[{"_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",6087212,"mediaKeyId","2891421-0e01ce3894f7dcd1e3d6cd40c753e209","parentId",2891421,"title","Committee debates delaying nursing-home withhold; amendment would study design and add $4 million fiscal implication","audioSeconds",2418,"startMs",2094000,"endMs",4512000,"viewUrl","/Search/View?dp=1&key=2891421-0e01ce3894f7dcd1e3d6cd40c753e209&start=2094&end=4512","thumbnailUrl","https://assets.pipeline.soar.com/2891421-0e01ce3894f7dcd1e3d6cd40c753e209/thumbnail_2094000.jpg","articleUrl","/articles/6087212/North-Dakota/Committee-debates-delaying-nursing-home-withhold-amendment-would-study-design-and-add-4-million-fiscal-implication","mediaUrl","https://secure.pipeline.soar.com/6087212-01540c4a06ef47f220217995d2b48ace/orig.mp4?Expires=1771153162&Signature=DAz04VATU7uyGqdDohE-kt07nOVc~urqMsTKTkMC5FhqStC97ZMExbA3Bw5Pv01IDvV9Af8PV2wXnEILbZxSupTnY7uZrZl~2pKPle3rlVHpotGdl6DYyhWb3~GnaMPlXS2ovj3578ywpMzUEFVwrQkhdNMD0kbTuMhrlgaGbRHN6X4D-ArssQ3yN9LSByYyQPEMznkUCqzQDRRTym7SyFJlUhoWhCnJJKmn4XKmib4cqGsi4LklaSdusPQbQYETXkl-i-Cv043dO2foBcalj5i10o0VJm2v5m0OqQzNPvF1w~9NGlJCbCwRC3xyRPZACcFgn1KTBvOI4gqb~uLX8A__&Key-Pair-Id=KUT5TJCACFTXG","author","North Dakota State Legislature","date","2025-04-07T00:00:00Z","article","Members of the Appropriations — Human Resources Division debated amendments that would change the timing and design of a proposed Medicaid “withhold” tied to nursing facility quality incentives and clarified use of $2 million in behavioral health funds for nursing homes and basic care.

What the amendment would do: Committee members reviewed language — described by proponents as study or “runway” language — that would delay the department’s planned withhold implementation and require the department and providers to collaborate on a model and report an incentive program plan to legislative management by Sept. 1, 2026. The amendment’s supporters said it gives providers time to prepare; critics said it would merely delay action and carries a $4,000,000 general fund impact if the withhold is not implemented as drafted in the governor’s recommendation.

Department view and fiscal impact

Sarah Acre, identified in committee as Executive Director of the Division of Medical Services at the North Dakota Department of Health and Human Services, told the panel the department looked at the amendment and could “live with that language,” but emphasized the difference from the governor’s budget was timing. “I support the concept of really working with the providers on this issue,” Acre said, and added the current governor’s budget moves faster toward implementation. The committee’s staff and the department explained the draft governor’s proposal included a $4,000,000 reduction in general fund outlays tied to switching some incentive dollars into a withhold mechanism; adopting language that delays or removes the withhold would require adding those dollars back to appropriations.

Lawmakers’ positions

Senator Davison said he is not yet for or against the amendment and asked for more time to study operational issues. Others, such as Senator Davison (discussion), urged proceeding with the department’s timeline to push quality improvements, while other senators explicitly asked staff to remove the withhold reduction pending study. “The difference is the time for implementation,” one member summarized of the amendment and the governor’s draft.

Related appropriations and amendments

Committee members also discussed two other items tied to behavioral health and institutional capacity: House Bill 14‑25 and a $2,000,000 line item the House added for behavioral health services for nursing homes and basic care facilities. An amendment circulated to clarify that existing $2,000,000 would fund training, technical assistance, consultation and direct patient care to help nursing homes and basic care facilities accept patients with medically based behavioral health disorders; committee discussion focused on whether the funding should be general fund and how it interacts with other rate and incentive decisions.

Next steps

No formal amendment vote or final appropriation decision occurred in the transcript. Members agreed to hold the language aside for additional work and to consider the amendment in the context of other rate and funding decisions. Department staff said they will continue collaboration with providers on design options if asked.","mediaType","Video","parentTitle","Senate Appropriations - Human Resources Division Monday, Apr 7, 2025 10:02 AM - 11:49 AM","oneSentenceSummary","Lawmakers debated whether to delay implementing a proposed Medicaid withhold for nursing homes and to require a study and provider collaboration; the change could add $4,000,000 to general-fund appropriations.","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},6087217,"Parents, architect outline proposal for four-person ‘medical homes’ to keep medically fragile relatives in community",3001,393000,3394000,"/Search/View?dp=1&key=2891421-0e01ce3894f7dcd1e3d6cd40c753e209&start=393&end=3394","https://assets.pipeline.soar.com/2891421-0e01ce3894f7dcd1e3d6cd40c753e209/thumbnail_393000.jpg","/articles/6087217/North-Dakota/Parents-architect-outline-proposal-for-four-person-medical-homes-to-keep-medically-fragile-relatives-in-community","https://secure.pipeline.soar.com/6087217-dc52a31dc745146f99c76992d04ff1cf/orig.mp4?Expires=1771153162&Signature=Lk-hPvVIwYOaozCTt56mPgRAjl7o9~-NExnMGC5aEXbAimM-9gE9SYU1Bp98HKx1hfJuZHDKLWUzfv3pFbakKmAqsOvL2l63koi0bRlh9su26Stu6It~nH3nM0sgbXCWV-ZNHi22Kt3KCV9PD-8PE25qB1TJQoVgGxlD2nDIhfhdqkpQhnoJtMtD7bsM4l7VoWNJPn1IF8Tf9TP3-ZU8OOKVVAWcIxsz8CcO4VDg5c91QFKcHYNDHSUdXhYGSktI3AucO0n9E8kL9CCuLDHVYONSV1oPWl5291JlBY-8yCh34C8seymIv1OhEOojhMOpKoJl9XdgIJvp1oplBWbgiA__&Key-Pair-Id=KUT5TJCACFTXG","Chairman Deaver and members of the Appropriations — Human Resources Division heard a proposal for building small community medical homes for people with intense medical needs, presented March by caregiver Matt Shores and local architect Jeff Hubel.

The proposal calls for purpose-built homes of roughly 5,000 square feet containing up to four apartment-like sleeping units (roughly 900 square feet each) arranged around a shared “great room,” with space for medical equipment, staff support areas and covered parking. Jeff Hubel said the firm prepared a budget-level cost estimate with contingencies and allowances but no site is selected. “We do not have any cost built into this for demolition at this time,” Hubel told the committee, adding that his estimate includes a 12% design contingency and a 10% owner contingency to reflect current market uncertainty.

Why it matters: caregivers and advocates told the subcommittee they are running out of community options for people who require significant medical supports but do not need hospital or institutional care. The homes are meant to be “unbundled” from services — the building would provide living space and infrastructure while families and clients choose which providers deliver medical and personal supports.

Details and testimony

Matt Shores, who testified that he has cared for his adult daughter at home for years, told the committee the homes would let families keep loved ones near where they live. “My name is Matt Shores. And I had testified earlier about a concept for medical homes that could be located around the state rather than institutional care,” he said.

Architect Jeff Hubel described the technical trade-offs in design. He said buildings could include emergency power and high-flow oxygen hookups while leaving other, moveable items — including many pieces of medical equipment — to be supplied for each resident. “There’s a certain amount of infrastructure that you can build into the homes,” Hubel said, noting the budget reflects added cost pressures from labor and materials.

George Zink, joining by phone from Fargo, urged that units be treated as efficiency apartments with separate bathrooms and space for overhead rails and oversized doorways for wheelchairs. “All of the efficiency apartments and or bedrooms . . . would need to have separate bathrooms, overhead rails, large doorways,” Zink said. He also pressed for family involvement in final design work.

Committee questions and constraints

Committee members pressed on cost, zoning and operations. Hubel said homes of fewer than five units are less likely to face zoning challenges in residential neighborhoods and that siting near existing infrastructure reduces site costs. He estimated construction of a single home would take about 10 to 12 months after design, while the proposal overall could be completed “within 1 to 3 years” depending on financing and approvals.

Ownership and operations were not resolved. Zink and Shores both said they preferred private investment or nonprofit development rather than direct Department of Human Services ownership; Dirk Wilkie, interim commissioner of the Department of Health and Human Services, told the committee the idea was not a departmental proposal or in the governor’s recommendation and that the department would welcome follow-up conversations.

Scale and demand

Shores said earlier work estimated roughly 80–85 clients statewide with support-intensity scales of 10 or greater who could benefit from this model; committee members and presenters agreed two or a few pilot homes would not meet total need but could serve as a trial. Shores summarized the concept in a working document circulated to the committee noting the homes would be spread across the state (Bowman, Williston, Minot, Bismarck, Fargo were cited as examples) and should permit residents to retain chosen service providers if a provider later discontinues services.

Next steps

Committee members recommended further work with the department, including refining language in a bill’s section 31 and drafting study or amendment language to clarify funding, ownership, siting and operational responsibilities. Bruce Murray, who identified himself as a volunteer lobbyist supporting the project, offered to help with drafting and stakeholder conversations.

Ending

No formal action was taken. Members agreed to continue discussions with the Department of Health and Human Services and with family stakeholders and providers to refine costs, developer incentives and program language before placing any funding in an appropriation.","Caregivers and an architect presented a concept and budget estimates for small, four-resident medical homes that would separate housing from services so families can keep medically fragile relatives close to home. Committee members asked about costs, zoning, ownership and timelines and recommended further study and department involvement.","actionData","errors"]

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Committee debates delaying nursing-home withhold; amendment would study design and add $4 million fiscal implication

Parents, architect outline proposal for four-person ‘medical homes’ to keep medically fragile relatives in community