Senate panel hears competing views on bill to decentralize psychiatric care and fund regional facilities

The Senate Appropriations Committee, Human Resources Division opened a public hearing on Senate Bill 2096, a proposal that would reallocate funding toward regional behavioral‑health facilities and services and provide $5 million for limited upgrades to the existing Jamestown facility.

Supporters told the committee the bill would decentralize acute psychiatric care into four regional hubs and expand residential supports, while opponents warned the plan could weaken the state hospital safety net and raise Medicaid eligibility questions.

Senator Tim Mathern, the bill’s prime sponsor, said Senate Bill 2096 offers “a forward‑thinking alternative” to building a single new state hospital. “Instead of putting $300,000,000 into Jamestown, I suggest we take $100,000,000 and give a quarter of it to the Bismarck region, a quarter of it to the Minot region, a quarter of it to the Grand Forks region, a quarter of it to the Fargo region,” Mathern said, describing an approach that would permit the Department of Health and Human Services to contract with local providers or build facilities where private providers are unwilling. Mathern proposed up to $25,000,000 per region (a portion of a $100,000,000 total) and $5,000,000 to upgrade Jamestown’s campus so it can continue to serve certain forensic and correctional patients.

A graduate‑student testifier who identified herself as Madison Hansen said the state hospital in Jamestown is routinely at capacity and that regionalization would increase access, reduce strain on emergency services and law enforcement, and enable residential options for adults with serious, persistent mental illness. “By establishing four regional facilities, the state would alleviate capacity strain through a decentralized system,” Hansen said.

Opponents — including Carlotta McClary, executive director of Mental Health America of North Dakota and the North Dakota Federation of Families for Children’s Mental Health — urged the committee to support the administration’s plan for a new state hospital instead. McClary said private hospitals frequently turn patients away and that constructing multiple 24‑bed standalone facilities could produce institutions that are ineligible for Medicaid reimbursement under the institution for mental diseases (IMD) rules. “Rather than expand regional services, the consequences of this bill could very well be significantly decrease regional services,” McClary testified.

Pam Segnus, executive director of Behavioral Health at the Department of Health and Human Services, told the committee the state has been expanding community services and that the department already contracts with multiple private hospitals for inpatient psychiatric care. Segnus said a modern state hospital remains necessary to serve people with complex forensic and long‑term care needs that the private sector does not plan to serve in the future. “North Dakota needs a modern state hospital,” she said, adding that last session the legislature appropriated $12.5 million for design and that the governor’s executive budget includes $300,000,000 to build a new facility.

Committee members asked about staffing, Medicaid reimbursement, and whether the proposal depends on a change to the federal IMD exclusion. Mathern and other witnesses told the committee that the regional contracting approach could proceed without an IMD waiver if the state contracts within existing hospitals or if private hospitals expand beds in existing licensed facilities; Mathern also said staffing shortages make it difficult to recruit clinicians to smaller, more remote sites like Jamestown and argued regionalization would improve staffing feasibility.

The hearing drew multiple written and oral testimonies; the committee record includes at least nine submitted testimonies and several in‑person speakers who urged both support and opposition. The committee did not take a vote on Senate Bill 2096 during the hearing and left the record open for further consideration.

The committee context: members repeatedly stressed the need for a full continuum of care (community services, regional inpatient units, and a state hospital safety net) and pressed for more operational details on workforce, Medicaid reimbursement pathways, and how the Department of Health and Human Services would execute contracting or construction authority in each region.

The committee will retain the bill in committee pending further departmental budget materials and additional testimony.