North Dakota lawmakers are debating how best to expand mental health services, particularly for tribal communities struggling with demand. The Tribal and State Relations Committee is drafting legislation that would establish an “IMD waiver”—an Institution for Mental Diseases waiver that would allow facilities with more than 16 beds to access certain Medicaid reimbursements. Currently, without this waiver, which is available in 37 other states but not North Dakota, such facilities cannot receive Medicaid funding. Tribal officials say this limitation forces them to send dozens of tribe members to other states for treatment.
The Good Road Recovery Center, operated by the Mandan, Hidatsa and Arikara Nation, serves tribal citizens and does not turn away anyone seeking services regardless of insurance status. According to the center’s chief operating officer Paige Bell, while the state has made progress in funding new mental health initiatives, current approaches “aren’t working” or “aren’t enough.” Bell noted that the facility’s unique Indian Health Service status allows it to receive certain reimbursements that the state’s substance use disorder vouchers cannot match, yet those existing reimbursements still fall short of meeting service demands.
Competing Approaches to Resource Allocation
Not all healthcare providers support the IMD waiver approach. Kurt Snyder, chief executive officer of Heartview Foundation, argues that a waiver would make the state overreliant on inpatient services for treating mental health and substance use disorders. He advocates instead for expanding community-based programs like the North Dakota Training Academy for Addiction Professionals, a state-funded initiative that trains addiction counselors distributed across the state. The program issues approximately 25 addiction counseling licenses annually, and Snyder recommends using Medicaid dollars to increase peer support specialists rather than fund inpatient facilities.
The North Dakota Behavioral Health Planning Council has historically opposed the waiver, with Chair Tania Zerr noting that “much of the discussion ultimately comes down to how limited resources are allocated and ensuring that community support remains the foundation of the system.” Senator Tim Mathern, director of public policy at Prairie St. John’s, supports the waiver but also acknowledges the need for increased funding in both inpatient and outpatient settings.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.thedickinsonpress.com/news/north-dakota/north-dakota-may-expand-medicaid-for-mental-health-but-some-see-other-options