutional placements over time and asked the committee to consider the targeted increases as a workforce‑stabilization strategy.","Agency officials told the House appropriations panel that North Dakota’s in‑home provider rates lag regional benchmarks; they proposed targeted rate increases for specific HCBS services, citing provider recruitment challenges, higher client acuity and shifting service mixes that require nurse involvement and 24‑hour supports for some clients.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6372741,"Department details DOJ settlement benchmarks, Money Follows a Person transitions and rental‑assistance request",731,4309000,5040000,"/Search/View?dp=1&key=2147274-033dab7a2bf5d9510986b89198643d7d&start=4309&end=5040","https://assets.pipeline.soar.com/2147274-033dab7a2bf5d9510986b89198643d7d/thumbnail_4309000.jpg","/articles/6372741/North-Dakota/Department-details-DOJ-settlement-benchmarks-Money-Follows-a-Person-transitions-and-rentalassistance-request","https://secure.pipeline.soar.com/6372741-bb3e91368f3c277eb207c74c236a9a5f/orig.mp4?Expires=1771184353&Signature=dVwpgc4B03GR9Z92rwhaEeLgjRZseyhdPdpGjcTdyD9QHN7Ridj8lDcH2aNvv3ym47tArbwD2wvy4NjS15Hsdi-Fp-sARmOP-DIwL4slNVCnAVarAebTO5Wt3AzstslRM2uu6zjHxhy83t7UItRoWWAv1BMFJw7uAbmNWpUoepz3mqFSm7N1cnf6w9QckOxJ8ClxXP434V03dclqinnVZHYQTXFwT7qu3y~IHOf~6aq8dYfBavYEh8jyky5-cU5snFQqNeWZ13XXQkIAPTGEMWBgIlidQ1J1L447o~BgtHJBZOy4BZ4J4BiALZul1VdVgdoGhxnRPWAcr~ddYOfpYQ__&Key-Pair-Id=KUT5TJCACFTXG","Nancy Nicholas Meyer, director of Adult and Aging Services, told the House Human Resources Appropriations panel that North Dakota entered a settlement agreement with the U.S. Department of Justice on Dec. 14, 2020, to address alleged over‑reliance on institutional long‑term care and to expand community alternatives.

Meyer said the settlement implements Olmstead principles under the Americans with Disabilities Act and requires the state to expand options and help people move to the most integrated setting consistent with their preferences. \"On December 14, 2020, North Dakota entered into a settlement agreement with the US Department of Justice,\" Meyer told the committee.

Why it matters: The agreement sets multi‑year benchmarks for diversions and transitions that the department must meet or demonstrate substantial compliance with. The department told lawmakers it needs continued or new state funds for rental assistance and transition/diversion supports because federal COVID‑era relief that supported some activities is ending.

Program details and metrics Meyer gave to lawmakers:
- Money Follows a Person (MFP): federal grant program used to assist people to move from institutional settings to community living; North Dakota reported supporting 1,040 transitions since 2007, with 38% of those in the past four years.
- Diversions and transitions: In recent years the department reported increased diversions (people kept out of institutional placement) and transitions (people moved from institutions to the community). Meyer said in 2024 there were 261 diversions and 73 transitions using transition/diversion supports.
- Benchmarks: Settlement benchmarks increase over time; later years require larger percentages (e.g., department materials cited targets that rise toward 70–85% of TPMs (target population members) who request transition). Meyer said the settlement sets an aggregate multi‑year target and that year‑by‑year benchmarks are part of the agreement.

Meyer described primary barriers to transitions as shortage of accessible, affordable housing and supports. She told the committee that a state rental‑assistance fund helped earlier cohorts and the department requests continuing state funds to fill gaps while clients await federal vouchers. \"It is our number 1 issue,\" Meyer said of housing availability.

Budget requests tied to settlement work discussed in the hearing:
- $300,000 general fund request for state rental assistance to support transitions and meet settlement benchmarks (the department said carryover funds from previous appropriations are now expended),
- A $5.2 million package in total funds (roughly $2.7M general fund and $2.5M federal match) to continue transition/diversion supports learned during the MFP and settlement implementation,
- The department said it is meeting earlier targets (reported meeting a 60% target and achieving 64% for a stated benchmark year) but future years’ targets are more aggressive.

Discussion and next steps: Committee members asked whether failure to meet benchmarks would trigger penalties; Meyer said the settlement calls for evaluation of substantial compliance and ongoing negotiation with the DOJ, and the department meets periodically with DOJ staff. Committee members pressed for clarity about timing, and the department said it will continue to report progress and stressed the dependency on affordable housing and rental assistance to achieve further transitions.

Ending: Meyer urged the committee to view the requested state rental assistance as a practical tool to help meet settlement obligations and to give consumers more community options rather than rely on institutional care.","Adult and Aging Services described obligations under a December 2020 settlement with the U.S. Department of Justice requiring outreach, diversion and transition work and set out benchmarks that drive requests for state rental assistance and transition funding to meet Olmstead‑related goals.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6372746,"North Dakota hearing: Adult and Aging Services details expanding Home and Community-Based Services and staffing shifts",12019,303000,12322000,"/Search/View?dp=1&key=2147274-033dab7a2bf5d9510986b89198643d7d&start=303&end=12322","https://assets.pipeline.soar.com/2147274-033dab7a2bf5d9510986b89198643d7d/thumbnail_303000.jpg","/articles/6372746/North-Dakota/North-Dakota-hearing-Adult-and-Aging-Services-details-expanding-Home-and-Community-Based-Services-and-staffing-shifts","https://secure.pipeline.soar.com/6372746-4225449944dd743015fdf1ec2011e57d/orig.mp4?Expires=1771184353&Signature=iFP7gHXjuKqSLqWWa24OtQCyzGm8vKuq73IKBej5ve5BdacWf513sI5W1jCEV3i~YhoTgLG-nS8BGUJqgLZIF-8K0k4K89336WhdvPZL6-QY56Cg51JM6gjquANqmgAwJ3FkuYsUhJuUjW~MP4yBpN6fn9zn8nNR0UPwbxFp7TBPvycPl48EUIDdQBVbt6Qi2s6OiUCEi9DeRQCmSBW55C4nH2z4WiiEpWZFDYhWNLIjdtWbY9B-dmPDwfx8qtLrfOjWr01n119uZgn40RoRzh6dByOurfLbtLh6pc1Bhv9rVmH6nwaff8HOq7UFKxH6hRexu05eRgzTH~s1sI2q5g__&Key-Pair-Id=KUT5TJCACFTXG","Nancy Nicholas Meyer, director of Adult and Aging Services at the North Dakota Department of Health and Human Services, told the House Appropriations Committee Human Resources Division on the House Bill 1012 budget presentation that her division’s workload and client complexity have grown sharply in recent years.

Meyer said the division administers Older Americans Act programs, the state-funded SPED program and Medicaid‑funded Home and Community‑Based Services (HCBS) and handles vulnerable adult protective services and the long‑term care ombudsman office. \"I'm Nancy Nicholas Meyer. I'm the director of adult and aging services with the department of, health and human services,\" she told the committee.

Meyer said HCBS caseloads and acuity have risen since 2020. \"In calendar year 2024, in all of our programs, we serve 3,571 individuals,\" she said, and later summarized intake volume: \"On average, we're getting 150 new referrals every month. And 80 of them are turning into cases.\" She told members that the division converted about 72 county case‑management positions to state FTEs and added several investigators and case managers to respond to demand.

Why it matters: Committee members pressed Meyer on workforce and budget details because higher acuity and more people seeking HCBS increase state costs and drive multiple decision packages in the executive budget. Meyer emphasized that HCBS can be a lower‑cost alternative to institutional care for some people and that increasing numbers of clients require nursing‑level or medically complex supports.

Key program and budget details Meyer provided:
- SPED (state program) serves 2,465 people and applies to individuals with $50,000 or less in assets; most served have under $25,000.
- Total clients served across the division in 2024: 3,571 (54% increase since 2020).
- ADRL (Aging and Disability Resource Link) staff handled roughly 12,000 calls in the most recent year and was expanded in 2021 from a single line to a staffed call center of six positions.
- Nutrition: the division pays $8.89 per home‑delivered meal and $7.62 per congregate meal; there are about 205 nutrition sites statewide. Meyer said a 3% proposed reduction in some general‑funded provider grants in the executive budget was roughly $761,000 and would affect local providers.
- Case management: 64.7 field case managers plus eight supervisors (roughly 72 positions) manage open caseloads; Meyer cited a 117 weighted average caseload metric and said many cases require frequent contact.

Meyer described how rising client acuity—more co‑occurring behavioral health and higher medical needs—has increased demand for provider staff with higher skills, including nurses and supervisors, and has changed the content of services the division must buy or oversee. She told the committee that some HCBS recipients now need complex medical tasks in the home (tube feeding, trach care, insulin administration), which raises per‑client costs on waiver services.

Committee members asked for additional information. Chairman Nelson asked for trend charts showing multi‑year growth; Meyer agreed to provide more detailed historical graphs. Representative Murphy raised concerns about nutrition funding and local senior‑center capacity to cover rising food costs.

What’s next: The department’s executive budget includes multiple decision packages tied to these shifts — targeted rate increases for certain HCBS services, continuing the APS contracting level created with federal funds, and proposals to support transitions out of institutional settings. Meyer and staff indicated they would return to committee with further details and data on trends and utilization.

Ending note: Meyer framed the growth as a demographic shift and an operational challenge: an older, higher‑acuity population combined with rising expectations for in‑home care requires more trained workforce and targeted funding to keep services available statewide.","Department of Health and Human Services director Nancy Nicholas Meyer told the House Human Resources Appropriations panel that Home and Community-Based Services enrollment and acuity have risen markedly, driving requests for additional staff, targeted rate increases for in‑home providers and continued funding for senior nutrition programs.","actionData","errors"]

Article not found

Alzheimer’s Association outlines dementia care contract, says services reduce costs and help caregivers

Lawmakers hear proposal to raise targeted HCBS provider rates amid workforce, rural access concerns

Department details DOJ settlement benchmarks, Money Follows a Person transitions and rental‑assistance request

North Dakota hearing: Adult and Aging Services details expanding Home and Community-Based Services and staffing shifts