Lawmakers debate SUD voucher expansion, jail mental‑health payments and youth crisis pilots as HHS requests multiple program increases

Bismarck — The Appropriations — Human Resources Division debated several behavioral‑health program requests Friday, including expansions to the state’s substance‑use disorder (SUD) voucher program, a proposal to reimburse medical expenses at institutions for mental disease (IMDs), pilot funding for jail‑based mental‑health services, and a proposed youth crisis stabilization pilot.

SUD voucher expansion and IMD medical expenses

Department testimony said utilization of the SUD voucher program has grown and that an additional $2.5 million of general fund support would keep reimbursement rates aligned with Medicaid and meet increasing demand. The department described how the voucher program reimburses treatment providers and said earlier biennia had seen the program run out of funds mid‑biennium.

On IMD medical expenses, the House had not included funding. The Senate discussion flagged a $500,000 request that would reimburse certain medical costs incurred while a person is in a facility larger than 16 beds, because Medicaid reimbursement pauses for individuals in IMDs. The department said the program would reimburse provider purchases (for example, medications or urgent care needs) on a receipt basis, subject to administrative rules and later rulemaking and delayed implementation.

“The intent of the delayed implementation was that the Department would need to draft rules. What’s reimbursable? How did…what’s that process like?,” a committee member said; department staff said rules and reimbursement criteria would be developed before funds would be available.

Jail mental‑health services

Lawmakers also discussed a proposal to allow voucher‑style reimbursement for mental‑health services delivered in county jails where many detainees are held for extended periods. The original idea stemmed from a locality that used COVID funding to provide on‑site mental‑health care in a county jail and reported positive outcomes.

Committee discussion focused on (a) whether the proposal duplicates existing county investments, (b) the administrative burden of creating a new payment stream and provider requirements, and (c) whether a pilot or phased approach is preferable. The department said expanding the voucher program to add mental‑health providers would require statutory and administrative changes because current voucher providers are licensed addiction treatment providers.

Youth crisis stabilization and children’s services

The department had proposed a $6 million youth crisis stabilization pilot (split 50/50 general fund and federal), which the House declined. Committee members argued for a single pilot instead of two full pilots, and several senators linked the proposal to separate pending legislation to expand youth residential services. One lawmaker said stabilizing a child for 24–48 hours can avoid court escalation and reduce longer‑term costs.

Other program lines and conference recommendations

The committee also reviewed funding for juvenile residential treatment (QRTP), a voluntary treatment pilot for custody youth, and program cost‑to‑continue lines. Members generally supported continuing existing programs (Free Through Recovery and Community Connect) but expressed concern about unchecked expansion without clearer ceilings or utilization data. Several senators asked the department to provide utilization and outcomes data before final decisions.

Where the committee landed

Lawmakers signaled mixed priorities: some members supported keeping the SUD voucher increase and the IMD medical expense funding (with narrow rules), others favored piloting jail‑based mental‑health reimbursement rather than a statewide roll‑out, and several urged a single youth crisis pilot tied to planned residential expansions. No formal appropriations were adopted at the hearing; committee members asked the department to return with specific fiscal and operational details for each proposed program.