Senate Appropriations hears Health and Human Services budget overview as agency frames statewide priorities

Interim Commissioner Dirk Wilkie told the Senate Appropriations Committee that the Department of Health and Human Services (HHS) is the largest state agency and carries a responsibility to make a broad impact on North Dakotans through integrated programs.

Wilkie introduced the HHS budget presentation and said the agency's vision is "for North Dakota to be the healthiest state in the nation," noting the department's scope across public health, behavioral health, human services and medical services. "We are truly statewide," he said, noting HHS serves citizens through 60 locations across North Dakota and citing 2,581.83 full-time equivalent (FTE) positions.

Why it matters: HHS controls major state spending streams, most notably Medicaid, and its budget choices affect hospitals, long-term care, behavioral health providers and human service zones across the state. Committee members pressed division leaders on operating costs, workforce and projected construction and operating expenses for a proposed new state hospital.

Key facts and figures - Wilkie described six strategic priorities: supporting strong families and communities; advancing foundations of well-being (economic, behavioral and physical health); optimizing disaster response; improving agency infrastructure and operations; delivering customer-centered experiences; and fostering a culture of excellence. - The public health division budget was listed at $318,900,000 with 69% federal funds, 17% general funds and 14% other funds. - Behavioral Health division budget cited at $821,300,000 and over 1,000 FTE. - Medical/Medicaid biennial budget described as $2,900,000,000. - HHS total base of roughly $5.5 billion for the 2023-25 base, with the governor's executive recommendation adding roughly $717 million; the House reduced the proposed overall agency general fund by $28 million in the House draft shown to the committee.

Division roles and authority Wilkie explained HHS derives responsibility from multiple chapters of the Century Code, naming chapters 19, 23, 25 and 50 as statutory authorities the agency implements. He said HHS delivers services in collaboration with local public health, tribal leaders, universities and 19 human service zone offices.

Process and next steps Committee members were given a large "long sheet" summary of decision packages (the executive recommendation and House changes). Wilkie and division directors said they would return to divisions for detailed section hearings in subsequent days. Several senators asked for follow-up materials and line-item lists for programs mentioned during the overview.

Ending Wilkie concluded by reiterating the agency's emphasis on strategy and efficiency and told the committee HHS leaders would be available for continued section-level testimony in the coming days.