Committee hears bill to extend tribal care‑coordination fund window for capital projects

Representative Gretchen Dobrevich, sponsor of House Bill 1252, told the House Human Services Committee the bill would extend the window during which participating tribal nations may use tribal care‑coordination fund money for capital construction projects. “House bill 1252 seeks to provide tribal nations with the opportunity to utilize these funds for capital construction projects by extending the window for another biennium at the amount of 50%,” she said.

The bill would amend North Dakota Century Code section 50‑24.1‑40, which directs 80% of the state’s regular share of federal medical‑assistance savings generated by care‑coordination agreements to a tribal care coordination fund and returns 20% to the state general fund. Current statute limits use of those receipts for capital construction to no more than 50% through June 30, 2025, and no more than 35% thereafter. HB1252 would extend the 50% allowance for one additional biennium; a separate bill, House Bill 1461, would remove the cap entirely.

Supporters said tribes need more time because the state is only now beginning first distributions. Sarah Aker, executive director of the Division of Medical Services at the Department of Health and Human Services, said the first payments will be made in January 2025 and explained the mechanics. “For every dollar we spend in Medicaid about $51 comes from the feds, $0.49 comes from the state general fund,” she said, and described how verifying a service under a care‑coordination agreement converts the state share to federal funding and generates state savings. Using the department’s example, Aker said 80% of the $49 in state savings — $39.20 in the example — would be directed to the tribal care coordination fund and 20% to the state general fund.

Tribal leaders and citizens testified in support. Nolan Taken Alive, HEW chairperson for the Standing Rock Sioux Tribe, said his tribe signed a care‑coordination agreement recently and is still establishing vendor and finance processes; he described the need to align programs and staff before investing in capital projects. Todd Hall, a private citizen and member of Haradza Noobaga, urged stronger audit and state‑auditor review of the required reports and suggested state oversight mechanisms be discussed with tribal legal counsel.

Representative Lisa Finley DeVille, who represents Fort Berthold Reservation, said the fund “addresses the critical lack of adequate health care services to rural reservation areas” and emphasized tribal reporting and audit provisions; she said tribes would be required to submit annual reports detailing fund use and provide an independent audit every two years, with flexibility for more frequent audits.

Aker provided additional program details: care‑coordination agreements began appearing in 2018 and later years between health systems and Indian Health Service or tribes; participating entities include Sanford, CHI St. Alexius, Great Plains IHS, Turtle Mountain, MHA Nation and Standing Rock. She said the department will require annual tribal reports by Aug. 30 starting in 2025 and will begin audits in 2026 on a biennial schedule. Aker also said the first distributions cover claims from Oct. 2022 through Sept. 2024.

Committee members asked whether the proposed bills change the 80/20 split or the capital‑construction percentages; Aker and Representative Dobrevich said HB1252 keeps the existing percentage split and only extends the timeline, while HB1461 would remove the restriction entirely. Committee members also discussed tribal sovereignty and whether state audit requirements would require waivers or negotiation with tribal legal departments.

No formal committee action or vote occurred during the hearing; the committee closed the hearing after questions and testimony.