Dakota Boys & Girls Ranch warns of access loss after new ‘one‑assessment’ navigator process and urges rate modernization

Tim Ganger, senior director of residential partnerships at Dakota Boys and Girls Ranch, told the House Appropriations Human Resources Division that two recent policy changes — a centralized "one assessment" behavioral health navigator process implemented July 1, 2024, and an outdated PRTF rate-setting methodology — have contributed to fewer admissions and financial strain for youth residential treatment providers.

Ganger said Dakota Boys and Girls Ranch operates 48 psychiatric residential treatment facility (PRTF) beds and 12 qualified residential treatment program (QRTP) beds (60 total) in North Dakota and that these are short-term medical or foster-care levels of care (generally three to six months). He described how the state’s new behavioral health navigator process routes all applications through contracted navigators (Maximus is the contractor referenced) and that families and providers report delays, longer handoffs, and incomplete or outdated application forms. Ganger said his agency’s June 2024 census of 48 children dropped to 35 by August 2024 after the navigator process started and that his organization has since struggled to get back above 40 children.

Ganger said providers recorded 499 families contacting them since July 1 and that 214 referrals were passed to navigators; he estimated roughly 98 children who would previously have been placed in PRTF care were not admitted after the new process. He attributed the shortfall to the added friction in the centralized intake process and to an administrative approach that favors rigid document standards (for example, multiple updated universal application versions) rather than casework and provider assistance.

On finance, Ganger said the PRTF rate-setting methodology dates to roughly 30 years ago and omits contemporary costs such as electronic health records, cybersecurity, regulatory complexity and other allowable direct care costs. He said Dakota Boys and Girls Ranch operated at a $7.5 million loss last year and currently faces a $2.5 million operating shortfall; the program relies on philanthropy and foundation support to make up the difference.

Ganger recommended legislative steps including modernizing the rate-setting process within federal guidelines, reviewing the navigator implementation and customer service approach (families want a single contact rather than a rotating call-center model), and ensuring grants or appropriations flow to providers to enable post-discharge follow-up services.

Ending: Ganger urged lawmakers to address rate methodology and navigator design to ensure access for children with intensive behavioral health needs; he offered to provide additional data and participate in follow-up discussions.