North Dakota hearing: Adult and Aging Services details expanding Home and Community-Based Services and staffing shifts

Nancy Nicholas Meyer, director of Adult and Aging Services at the North Dakota Department of Health and Human Services, told the House Appropriations Committee Human Resources Division on the House Bill 1012 budget presentation that her division’s workload and client complexity have grown sharply in recent years.

Meyer said the division administers Older Americans Act programs, the state-funded SPED program and Medicaid‑funded Home and Community‑Based Services (HCBS) and handles vulnerable adult protective services and the long‑term care ombudsman office. "I'm Nancy Nicholas Meyer. I'm the director of adult and aging services with the department of, health and human services," she told the committee.

Meyer said HCBS caseloads and acuity have risen since 2020. "In calendar year 2024, in all of our programs, we serve 3,571 individuals," she said, and later summarized intake volume: "On average, we're getting 150 new referrals every month. And 80 of them are turning into cases." She told members that the division converted about 72 county case‑management positions to state FTEs and added several investigators and case managers to respond to demand.

Why it matters: Committee members pressed Meyer on workforce and budget details because higher acuity and more people seeking HCBS increase state costs and drive multiple decision packages in the executive budget. Meyer emphasized that HCBS can be a lower‑cost alternative to institutional care for some people and that increasing numbers of clients require nursing‑level or medically complex supports.

Key program and budget details Meyer provided: - SPED (state program) serves 2,465 people and applies to individuals with $50,000 or less in assets; most served have under $25,000. - Total clients served across the division in 2024: 3,571 (54% increase since 2020). - ADRL (Aging and Disability Resource Link) staff handled roughly 12,000 calls in the most recent year and was expanded in 2021 from a single line to a staffed call center of six positions. - Nutrition: the division pays $8.89 per home‑delivered meal and $7.62 per congregate meal; there are about 205 nutrition sites statewide. Meyer said a 3% proposed reduction in some general‑funded provider grants in the executive budget was roughly $761,000 and would affect local providers. - Case management: 64.7 field case managers plus eight supervisors (roughly 72 positions) manage open caseloads; Meyer cited a 117 weighted average caseload metric and said many cases require frequent contact.

Meyer described how rising client acuity—more co‑occurring behavioral health and higher medical needs—has increased demand for provider staff with higher skills, including nurses and supervisors, and has changed the content of services the division must buy or oversee. She told the committee that some HCBS recipients now need complex medical tasks in the home (tube feeding, trach care, insulin administration), which raises per‑client costs on waiver services.

Committee members asked for additional information. Chairman Nelson asked for trend charts showing multi‑year growth; Meyer agreed to provide more detailed historical graphs. Representative Murphy raised concerns about nutrition funding and local senior‑center capacity to cover rising food costs.

What’s next: The department’s executive budget includes multiple decision packages tied to these shifts — targeted rate increases for certain HCBS services, continuing the APS contracting level created with federal funds, and proposals to support transitions out of institutional settings. Meyer and staff indicated they would return to committee with further details and data on trends and utilization.

Ending note: Meyer framed the growth as a demographic shift and an operational challenge: an older, higher‑acuity population combined with rising expectations for in‑home care requires more trained workforce and targeted funding to keep services available statewide.