Community health centers urge continued state funding, cite expanded access and cost savings

Shannon Bacon, director of external affairs for the Community Healthcare Association of the Dakotas (CHaD), and representatives from member clinics told the House Appropriations — Human Resources Division on May 20 that state appropriations recommended in the executive budget (House Bill 1012) should be continued to sustain and expand community health center services.

CHaD represents federally qualified health centers that operate on a sliding-fee basis and supply integrated primary care, behavioral health and dental services in both rural and urban settings. Bacon said CHaD’s five member health centers operate 22 sites in 20 communities and provided care to more than 36,000 unique patients with about 126,000 visits in 2023. About 40% of patients served by CHaD centers use Medicaid and roughly 16% were uninsured, Bacon said.

“We provide care to all people regardless of their ability to pay,” Bacon said. She noted gaps remain — for example, Medicaid expansion in North Dakota currently does not include an adult dental benefit — and described ways state appropriations have been used, including support for chronic care management for seniors, mobile health units and integrated behavioral-health models.

Rachel Thomas, chief financial officer at Northland Health Centers, told the committee Northland serves eight mostly small communities and has used state funding to expand behavioral-health staffing, open a second Bismarck location focused on behavioral health and increase access to dentures for veterans. “By providing hometown behavioral health service as part of primary care, we can reduce the risk of preventable ER admissions and costly treatments,” Thomas said.

Jenny Cornell, behavioral health supervisor at Northland, described plans to deliver substance-use group treatment, counseling, medication management and integrated care at Northland’s new Bismarck clinic and said the center uses a contracted psychiatrist primarily by telehealth with two annual in‑person visits. She told legislators the clinic will reduce wait times and improve access for urban and rural patients in the region.

Bacon, Thomas and Cornell offered examples of how state funds have helped expand services: Coal Country Community Health Centers used funds for a community care services chronic care management program; Family Health Care in Fargo used funds to add optometry services on a mobile unit and to partner with local public health units to place sliding-fee primary care in underserved towns; and Spectra Health leveraged funds to create a collaborative-care psychiatric consult model embedded in primary care.

Committee members asked for clarifications about member organizations (for example Community Health Services, Inc., which operates a North Dakota site that serves North Dakota patients; Minnesota zip codes were removed from state-appropriation calculations for that site). Testimony concluded with a request that the legislature maintain the executive budget recommendation for community health centers in HB 1012.

Why it matters: Community health centers provide a safety‑net, especially in rural areas, by offering integrated primary, behavioral and some dental care regardless of ability to pay. Witnesses told the committee state funding enables clinics to expand services and reduce more costly downstream care.

What’s next: Witnesses asked legislators to sustain the executive budget recommendation in HB 1012 and to consider expanding Medicaid benefits for dental care, a subject said to be under discussion in the Senate.