Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Medicaid 11 15 Imd topic
No spam. Unsubscribe anytime.
Legislators hear case to pursue Medicaid 11‑15 (IMD) waiver; costs and approval rules cited as hurdles
Summary
State HHS and behavioral‑health experts urged the Tribal and State Relations Committee to support pursuing a Medicaid 11‑15 demonstration to allow federal matching for IMD care, while HHS warned of technical complexity, staffing and budget‑neutrality uncertainties.
North Dakota HHS and health‑care experts told the Tribal and State Relations Committee that pursuing a federal 11‑15 demonstration waiver to cover Medicaid payments for institutions for mental diseases (IMDs) could expand access to residential substance use and short‑term psychiatric treatment for adults, including tribal communities, but would require substantial technical work and carry fiscal uncertainty.
Krista Fremming, interim director of the Medical Services Division at HHS, summarized the waiver mechanics and the IMD exclusion: federal Medicaid matching is generally unavailable for adult patients (ages 21–64) treated in IMDs (facilities >16 beds) unless the state receives 11‑15 authority from CMS. Fremming said the waiver path includes required system milestones, independent evaluation, and a budget‑neutrality standard that new federal rules make harder to predict. She estimated the state would need a small project team (approximately five staff) to prepare an application and previously estimated application, evaluator and actuarial support costs in the low millions: “In 2023 ... we said between 3 and 5,000,000,” she said; the department reaffirmed that range as a planning estimate but emphasized major uncertainties tied to federal rule changes.
Health‑care consultant Eric Bailey and provider leaders urged the committee to pursue the waiver to avoid current workarounds that, they said, force Medicaid beneficiaries in residential SUD programs to disenroll and lose medical coverage. Bailey said the IMD exclusion fragments care and weakens tribal treatment programs: “An IMD waiver is a meaningful, proven step in the right direction,” he testified, noting other states’ approved waivers and examples where waivers expanded access while retaining program guardrails.
Committee members pressed HHS on costs and implementation details. Senator Mather asked whether an IMD waiver would reduce state hospital costs by shifting Medicaid‑eligible patients to federal match; witnesses said more detailed actuarial work is needed before reliable savings estimates can be given. Fremming said CMS negotiations, recent changes in budget‑neutrality law (HR 1) and final federal regulations will shape how waiver accounting is done and what savings, if any, are recorded.
Legislators debated technical and policy details and discussed a draft committee bill directing the department to apply for a waiver. Senator Mather moved to amend the draft to explicitly include both substance use disorders and "serious mental illness" in the waiver request; the amendment was seconded and debated, but the transcript records no completed roll call or final vote. Committee members asked for more fiscal analysis and suggested bringing in national waiver experts and additional stakeholders, including tribal health leaders, before finalizing legislation.
No formal committee vote to submit a waiver application is recorded in the hearing. Members left the record open for further analysis and recommended follow‑up briefings to refine cost estimates and waiver language.
