Senate human services panel approves $9M appropriation to continue family paid caregiver pilot, removes enrollment cap

The North Dakota Senate Human Services Committee unanimously approved an amendment to Senate Bill 23.05 that puts $9,000,000 into the bill, removes a provision capping the number of participants and changes the title to the "family paid caregiver service pilot project." The committee then voted to pass the bill as amended and re‑refer it to the Appropriations Committee.

The amendment and final motion were presented to the committee as a way to preserve the Family Paid Caregiver pilot while the state develops a cross‑disability waiver model. Sarah Akers, executive director of the Division of Medical Services at the North Dakota Department of Health and Human Services, told the committee the amendment was drafted with advocates, family members and department staff and aims to ensure continuity for people currently enrolled in the pilot and to allow the family‑paid caregiver model to be incorporated into the forthcoming cross‑disability waiver.

Akers described the fiscal calculations the department used. The department used the current aged and disabled waiver daily rate of $159.54 and assumed the service could be billed up to five days per week. Using a 1.5 percent inflation adjustment for state fiscal year 2026 (the governor’s budget recommendation), the department estimated a per‑person cost of about $42,102 for FY26, with a similar 1.5 percent increase for FY27; the two‑year (biennium) total per person was presented as about $84,214.55.

The department presented several enrollment scenarios and fiscal impacts: continuing current enrollees and those in appeal (about 70 people) yielded a biennium cost of roughly $5.9 million; adding slots to reach about 120 participants raised the estimate to about $10.1 million; and expanding to roughly 150 participants produced an estimate near $12.6 million. Committee members discussed multiple approaches — setting a per‑person cap, setting a dollar cap, or leaving enrollment flexible and appropriating a round dollar amount for the biennium.

After discussion, the committee adopted an amendment that fills the amendment’s appropriation blank with $9,000,000, removes the sentence capping the number of individuals served, deletes a stray article in the text and updates the bill title to keep wording consistent. Senator Hogan moved to pass the bill as amended and re‑refer it to the Appropriations Committee; Senator Weston seconded. Roll call votes recorded Senators Lee, Weston, Rohrs, Hogan, Van Osteen and Clemens voting Aye; the motion passed 6–0.

Advocates who participated in the working group told the committee the pilot fills a need for families caring for medically and behaviorally complex relatives when home‑ and community‑based providers are unavailable or inconsistent. Roxanne Romanek, who identified herself as representing "designer jeans of North Dakota," said the pilot arose from families’ inability to find qualified outside providers for medically complex children and adults and the program has reduced employment risks for caregivers. Kirsten Devorek of the Arc of North Dakota urged the committee to consider availability seven days a week for some caregivers because some families need night‑time coverage after day programs.

Committee members emphasized the amendment preserves the pilot while allowing appropriators discretion, and several members said they preferred placing a dollar figure in the bill rather than locking the program to a specific headcount. Sarah Akers told the committee that if the appropriation appears undersized during the biennium, the department could — within its budgeting processes — authorize additional slots if unspent dollars were available.

The committee also recorded several technical corrections the department and counsel would make before final drafting, including removing an extra article in a reference to the Centers for Medicare & Medicaid Services and aligning section titles to use the term "pilot project" consistently.

The committee voted to send the amended bill to Appropriations with a favorable recommendation. Senator Hogan volunteered to carry the bill.

Votes at a glance: - Amendment to insert $9,000,000, remove cap, and change title — adopted (roll call: Lee, Weston, Rohrs, Hogan, Van Osteen, Clemens — Aye) — outcome: adopted. - Motion to pass SB 23.05 as amended and re‑refer to Appropriations — passed 6–0.

Why this matters: The amendment preserves payments to legally responsible individuals providing extraordinary care in the family paid caregiver pilot while the state transitions services into a cross‑disability waiver. The dollar appropriation and removal of a participant cap are meant to give the Appropriations Committee and the department flexibility to cover current enrollees and some additional people rather than fix a headcount in law.