All Roll Calls
Yes: 187 • No: 80
North DakotaHB 10122025 Regular SessionHouseWALLET
AN ACT to provide an appropriation for defraying the expenses of various divisions of the department of health and human services; to create and enact a new section to chapter 6-09 of the North Dakota Century Code, relating to an extraordinary medical needs housing loan fund; to amend and reenact sections 50-06-06.6, 50-06-42, 50-24.5-02.3, and 50-33-05, and subsection 1 of 50-36-03 of the North Dakota Century Code and subsection 6 of the new section to chapter 54-07 of the North Dakota Century Code created in section 1 of Senate Bill No. 2176, as approved by the sixty-ninth legislative assembly, relating to leases of department of health and human services property, substance use disorder treatment program, basic care payment rates, state of residence for child care assistance, opioid settlement advisory committee, and children's cabinet; to provide for a transfer; to authorize a line of credit; to provide legislative intent; to provide for a legislative management study; to provide an application; to provide an exemption; to provide for a report; and to provide an effective date.
Sponsored By: House Appropriations
Signed by Governor
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Bill Overview
Analyzed Economic Effects
28 provisions identified: 19 benefits, 3 costs, 6 mixed.
Child care help for cross-border workers
Workers at North Dakota early childhood programs can receive the state's child care assistance workforce benefit without living in North Dakota. They must be approved for that workforce benefit. The usual physical-residency rule still applies to other applicants.
More treatment voucher options and help
Beginning July 1, 2026, treatment vouchers can help cover direct medical costs for eligible people who cannot afford them. The department can reimburse licensed addiction treatment programs with more than 16 beds, within the money appropriated for medical costs. Licensed providers in bordering states can also join the voucher program to serve underserved North Dakota areas. Those providers need a needs assessment and department approval, and can receive payment only for outpatient and community-based services.
More payments for infant care providers
The law provides $11 million in one-time funding for quarterly child care provider payments, beginning January 1, 2026. Monthly payments reach $200 per child from birth through 17 months and $115 per child ages 18–36 months. Licensed North Dakota providers must serve children through age three and hold a two-, three-, or four-star Bright & Early rating. Providers cannot also receive the child care assistance infant/toddler bonus. Through June 30, 2027, money must cover child care expenses, not debt repayment; recipients must report spending and enrollment annually.
Funding for behavioral health and disability care
For July 2025–June 2027, the law provides about $231.95 million for behavioral health clinics. It also provides about $89.88 million for the North Dakota State Hospital. The Life Skills and Transition Center receives about $68.35 million. This funding supports facility operations and care services, rather than direct household payments.
New disability facility beds remain blocked
From July 1, 2025, through June 30, 2027, the department cannot add licensed intermediate care facility beds for people with intellectual disabilities. This blocks growth in licensed bed capacity during those two years. It does not require current residents to leave.
Spending cap for expanded Medicaid coverage
North Dakota caps Medicaid expansion spending at $662.09934 million from July 1, 2025, through June 30, 2027. That includes $66.209934 million from the general fund. Spending can exceed appropriations for specified caseload increases, section 1915(i) coverage, changes in service use, or reduced federal matching funds. This is a program spending limit, not a stated cut to each enrollee's benefits.
Medicaid provider payment floors and limits
Medicaid expansion managed care must pay providers consistently within each type and specialty, including ASAM level 2.5 addiction providers. Urban and rural providers can be separate types; incentive, quality, or supplemental payments require a department-approved value-based program. Federal payment floors protect Indian and Tribal 638 providers, federally qualified health centers, and rural health clinics. Critical access hospitals get at least 100% of Medicare allowable costs; human service centers get current traditional Medicaid rates. Rates used to calculate managed care premiums generally cannot exceed 145% of January 1, 2025 Medicare rates, except listed behavioral health services, including partial hospitalization, intensive outpatient, professional, and non-institution-for-mental-diseases residential care.
Funding for local cultural center programs
The law provides a one-time $300,000 grant for a west central community cultural center's programs during 2025–27. The money comes from the Community Health Trust Fund. The applicant must certify that funds will support programs within the center.
Guardianship funding moves to dedicated office
Beginning April 1, 2026, the Office of Guardianship and Conservatorship receives $3.266178 million from the general fund. The money supports guardianship services after March 30, 2026, through the 2025–27 funding period. Unspent department guardianship funding authority also transfers to the office on April 1. The law does not change individual eligibility or set individual payments.
More funding for violence prevention programs
For July 1, 2025–June 30, 2027, domestic violence programs receive $4.25 million from the Community Health Trust Fund. Domestic and sexual violence prevention also receives $1.9 million from the charitable gaming operating fund. The money supports programs and organizations, not a new household payment.
Prevention services for at-risk youth
The department must use $750,000 in one-time 2025–27 funding for youth services aimed at preventing juvenile justice involvement. Services must target youth at risk who have not committed legally defined delinquent acts. This funds prevention services rather than household payments.
Funding to study state disability services
The Legislative Council receives a one-time $150,000 appropriation for consultants studying disability services. It comes from otherwise unappropriated Community Health Trust Fund money. Funding is available from July 1, 2025, through June 30, 2027. The study funding itself does not change benefits, eligibility, or household costs.
Higher daily payments for basic care
Qualifying basic care facilities receive a $5 daily rate increase from July 1, 2023, through June 30, 2027. Facilities must qualify as providers in the program for aged, blind, and disabled people. The $5 increase cannot count toward inflation-increase calculations. The law also provides about $1.45 million from the health care trust fund for higher daily rates during July 2025–June 2027. These payments go to facilities, not directly to residents.
Higher payments for human service providers
The law funds 2% inflation increases for human service providers in each year from July 1, 2025, through June 30, 2027. Nursing facilities are excluded. These are provider payment increases, not direct payments to households.
Local health and tobacco prevention funding
For July 1, 2025–June 30, 2027, the Community Health Trust Fund provides $3.275 million for local public health grants. Local public health units also get $6.25 million for tobacco prevention and control. Separate grants provide $500,000 for help quitting tobacco and $300,000 for youth vaping prevention. These funds support services and prevention work, not direct household checks.
More behavioral health facilities and services
For 2025–27, a northeast behavioral health facility gets $12.96 million, requiring a $3.24 million match. A northwest facility gets up to $3.45 million: $1.5 million new and up to $1.95 million carried forward. Northwest matching funds must reach $1.75 million; both facilities must operate for ten years or repay their grants. Northwest recipients must sign grant agreements, supply department data, and meet grant requirements; another $2 million develops partial hospitalization and intensive day treatment. Through June 30, 2027, certified community behavioral health clinics can add direct-service staff using generated income; the department must continue certification work and seek available federal funding.
More funding for community crisis help
For July 1, 2025–June 30, 2027, the law provides $1.8675 million for the 988 crisis hotline. It also provides $1 million for rural law enforcement crisis support, both from the Community Health Trust Fund. General fund grants add $300,000 for crisis organizations serving young adults at risk of homelessness or other serious life events. Another $285,000 supports a volunteer-based ecumenical ministry organization.
More support for medically complex children
For 2025–27, a licensed south central intermediate care facility gets a one-time $4.4 million grant. It must serve at least eight communities for people with intellectual or developmental disabilities. Funds cover only services for children and young adults with medically and behaviorally complex conditions. Required services include early intervention, clinical and residential care, community and home support, education, recreation, leisure, and assistive technology. A separate $100,000 grant funds a south central provider's statewide education, information, training, and peer support for families of children with special health needs or disabilities.
More support for rural emergency care
For July 1, 2025–June 30, 2027, the law provides $7 million for rural ambulance grants. Another $1.125 million from the insurance tax distribution fund supports rural emergency medical services grants. Critical access hospital networking receives $2 million. The ambulance and hospital networking funds come from the Community Health Trust Fund.
Opioid response funding and recovery representation
The law provides $8 million from opioid settlements for opioid harm reduction and response during July 1, 2025–June 30, 2027. The governor also appoints one person in recovery to the opioid settlement advisory committee. That member replaces the managing director of the Office of Recovery Reinvented.
Grants fund housing with support services
The law provides about $4.67 million in general fund grants for permanent supportive housing. The Department of Health and Human Services must set a method for distributing money to qualified groups. Recipients must use proven practices and provide services focused on each person's needs and recovery. They must report how services work and their results, and allow department visits to review operations.
Health facilities gain spending and leasing authority
During July 1, 2025–June 30, 2027, the department can spend up to $10 million on facility projects, maintenance, and demolition. Higher spending needs Emergency Commission and Budget Section approval; the state budget director can transfer related funding among specified budget lines. The department can lease property at the state hospital or life skills and transition center for up to 99 years. Each lease must produce a net economic gain after identifiable costs. Child care space leases must meet department requirements.
Fewer appeals over lost pandemic funding
From July 1, 2025, through June 30, 2027, people generally cannot appeal department decisions caused by unavailable federal coronavirus funding. This covers service denials or revocations, service or payment reductions, and program or service terminations. The funding must come from federal laws tied to coronavirus emergency declarations. Appeals remain available when federal law specifically provides otherwise.
Health department gains staffing budget flexibility
During 2025–27, the department can increase or decrease authorized staffing within available funds. It can transfer up to $14.771038 million in funding authority to its salaries and wages budget. It cannot add positions to move human service zone employees into state employment. Listed unspent project funds also remain available beginning July 1, 2025, instead of expiring. Covered projects include Medicaid, child welfare, child support, procurement, behavioral health, the public health laboratory, child care, background checks, and audits.
State borrowing supports child welfare technology
During 2025–27, the department can borrow up to $8.411218 million from the Bank of North Dakota for child welfare technology. Interest cannot exceed the bank's prevailing rate for North Dakota government entities. If the department borrows, it must request an additional appropriation to repay the credit line. Households do not take on the loan.
Larger treatment centers get higher allocation
Beginning July 1, 2026, larger residential addiction programs can receive up to 50% of treatment voucher funding, up from 45%. This raises their allowed share while keeping a fixed ceiling. The rule applies to programs with more than 16 beds. During the biennium's last quarter, the department can also move projected unused smaller-program, outpatient, and ancillary-service allocations to larger residential programs.
Nursing home payments fund care incentives
The department and North Dakota Long Term Care Association must design a nursing facility payment holdback. Withheld payments fund a value-based care incentive program. The department cannot start the holdback before July 1, 2027. The law does not state the holdback rate.
Disability housing loans carry construction deadlines
The Bank of North Dakota runs an ongoing loan program for new housing for people with disabilities and extraordinary medical needs. Loans can cover land purchases and reach $3.3 million per project, with interest capped at 2% and repayment within 20 years. Projects must meet state health and housing agency requirements. Applicants must show need, long-term viability, and financial information required by the bank. Construction must finish within 24 months after approval, or recipients may forfeit the entire loan.
Sponsors & Cosponsors
Sponsor
House Appropriations
Affiliation unavailable
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
Senate vote • 5/1/2025
Second reading, passed as amended, yeas 37 nays 9
Yes: 37 • No: 9
House vote • 5/1/2025
Second reading, passed, yeas 61 nays 26
Yes: 61 • No: 26
Senate vote • 4/17/2025
Second reading, passed as amended, yeas 37 nays 10
Yes: 37 • No: 10
House vote • 2/25/2025
Second reading, passed, yeas 52 nays 35
Yes: 52 • No: 35
Actions Timeline
Filed with Secretary Of State 05/19
6/11/2025HouseSigned by Governor 05/16
5/17/2025HouseSent to Governor
5/2/2025HouseSigned by Speaker
5/2/2025HouseSigned by President
5/2/2025SenateSecond reading, passed as amended, yeas 37 nays 9
5/1/2025SenateConference committee report adopted
5/1/2025SenateReported back from conference committee, in place of, placed on calendar
5/1/2025SenateSecond reading, passed, yeas 61 nays 26
5/1/2025HouseConference committee report adopted
5/1/2025HouseReported back from conference committee, in place of, placed on calendar
5/1/2025HouseConference committee appointed Dever Cleary Davison
4/22/2025SenateConference committee appointed Nelson O'Brien Mitskog
4/21/2025HouseRefused to concur
4/21/2025HouseReturned to House (12)
4/17/2025HouseSecond reading, passed as amended, yeas 37 nays 10
4/17/2025SenateAmendment failed
4/17/2025SenateAmendment proposed on floor
4/17/2025SenateAmendment adopted, placed on calendar
4/17/2025SenateReported back amended, do pass, amendment placed on calendar 15 0 1
4/16/2025SenateCommittee Hearing 08:30
3/31/2025SenateCommittee Hearing 11:00
3/27/2025SenateCommittee Hearing 10:00
3/27/2025SenateCommittee Hearing 09:00
3/27/2025SenateCommittee Hearing 02:00
3/26/2025Senate
Bill Text
Enrollment
FIRST ENGROSSMENT
FIRST ENGROSSMENT with Conference Committee Amendments
FIRST ENGROSSMENT with Senate Amendments
INTRODUCED
Prepared by the Legislative Council staff for Conference Committee
Prepared by the Legislative Council staff for House Appropriations Committee
Prepared by the Legislative Council staff for Senate Appropriations - Human Resources Division Committee
Prepared by the Legislative Council staff for Senator Mathern
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