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.