North Dakota faces $1.4B Medicaid cuts under proposed federal funding changes

North Dakota is facing significant challenges as proposed federal funding reductions loom, particularly from the "1 Big Beautiful Bill Act," which has already passed the U.S. House of Representatives. During a recent legislative management meeting, officials discussed the potential impacts of this bill, which could lead to an estimated $1.4 billion reduction in Medicaid funding for the state over the next decade. This represents a 12% cut to North Dakota's projected federal share of Medicaid, primarily due to new work requirements and increased cost-sharing for Medicaid expansion enrollees.

The proposed legislation includes a mandatory work requirement of 80 hours per month for able-bodied adults aged 19 to 64 without dependents, set to take effect at the end of 2026. Additionally, it would shift eligibility determinations from annual to semi-annual and prohibit coverage for undocumented immigrants. These changes are expected to reduce Medicaid enrollment in North Dakota by 18% by 2034.

The bill also proposes alterations to the Supplemental Nutrition Assistance Program (SNAP), increasing state cost-sharing for benefits and administrative costs. Currently, North Dakota receives approximately $260 million biennially for SNAP, but the new provisions could increase the state's financial burden by an estimated $18 million per biennium.

In addition to the proposed cuts, the meeting highlighted recent federal funding rescissions that have already impacted the state. Approximately $100 million in federal funding has been cut, including $75.8 million from the Department of Health and Human Services, affecting various health programs. Specific projects, such as wastewater initiatives in Lincoln and Pheasanton, have also been directly impacted by the termination of FEMA infrastructure funding.

As North Dakota navigates these potential and realized funding reductions, state officials emphasize the need for ongoing monitoring and assessment of the implications for community services and programs. The discussions at the meeting underscore the urgency for stakeholders to prepare for the changes ahead as the legislative process continues.