NORTH DAKOTA
A major Medicaid home and community-based services program for elderly and disabled people was the focus of both budget-cutting actions in FY 2002 and legislative revisions to the state's income and asset tests in the spring of 2003. The state also began a progam in 2002 that provides nursing homes with monetary incentives to close beds.
The Budget
In his proposed budget for FY 2003-05, Governor John Hoeven recommended increasing funding for home and community-based services (HCBS) for elderly and disabled people by $5.4 million, but by mid-April 2003, the House had included a $2.6 million increase while the Senate was recommending a $1 million increase. The state had imposed a freeze in 2002 on new clients for the Medicaid Service Payments for Elderly and Disabled (SPED) waiver program, which had a caseload of about 1,700 at the time of the freeze and about 200 people on a waiting list for services. In an attempt to tighten financial eligibility requirements for the program to save money, the state Senate in the spring of 2003 lowered the asset requirement for eligibility from $50,000 to $25,000. The House restored the $50,000 asset test, but imposed a requirement that people with assets of between $25,000 and $50,000 would have to pay for services on a higher sliding scale, which became the final version of the legislation. Fees also vary depending on a recipient's income.
The FY 2001-2003 biennium appropriation for community-based developmentally disabled services included $164 million for residential and day service providers and family supports and $9 million for supportive services provided by the eight regional human service centers. In FY 2002, almost 2,000 adults and children with developmental disabilities received residential services. About 1,100 people of that total receive supports in their homes, apartments or family foster care homes. State general fund support for services for people with developmental disabilities totaled $53.7 million in FY 2001-2003.
Planning and Reports
The state received a $900,000 federal Systems Change grant in September 2002. Administered by the Governor's Olmstead Commission, the grant will help the state evaluate and implement ways of effectively delivering health and human services in urban and rural counties. Special emphasis will be placed on enhancing home and community-based services for people with disabilities. A total of 20 focus group sessions were conducted by the Olmstead Commission around the state (two in each of the eight regions of the state and one session on each of the four Indian reservations).
Nursing Homes
In 2001, the Legislature enacted the Nursing Facility Bed Reduction Incentive Program and appropriated $4 million from the health care trust fund to provide incentives to nursing facilities to reduce licensed bed capacity. Through September 2002, the Department of Human Services had paid $3.2 million to nursing facilities to eliminate 270 beds. North Dakota ranked first among the states in terms of nursing home residents per person age 65 and older in 2001; the state also had the third highest nursing home occupancy rate in the country that year. However, the average number of people receiving Medicaid-funded nursing home services in North Dakota decreased from a monthly average of 3,869 in FY 1998 to 3,730 in FY 2002.
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