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HHS requests 103 FTEs and expanded authority to stand up four CCBHCs, cites $20 million needed
Summary
Department of Health and Human Services told the appropriations subcommittee it needs 103 new full‑time positions and roughly $20 million of authority to staff four Certified Community Behavioral Health Clinics (CCBHCs); lawmakers discussed alternatives including a separate line in the FTE block grant and quarterly reporting requirements.
Bismarck — Department of Health and Human Services officials told the Appropriations — Human Resources Division on Friday that the state will need 103 new full‑time equivalent positions and expanded spending authority to stand up four Certified Community Behavioral Health Clinics (CCBHCs) planned for Williston, Dickinson, Minot and Fargo.
The department’s presenter, identified in the hearing as Donna, said Pam Sangness’s team calculated staffing needs and “in order to stand up the 4 CCBHCs and to continue to be current on all the services without turning people away, we will need 103 FTE.” Donna added, “So every million dollars that we have will get us 5 FTE for a full 24 months.”
The request to add roughly 103 FTEs prompted discussion about cost and funding sources. Donna said a rough funding estimate to staff the 103 positions for a 24‑month biennium is about $20,000,000 of authority in the FTE block grant, and she told the committee: “So the request of a hundred additional FTE, we will likely need around $20,000,000 give or take in order to make sure that those 4 CCBHCs are up and running.”
Why it matters
Committee members pressed staff about how much of the positions will be billable and when revenue will begin to offset salary costs. Donna and Deputy Commissioner Sarah Stolt said many services are billable to commercial insurers and Medicaid once rate setting and billing codes are established, but that establishing Medicaid reimbursement for new CCBHC service codes typically requires a full year of documented costs before rates are set.
“Because we’re a governmental entity, we need a full year to establish what the actual costs are… and that’s why it takes a year to get the revenues,” Donna said, repeating a point Sarah Stolt later described to the committee as a federal requirement for governmental entities.
How lawmakers could provide authority
Several senators and staff discussed two mechanical approaches: (1) raise the department’s overall FTE block grant authority by the requested amount, or (2) add a separate, earmarked line in the block grant specifically for the CCBHC positions while keeping broader underfunding elsewhere.
Donna said either approach could work but emphasized that the legislature should record an approved FTE count if it wants the department to treat it as an explicit authorization: “If you were wanting to fund a new initiative… you could have a separate line just like that mechanically, and then the money would go in the FTE block grant for the department to manage as a whole.” She noted the department could stagger hires and that not all 103 FTEs would need to be on payroll the entire biennium.
Concerns and clarifications
Lawmakers asked for a spreadsheet with timing and revenue assumptions; Donna agreed to provide one for the committee. Committee staff (Keith) later noted bill language governing the block grant already allows the department to move FTEs up and down, but implementing a separate pool would require additional bill language.
Senators also sought clarity on partnerships with private providers. Pam Sangness, the departmental executive director for behavioral health, told the committee CCBHCs will partner with private providers to avoid unnecessary duplication and to coordinate care across regions. She said private pay, private insurance and Medicaid clients can be served: “They cannot turn anyone down. So whether they’re private pay, have private health insurance, have Medicaid, or don’t have any insurance, the CCBHC can serve all of those populations.”
Ending and next steps
The department promised to supply a staffing and authority spreadsheet and to return with Pam and other staff later the same day to answer follow‑up questions. Committee members discussed placing the 103 FTEs on a separate line or adding the dollars to the block grant; no formal vote or final appropriation was taken during the hearing.
The subcommittee also flagged reporting requirements: Donna pointed to proposed quarterly reports the department would produce so lawmakers can track how the FTE block grant and any earmarked CCBHC authority are used.
