[{"_1":2,"_100":-5,"_101":-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],{"_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",6365798,"mediaKeyId","2159776-5fdd09839ab1e5a2e2ea8c1285b451b3","parentId",2159776,"title","Health officials say 90-day pre-release Medicaid coverage may not be cost‑effective; state wins $5 million to link county and tribal jails to Medicaid","audioSeconds",343,"startMs",2359000,"endMs",2702000,"viewUrl","/Search/View?dp=1&key=2159776-5fdd09839ab1e5a2e2ea8c1285b451b3&start=2359&end=2702","thumbnailUrl","https://assets.pipeline.soar.com/2159776-5fdd09839ab1e5a2e2ea8c1285b451b3/thumbnail_2359000.jpg","articleUrl","/articles/6365798/North-Dakota/Health-officials-say-90-day-pre-release-Medicaid-coverage-may-not-be-costeffective-state-wins-5-million-to-link-county-and-tribal-jails-to-Medicaid","mediaUrl","https://secure.pipeline.soar.com/6365798-73275c8b0bc89600bf94b067b23aa433/orig.mp4?Expires=1771193103&Signature=Pl-SwSaX~1-S0vY2QUAS~H0V4m9PQGqLOH4y-iJIdNOhY4w02GlT58l3S7kdny91MmHVUFXXYe~rASxgV3uBgXDMSImvTptIhEe04JBuqvBsCKwJ8G7z8V4t~VIAv1sxEiSTAgV1CfnUH0kLlYlK-pn6JNCaNK4xZRTfgqtKGtroeSIduuXbSwzQ9UCFRvux3b9hBAcT7TeSHsJWyW0EPpsMLoyFs06s8wwxGyAO5wLktohh2iGQ~EKCKzMVj33s1G-qY8JwT1C9P7-blZhJwUb2DFyywghuHeEO~FSn2YBpyU5WgoeohfnXIiE~cn~qDy7tbZbegr0-kqnlEUAgmA__&Key-Pair-Id=KUT5TJCACFTXG","author","Senate Human Services, ND","date","2025-01-27T00:00:00Z","article","Department of Health and Human Services staff told the Senate Human Services Committee that federal changes allow states to seek Medicaid payment for services provided to incarcerated individuals during a pre‑release period, but that North Dakota officials are unsure whether pursuing that option would be cost‑effective under the state’s managed‑care arrangement.

Sarah Acre, Executive Director of the Division of Medical Services, described two related federal options: a congressional authorization for up to 30 days of Medicaid payment prior to release and a Biden administration allowance up to 90 days. Acre warned that 1115‑type changes that authorize pre‑release coverage require extensive federal reporting and administrative work and that under North Dakota’s managed‑care capitation the state could pay more in capitation than it would save. She said, as a result, the department is not certain pursuing the waiver is the right option now.

Acre also told senators the department is pursuing other steps. She said the department applied for and received a federal award of $5,000,000 to build systems that exchange eligibility information with county and tribal jails, improve notifications when someone is incarcerated or discharged, and help identify people who are not on Medicaid but may qualify. Acre said the grant will be used for tribal jails as well as county jails.

Committee members raised concerns about variation in jail health care and about using suspension versus termination of Medicaid eligibility while someone is incarcerated. Acre said North Dakota already suspends Medicaid eligibility upon notification of incarceration, and that the state can reactivate coverage for services rendered outside the carceral setting (for example, hospitalization lasting more than 24 hours while the person is outside the facility).

On cost, Acre said most incarcerated people would fall under Medicaid expansion and the state pays capitation to a managed‑care organization; the department must consider whether increased covered care prior to release would increase state spending. She said the department will continue studying options and working with the Department of Corrections and Rehabilitation (DOCR) and local jails.

Ending: The department recommended further study and technical work with DOCR and county partners; no committee vote was recorded on policy or statutory change during the session.","mediaType","Video","parentTitle","Senate Human Services Jan 27, 2025 II","oneSentenceSummary","Department of Health and Human Services staff told the Senate Human Services Committee that federal options allow Medicaid payment for services up to 90 days before a person’s release from custody, but the department is unsure whether pursuing that option would be cost‑effective under North Dakota’s managed‑care arrangement.","taxTitle","Human Services, Senate, Legislative, North Dakota","taxId",28905,"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},6365802,"ND Health Department outlines limits, safeguards and next steps for paid family caregiving in Medicaid waivers",1538,174000,1712000,"/Search/View?dp=1&key=2159776-5fdd09839ab1e5a2e2ea8c1285b451b3&start=174&end=1712","https://assets.pipeline.soar.com/2159776-5fdd09839ab1e5a2e2ea8c1285b451b3/thumbnail_174000.jpg","/articles/6365802/North-Dakota/ND-Health-Department-outlines-limits-safeguards-and-next-steps-for-paid-family-caregiving-in-Medicaid-waivers","https://secure.pipeline.soar.com/6365802-5bc44c1a24941765fbccc3e77173ca57/orig.mp4?Expires=1771193103&Signature=X6E3aRzZvdA6DrUgsv9AK23WV2e6QUbO~q-IpvT3J7ugF5uRxtdHxXyuJ2YXnVqetfWzAgY5buSlQkQ1L6BDEPw6mIWx-SfFjRF0KP6rF2~yaUIvH-VYBl1umJOnyEYxm1HuPlP8pMORymUWH5tt8qPmWuiwWP-dUSLuExavnwqsMdxayglax46G03cOeu~WI7ltpc1jhDLlMQnOyWAN-eTHASnUJjPCs8rnSi56aOswguo87t7SuT0fZdC-v5SkOLmlZGeyXeANt2jjXDL3RZOsB2dvTuVbo1BybFrzItqJMuN9j3UzbT~7QOaY93i220z4GIU4da~f~F~J5DalTQ__&Key-Pair-Id=KUT5TJCACFTXG","Sarah Acre, Executive Director of the Division of Medical Services at the North Dakota Department of Health and Human Services, told the Senate Human Services Committee that federal rules bar payment to a legally responsible relative for state-plan personal care services and make paid family caregiving available only through Home and Community-Based Services (HCBS) waivers.

Acre said, “This is 42 CFR 440.167, which governs the federal regulations around personal care,” and emphasized that the federal regulation defines a family member who is a “legally responsible relative” as ineligible to provide state-plan personal care. She said, “in order for somebody to ever access paid family caregiving, it has to be through one of our HCBS waivers.”

The department summarized differences across existing waivers and how family-paid caregiving would fit. For medically fragile children the waiver includes a yearly dollar cap — Acre said that cap is $25,300 per individual — and families may spend that amount across services as they choose. By contrast, the Developmental Disabilities waiver currently allows 600 hours of respite per year; the autism waiver allows 40 hours of respite per month. Acre said the medically fragile waiver places no explicit hourly cap but is limited by the dollar cap.

Acre walked the committee through additional federal expectations for paying legally responsible individuals through an HCBS waiver. She said states must specify who qualifies for payment, identify which waiver services will allow payment, and explain how the state will distinguish “extraordinary care” from “ordinary care.” She also described program-integrity safeguards states commonly use: documentation requirements, finer-grained billing units (for example, 15-minute units), and electronic visit verification. “If you didn’t document it, it didn’t happen,” she said when describing recoupments tied to missing documentation.

On implementation, Acre said the department has requested funding in the current biennium to support waiver redesign and to prepare a cross‑disability children’s waiver. She said the department is starting work on a level-of-care assessment redesign and on defining the new waiver’s service array, provider qualifications and outcome measures, and that some funding would go to service infrastructure such as family navigators and case-management supports.

Committee members pressed on program integrity and workforce issues. Senator Hogan asked whether states have seen fraud under paid family-caregiver programs; Acre responded that some states that rapidly expanded family caregiving during the COVID public health emergency later sought to end or narrow those programs because of cost increases and fraud concerns, and that Idaho had recently asked to end its paid family-caregiving supports. Acre said those experiences argue for starting with narrow requirements and safeguards, monitoring outcomes, and expanding services over time if safeguards work.

Acre described the advisory and planning history for a cross‑disability children’s waiver: a 2021 legislative study (Senate Bill 2256), a 2022 Alvarez and Marshall study recommending cross‑disability supports, and a 2023 law (Senate Bill 2276) that established a cross‑disability advisory council that met December 2023–May 2024. She said the council and consultants assembled a menu of design options and prioritized flexibility and avoiding service reductions for children who move into the new waiver.

Acre and committee members agreed to continue technical drafting. Senator Hogan and Acre discussed meeting to refine bill language so pilot-family-caregiving policy aligns with cross‑disability waiver design and federal approval requirements.

Ending: The department said it will continue design work and technical drafting with legislators and advocates; no formal vote or change to statute was taken during the committee session on this topic.","Department of Health and Human Services staffers told the Senate Human Services Committee that federal rules prevent paid family caregiving under the Medicaid state plan and that access must come through HCBS waivers; officials described program caps, CMS requirements and steps toward a cross-disability children’s waiver.",{"_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},6365792,"Senate committee narrows emergency civil‑hold timeline to 72 hours and advances bill 6‑0",490,3266000,3756000,"/Search/View?dp=1&key=2159776-5fdd09839ab1e5a2e2ea8c1285b451b3&start=3266&end=3756","https://assets.pipeline.soar.com/2159776-5fdd09839ab1e5a2e2ea8c1285b451b3/thumbnail_3266000.jpg","/articles/6365792/North-Dakota/Senate-committee-narrows-emergency-civilhold-timeline-to-72-hours-and-advances-bill-60","https://secure.pipeline.soar.com/6365792-c5823515ae3bf9d5b478b6572d39b06c/orig.mp4?Expires=1771193103&Signature=ISXfOMg2H7caU4F6Nsxf4YIy3w5Hm-fggV894JYHu-h~waFrfMy33at3Fi5rN90hxwEuim800JDmud0f8BVW-zdCksDR6wnD4WMbNezSGpyrvzCCmo7F~Mfx5OTHznn2vukQhArCP4hEdGUpudpP7LUH4zOtoV99xilVmEo6Cl8~1nV40bxos6XcgzbnhKepysCVGpVIjTf-oTIwgD~VjtLcaQUobtPn62Hdh27h8hY8v6bxY9jz3lplGm5txLoNk6SUZ7lsBgdClUhky3d1oTW8QA-T1z3JUHoKdUiDu81520zBY4MyKqjD-04Z8T~HpHfxeGc4bovLRZADqdNpdA__&Key-Pair-Id=KUT5TJCACFTXG","The Senate Human Services Committee amended language on a bill addressing emergency civil‑hold procedures so that the required evaluation period reads as a flat 72 hours after admission and voted the bill out of committee by unanimous roll calls.

Committee discussion focused on whether the statute should retain separate 24‑hour and 72‑hour timelines or move to a single 72‑hour period. Advocates and hospital representatives raised concerns that 24 hours can be too short when transport or medical stabilization is required, while others worried that longer holds without clear criteria could unduly restrict an individual’s rights.

Victoria (staff) described draft language that would remove the bifurcation and require the superintendent or director to “require an immediate examination of the subject within 72 hours after admission.” After debate, Senator Roars moved to reconsider the committee’s earlier action and Senator Hogan seconded; a roll‑call vote recorded Senators Lee, Weston, Roars, Hogan, Van Oosten and Clemens each voting “Aye,” and the motion to reconsider passed 6‑0 on the record.

The committee then debated the amendment that applied 72 hours uniformly, including holidays and weekends, and moved the amendment. The committee voted by roll call — Senators Lee, Weston, Roars, Hogan, Van Oosten and Clemens recorded “Aye” — and the amendment carried 6‑0. Senator Roars then moved a “do pass as amended” recommendation and Senator Van Olsteen seconded; the committee recorded a 6‑0 roll call in favor and reported the bill out of committee as amended.

Speakers asked procedural questions about when the statutory clock begins (the department said the timelines start upon “admission” to the receiving facility) and about transportation costs and liability during interstate or intercity transfers; department staff said county transportation rules and other statutory provisions apply and that they would follow up on logistics.

Ending: The committee adopted the amendment and moved the bill forward unanimously; staff said they would refine statutory language and provide updated drafting for the next session steps.","The Senate Human Services Committee amended a bill to make the emergency evaluation period a flat 72 hours after admission, voted to reconsider earlier action and approved a due‑pass as amended recommendation by a 6‑0 roll call.","actionData","errors"]

Article not found

Health officials say 90-day pre-release Medicaid coverage may not be cost‑effective; state wins $5 million to link county and tribal jails to Medicaid

ND Health Department outlines limits, safeguards and next steps for paid family caregiving in Medicaid waivers

Senate committee narrows emergency civil‑hold timeline to 72 hours and advances bill 6‑0