[{"_1":2,"_88":-5,"_89":-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],{"_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",6287763,"mediaKeyId","2546999-18a92d148809bc0e1f81bf5e0db7ca0e","parentId",2546999,"title","Health department warns of salary 'underfunding,' FTE-count errors as lawmakers weigh cuts","audioSeconds",2400,"startMs",340000,"endMs",2740000,"viewUrl","/Search/View?dp=1&key=2546999-18a92d148809bc0e1f81bf5e0db7ca0e&start=340&end=2740","thumbnailUrl","https://assets.pipeline.soar.com/2546999-18a92d148809bc0e1f81bf5e0db7ca0e/thumbnail_340000.jpg","articleUrl","/articles/6287763/North-Dakota/Health-department-warns-of-salary-underfunding-FTE-count-errors-as-lawmakers-weigh-cuts","mediaUrl","https://secure.pipeline.soar.com/6287763-c9f22727bfee3253af407b0cf0098441/orig.mp4?Expires=1770998353&Signature=kx--s3G4Gt08BPvl8DiZF5LND-qgjPyZtxMncWAmX-51YR792eAyk0dDTM8jCf8JdzotTxJRg0GrPdu3U5YG~pA5ca3Yf6HRct4TmWFB4vjw4DWYKXTTrzRAxRCe-hHPI1jrB2lRhcTXvtgDeewGpp1FTlqTm0JKlKqjue~luwrgG5B4ZjjUV8hCp0ni3eklwk8aAe6tPS0CpSwkIOHtXWPxdkFe1yCvDFQianYG2KfPHVVw12AaNCpeE9Mej~M0BJ~5dd9aacLjE6BlK8n2WgZxtXskkeMmpuuBNVGCN5VCkn1qdRm8NdxaUI0XSWSIBb0fYyEkJYpT0Bo8rDkxQg__&Key-Pair-Id=KUT5TJCACFTXG","author","North Dakota State Legislature","date","2025-03-11T00:00:00Z","article","Donna Auckland, chief financial officer for the Department of Health and Human Services, told the Senate Appropriations Human Resources Subcommittee on March 1 that the department’s salary block grant has structural and accounting problems that members should consider as they finalize biennial budgets.

Auckland said the department builds its salary budgets from a dollar block-grant rather than an FTE count and that last biennium’s accounting left the department with funded positions that were not included in its official FTE count. She said lawmakers approved funding for about 98 positions last biennium but the FTE count in the system did not include them; for the upcoming biennium the department submitted 2,688.35 FTE, but roughly 95 of those positions were budgeted at $0. ‘‘If I had the dollars in my budget right now and I hired them all at lower level positions, I could hire 2,700 people today as long as I don't go over my dollars,’’ Auckland said, adding that in practice she is constrained by the available appropriation and the department’s actual payroll (about 2,450 employees paid in February).

Auckland walked the committee through how the salary numbers were built: a legislative base she said was roughly $544 million for the current biennium, internal reallocations to reflect operational versus one-time funds (for example, moving ongoing operations to pay for 24 CCBHC positions previously funded with one‑time money), and projected expenditures. The department projects salary spending of about $535 million in the current biennium and expects ‘‘roll up’’ (vacancy savings that become available) of roughly $13.4 million.

She also said the governor’s compensation package and the legislature’s earlier increases create a ‘‘cost to continue’’ problem. Because pay increases compound, the department needs to budget 24 months of the prior biennium’s increases to keep pay whole for the next biennium; Auckland put that incremental cost at about $10.3 million in her calculations.

On underfunding, Auckland said the House proposal would reduce the salary block grant by $30 million and that the department allocated that proposed reduction across divisions based on general‑fund shares rather than FTE or vacancy patterns. She warned members that the consequences differ by position: positions that carry federal match requirements could lose the ability to draw down federal funds if the general‑fund match is eliminated. ‘‘Because I underfunded us by $30,000,000, even though I have a position that’s $200,000, I would be losing all — you might have cut me $100,000, but because I can’t match that, I was actually cut $200,000,’’ she said.

Auckland and members also discussed the treatment of prior appropriations and one‑time funds. She said last biennium a reduction of $19.5 million was allocated across divisions and that the governor’s decision packages added $9.8 million intended for FTE flexibility and $250,000 for regional pay differentials in the northwest.

FTE counting and clean‑up drew strong attention. Committee members and staff identified roughly 95 positions entered in the department’s system at $0 funding and suggested removing those positions from the official FTE count to make reports match operational reality. Auckland agreed the positions could be removed and said she had given the list to legislative counsel for verification. OMB staff on the record said that the long‑sheet FTE number reconciles with what OMB is carrying from the governor’s budget and that under the block‑grant approach FTE counts are less operationally critical than the dollar allocation.

Committee members asked for follow up details and visuals: Heather was asked to explain why certain facilities (for example LSTC) ran over budget with contract labor, and Auckland agreed to prepare a visual explanation of how cost‑to‑continue calculations work and to provide more detail on vacancy savings and roll‑up assumptions.

The department emphasized that the committee must decide how much flexibility to leave in the block grant for directors across divisions to respond to real‑time staffing needs. Auckland said the House had effectively left the department about $7 million of flexibility after the proposed reductions, and she warned that less flexibility could constrain program growth such as Certified Community Behavioral Health Clinic (CCBHC) expansion and public‑health staffing for inspections and outbreak response.

The committee held no formal votes during this discussion; members asked for additional data and options to be provided in coming weeks.","mediaType","Video","parentTitle","Senate Appropriations - Human Resources Division Tuesday, Mar 11, 2025 8:55 AM - 12:02 PM","oneSentenceSummary","Donna Auckland, chief financial officer for the Department of Health and Human Services, told the Senate Appropriations Human Resources Subcommittee that a $30 million House reduction to the department’s salary block grant, plus legacy accounting errors and how pay increases were budgeted, will reduce flexibility and could prevent the state from drawing federal matching funds.","taxTitle","Appropriations - Human Resources Division, Senate, Legislative, North Dakota","taxId",28901,"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},6287758,"Public Health division flags falling immunization rates, autopsy workload and calls for maternal and domestic‑violence funding",7328,3373000,10701000,"/Search/View?dp=1&key=2546999-18a92d148809bc0e1f81bf5e0db7ca0e&start=3373&end=10701","https://assets.pipeline.soar.com/2546999-18a92d148809bc0e1f81bf5e0db7ca0e/thumbnail_3373000.jpg","/articles/6287758/North-Dakota/Public-Health-division-flags-falling-immunization-rates-autopsy-workload-and-calls-for-maternal-and-domesticviolence-funding","https://secure.pipeline.soar.com/6287758-d3b33ed6be7c441c83d6261bf8100bc7/orig.mp4?Expires=1770998353&Signature=Pnt3K0F-chT0F~MHrLRqPeQv3g3lrojdEDTh1XEEwRzKLWIN6TN6Dpd5tF09gSnc7Z6bnSkXxcrR1CvnhmnrRFzNy5CI4i0efdihjvjw6mdSZceO4AA6XRFO7KhOa1~yLzys1mNYvldKMhlc-8xgmke0PTVjGVfKoF~PmPhp7M4gNVmSwhQFPkS7KVByQhk3STdQ1IqzSMhexZK6JXxFFxbP5cTntazMpr~YrdBLdaGMKW9M3TtfoDhHoEcj0LrRCpKoVn5-GsoHFQTbI6RbczIefkT2~EZb3H67rfNqoxpKubLHkVVhNgqdz5gnXQQVZ1AarqwxR2XOkoSRBpcmUw__&Key-Pair-Id=KUT5TJCACFTXG","Kirby Krueger, director of disease control and forensic pathology at the Department of Health and Human Services, and other public‑health leaders briefed the Senate Appropriations Human Resources subcommittee on March 1 about program priorities and budget requests for the Public Health Division.

Krueger described the forensic pathology workload and contracting arrangement with the University of North Dakota (UND). The department’s Bismarck forensic office performed 188 autopsies in 2023 and 122 in 2024; UND handled the remainder under contract. Krueger said the state’s coverage is divided geographically by contract: certain western and south‑central counties routinely send cases to Bismarck, other counties send to UND. He told the committee the Bismarck forensic examiner position is currently part time (Doctor William Mazzello works two days a week) and that a single full‑time pathologist would not be sufficient to meet the state’s current autopsy volume.

On immunizations, Krueger and Molly Howell, immunization director, presented statewide trends and county‑level variation. They said MMR coverage among kindergarteners has declined since the early 2020s and that the state’s exemption rate for kindergarten immunizations has risen toward about 7 percent statewide, with local pockets much higher. Howell noted that measles remains highly contagious and that two doses of MMR achieve about 97 percent effectiveness, while a single dose is roughly 93 percent effective. Committee members asked whether prior spikes (for example in the 1970s) provide a useful model; Howell explained historical program changes (single‑dose to two‑dose recommendation and the start of school immunization requirements) but said modern pockets of under‑vaccination are what create outbreak risk now.

Public‑health leaders highlighted federal funding constraints for immunization operations and the difference between vaccine procurement (federal Vaccines for Children entitlements) and operational supports such as reminder/recall systems and outreach, which rely on federal grants that have flattened.

Kim Mertz, section director for Healthy and Safe Communities, outlined program areas across maternal and child health, WIC, newborn screening, school dental programs (SealND), a poison‑control hotline (contract with Hennepin County), domestic‑violence and sexual‑assault services, and chronic‑disease initiatives including tobacco prevention. Mertz summarized several budget asks included in the executive recommendation: a $2.0 million package to expand maternal and child health services, $2.25 million proposed for domestic‑violence services in the governor’s recommendation (the House provided about $2.1 million, with an additional Community Health Trust Fund shift in some lines), and a $2.2 million request to expand coordinated immunization access including RSV antibody and Hep B access for infants.

Mertz and staff described other program statistics and needs: the WIC program served more than 16,000 participants in the prior year; newborn‑screening covers roughly 34 conditions and screens about 11,000 infants yearly; the SealND school sealant program screened thousands of students and applied preventive sealants; the poison hotline handled more than 6,000 calls in 2023. They also summarized the domestic‑violence network’s caseload: in 2023, programs served 6,131 new victims of domestic violence statewide and the sexual‑assault programs reported 1,288 new primary victims (data collected by the state coalition).

On workforce and recruitment, Mertz described loan‑repayment programs administered by the Primary Care Office. The department reported a combined loan‑repayment funding pool (state and federal) in the executive recommendation; Natalie Young, primary care director, said the programs prioritize rural and shortage areas (dentists awarded through the program are required to provide at least $20,000 a year in Medicaid services) and that federal loan‑repayment contracts have steep penalties for default, which limits defaults in practice.

Committee members asked for follow‑up: where county immunization rates are lowest (Shelidan, Wells and Williams counties were flagged as examples), requests for data on defaults and completions for loan‑repayment participants, contract details for the UND autopsy agreement, and clarity about how Community Health Trust Fund dollars were shifted to general fund in the House version of the bill. The committee did not take a vote; staff and agency leaders agreed to provide follow‑up documentation and to return with additional detail.","Public Health Division leaders told the Senate Human Resources Appropriations subcommittee that kindergarten vaccine exemptions and declining MMR coverage pose outbreak risk, the forensic pathology workload has increased and relies on a UND contract, and the division seeks funds for maternal health and expanded domestic‑violence services","actionData","errors"]

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Health department warns of salary 'underfunding,' FTE-count errors as lawmakers weigh cuts

Public Health division flags falling immunization rates, autopsy workload and calls for maternal and domestic‑violence funding