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DHHS reports Pay-for-Success pilot not implemented; $2.5M unobligated
Summary
DHHS told the interim committee that the Pay-for-Success pilot authorized in 2023 has not been executed: $2.5 million transferred for the pilot remains unobligated and the department recommended caution to avoid overlap with rural health transformation funds.
BISMARCK — Department of Health and Human Services staff reported Feb. 19 that a Pay-for-Success pilot authorized by the 2023 Legislature has yet to be implemented and that $2.5 million earmarked for the program remains unobligated.
Tim Eisinger, who oversees multiple DHHS program areas, told the Human Services interim committee that the department never finalized a relationship with an intermediary (previously discussed as MACOM Capital) or executed the principal steps required to open a pilot cohort. He said the department now views the pilot as potentially conflicting with rural health transformation initiatives and recommended against prioritizing implementation at this time.
—No appreciable efforts have been made to implement the program,— Eisinger said. —At present, $2.5 million requested and transferred from the SIF have never been utilized.—
Eisinger said the unobligated funds would revert to the Strategic Investment Fund on July 1, 2027, unless the Legislature or an implementing authority directs otherwise. He suggested that the committee could consider repurposing the appropriation or ensure any future effort would not compete with rural health transformation projects.
Why it matters: The Pay-for-Success concept seeks to align payments with outcomes, but its lack of execution raises timing and duplication concerns. Committee members thanked DHHS for transparency and indicated no immediate committee action while program design and state priorities are reassessed.
