(dramatic music) - This is North Dakota Legislative Review.

I'm Dave Thompson for Prairie Public and thank you for joining us.

Our guest today is West Fargo Republican Senator Judy Lee.

Judy is chair of the Senate Human Services Committee, also serves on state and local government, correct?

- [Judy] Right.

- Okay.

- [Judy] Correct.

- Senator, thank you for being here.

- I'm happy to be invited, thank you.

- Well, let me ask you about the committee you chair.

What are your big issues right now?

- Well, we're trying to figure out how to budget properly for a variety of things, but we're especially tuned into continuing the work we've been doing in behavioral health.

We have done a lot of work in that area, and it looks as if the state hospital being replaced is still in the human services budget, which was moved over.

Here's a trivia question for you.

What are the two buildings in North Dakota that are owned by the state that predates statehood?

- Well, I think you said one of 'em, state Hospital.

- And the other one is Oxford House at UND.

- Oh.

- I did not know that, thank you.

- Right.

But we are treating people for serious mental illness in a building that was built, I think it's 1877, but definitely pre 1889.

So there are good plans in place that will be properly accommodating individuals who have serious mental health issues.

We are going to also be looking at regional sites.

There are plans in the mind for that, but it's also important to know that we haven't been forgetting that right now, there were 6,000 hospital days paid by Medicaid in this last, during the end of this session now, or interim, for people who were hospitalized in those facilities in North Dakota that are in communities like the hospitals that have psychiatric units and so forth.

So there's a lot of effort being put into having people treated in the area where they live, where family members can be a part of the treatment plan and the individuals can feel supported in their own familiar community.

- So I hear this question.

Why is there a need these days for a state hospital?

- Well, there is because we have, for one thing, the group that is sort of informally called sex offenders, there is a more formal name for that, but we've had questions about why we don't provide space for them as they become older in skilled care facilities, where there isn't any skilled care facility where the adult children of a resident wants to have a sex offender living in that facility.

They are unwilling, and I don't blame them, to accommodate them.

There really needs to be a separate facility, because once it is established that, that they are maybe suffering from dementia, but other kinds of mental health conditions that also include being sexually aggressive, then they really need to be someplace where they're not going to harm somebody.

And so there will be facilities that will properly accommodate those individuals too, because they need a decent place to live that is not going to endanger or jeopardize other people as well.

So this is going to be an area where people will be able to come for serious mental health issues with the idea that they will be moving through the treatment programs and out the next door, to go back into the community again as they improve and can go into regional settings in their home areas.

- Right now, the hospital is located next to the James River Correctional Center.

- [Judy] Right.

- And I've been hearing, and I wanted to find out if it's true that there are plans maybe to move the state hospital.

- Well, the current projection, or proposal I should say, is in a little different site on the other side of the road that that winds through there.

And I think it's quite a nice setting looking at the drawings and renderings that we have seen.

It's fewer beds than the current facility has, but just laid out in a really efficient way.

When this process started, I asked if we couldn't have a process similar to what we did with the medical school, because we wrestled with that in Grand Forks several years ago now.

And there were three different proposals, which would've been maintaining the building as it was and doing some improvements on the old St. Michael's hospital.

And the second proposal was adding onto that building, and the third one was building a new one, which was obviously more expensive at the beginning.

Well, those three proposals were brought by Dean at the time, Joshua Wynne and Dave Molman from a hospital there, Altru.

And all of them were just explained to us in the interim committee.

And so we discussed it and we asked, because we can't tell them to do it.

They don't work for us.

Asked if the advisory committee for the medical school would be willing to really vet these three proposals and tell us what they felt in the long term or going to be the, would be the better decision and the best decision.

And they did and came back to us and showed us really good data on why, yes, it's more expensive today, or a few years ago, to do this.

But there are so many good things about it, not the least of which in addition to the technology and all of that kind of thing, but it integrated many of the health careers that are there in the same building.

So when the medical students are training, so our occupational therapists, physical therapists, and now there's a proposal, and this makes me very happy if we make it happen, to have the college of nursing also connected, because the way they train healthcare professionals there is as a team.

And that has been so successful.

I'm so proud of our medical school for what they're doing, Joshua, in the past, and now Dr. Jenkins who was there is going to move forward in the same positive way.

But that plan worked so well for the hospital, or excuse me, for the medical school, that I really am pleased to see that some of those same things were used in the process now of planning the state hospital, where we're really looking at what is going to be the most cost effective and best way to help our neighbors who need that help.

- When you talk to 'em about the medical school, I know several physicians in our localities here, and they say it is a team effort.

- [Judy] Yes.

- So that was a big thing then for that to happen.

- And they have been a remarkably wonderful contributor to the health of North Dakotans, because rural healthcare is always a challenge.

But having a medical school, and we support it with one mil in property taxes, and there is an effort to remove that one mil, because it's a property tax mil.

It's like $4 a year or something.

Anyway, the thing is that six, I believe it's 64% of our physicians in North Dakota graduated from UND Medical school.

They have done a really grand job of allowing our medical school students to experience rural healthcare as they're moving through the program and they settle in those areas and find that they really love living in North Dakota in some of those smaller communities.

And it has been invaluable in making sure that we have the kind of care we need.

- And there were incentives to help people become rural doctors.

- Absolutely, absolutely.

And there are loan forgiveness programs for many of the medical professionals in which there's, excuse me, a shortage.

Nurses can apply for it.

I'm a bigger fan of the loan repayment than I am of scholarships upfront, because I changed my major a couple times.

And so as an example of myself, I might have gotten a scholarship for something that I didn't end up graduating in.

And so if they have found a way to make it to that final point and they can apply for these loan forgiveness programs, they are reasonably generous and are evaluated by the health council in the Department of Health and Human Services when they apply.

- About the state hospital, have you looked at the full budget bill?

- I have looked at it, but I'm sorry I can't take a quiz on it since I'm not in appropriations, but we're looking at over $300 million being in the budget now for that.

And I did hear just in passing an additional portion of it.

But anyway, that is what it's going to take.

And yes, there are a lot of zeroes there, but there are a lot of zeroes in everything we're doing right now.

And the good news is, and not to spend money wastefully, because I'm very aware of that, but we are trying to make sure that we have used the resources that we have in the best possible way to prepare North Dakota for the future.

And I think this is one of them.

- And that's a good time to do it, because North Dakota has cash.

- [Judy] Yes.

- Available.

Plus we have the Bank of North Dakota.

- Oh, yes.

- And there's still some room on bonding at this point.

- Absolutely.

All three of those are very good ways for us to make this happen.

So we're looking at a good combination and I have faith in our appropriations committees and working on that, but then we all get to vote on them.

And so we have to, the majority of us have to agree that they're going to be a good plan in the end.

- How about providing, there's been some concern about providing services in rural areas, especially mental health services.

Have we progressed on that?

- Oh, absolutely, in many different ways.

And I didn't bring the chart that shows all the ways we did that, and you wouldn't be able to see it easily anyway.

But for example, we are changing all the human service zone offices into certified behavioral, community behavioral health clinics.

They're going to have an entirely different manner of working.

They have been the safety net for behavioral health services all along, but now they're going to be me.

A person that walks in the door will be met by someone who says, how can I help you today?

And there will be eligibility workers there to help them understand which programs they might qualify for as they find out what their needs might be.

And there will be professionals there who can assist them.

And that's, you know, the eight regions cover four in the top of the state, four in the bottom half and covers the whole state.

- And just as a comment, how things are intertwined.

- [Judy] Yes.

- Because the regional service centers basically help local governments because it lowered property taxes.

- Yes, absolutely.

- And they're helping people by getting people the treatment they need.

- Absolutely, we need more of those professionals.

So, come on folks, let's graduate as counselors, please.

Excuse me.

But also the human service zones.

And we have 19 of those now.

As you may recall, we changed it from all county services.

So a lot of that is state funded now.

And so that has reduced the property tax amount, kind of making that little switch through here.

Excuse me.

So in addition to the big buy down that we've had in contributions to schools, K-12 schools, the contributions that we have made in some of these other areas through taking over much of the responsibility for human services costs, has also contributed to not having the high property taxes we would've had if that hadn't been done.

- Now I do have to, you brought up property taxes, I do have to ask you about property taxes.

You get the next bite of the apple in the Senate.

What do you think about the bills that have come over?

- Well, it's kind of interesting that the House sent us three and we're supposed to choose, but that isn't always the way it works.

But that's okay.

You know, I trust our finance and tax committee to give a careful attention, and the appropriations committee will, of course, and so will the whole Senate.

So I have a little struggle with caps, and here's one example why.

Everybody complains about it.

And I think it's because we get our property tax bills in December, right?

At the time we're buying Christmas presents.

But for people who have a mortgage on their home, almost all of them will be escrowing for their taxes.

And so it's not that the big check has to be written by everybody, it's just, oh, darn, look at that.

However, it does make a difference when we look at where those taxes go.

So for example, I live in one of the fastest growing school districts in the state.

We have had as many as 500, but always three to 400 new students every year, for the last several years.

We were building almost one school a year.

So we had between three and 400 new students this year.

And I was told that Fargo had 12.

So Fargo has one issue with the caps.

West Fargo School District has a different issue with the caps.

And yes, they're talking about proposals that would allow the communities to pass bond issues that would work on some of these things.

But we can't be too limiting here.

I want to make sure that people know that they always have the right to talk to the people who are in control of those, the school boards, the cities, the counties, please folks, get involved in and go to a meeting or watch them virtually.

Every single meeting you can watch virtually now, not only live, but recorded and see what your elected officials are doing, because those of us who live in town need to have our potholes fixed and our snow removed, and we need police and fire protection and all of those things.

The people who live in rural areas need all of those roads and bridges repaired.

That's another big deal.

And they need to have law enforcement and public safety also with fire departments and sheriff's departments and so forth.

So we're all in this together.

And I'm a little disappointed, actually, in a way, to see that there's a rural caucus that has formed, because I've always thought it was not necessarily good to look at the national level and see everybody dividing up into little camps.

And I'm using the human services committee as an example.

There are six people on our committee, four of them are from Cass County.

We spend about half of our time talking about things that affect rural health.

So we all care about what happens both in the cities or more developed areas and in the rural areas, even if we are a couple of generations away from the farm now, because I'm a couple of, I'm one generation away.

But the point is we care about having services out there in the country and we know it costs more to get some of those services moved out there.

And not everybody finds it easy to recruit.

That's a toughie.

So I don't have a perfect answer, but I want you to know we're really working on making sure everybody has the services they need.

- Sure, and when you talked about caps, the argument was made to me that, you know, Cass County has other ways to raise money for example.

It could be a sales tax, could be other things.

And you go to Slope County, they don't have that ability.

So their caps may be, in some respects, inherently unfair.

- Well, I think that's inherently unfair, but so is the idea that sales taxes should be the way to go, because there is no more regressive tax.

Even if I don't have an income, if I'm buying a loaf of bread, well, not, we don't say tax groceries, that's a bad example.

But if I'm buying anything that requires sales tax, I have to pay it.

So I'm really concerned about thinking that we can balance this on the back of sales tax paying.

You know, there are states who have very high sales taxes and there are communities that do in some other states.

So I think we have to be careful about who pays some of these other taxes.

Interestingly enough, I've been working, because a judge asked me to talk about this or to make some effort on this behalf about healthcare in jails and the Department of Corrections and Rehabilitation, DOCR, is responsible for the healthcare in the penitentiary, but the counties are responsible for healthcare in jails.

And so I'm trying to find out, I did try to find out is there a baseline that every county has to meet?

And I learned that the baseline is what the poorest county can afford.

And it's a county that is about half tribal area, which has no property tax that comes to the county.

So, and they have a lot of needs in that county, because of issues that are on the reservation or Indian land also.

So it's really not fair to do that.

So I don't know how we're gonna end up here, but it's a really big issue that we need to look at having some baseline for healthcare in the jails.

Because if somebody needs healthcare, if it gets into an advanced level thing, if somebody has hepatitis C, it's a lot cheaper to give them the immunizations than it is to pay for a liver transplant.

Now, people aren't in jail for as long a time as they would be in the penitentiary.

I get that.

But the federal government does not permit Medicaid to apply for anybody who's incarcerated.

So we can't rely on that.

The feds have changed their rules a bit.

So now six weeks before they're discharged, they can apply and so that they will be covered when they get out.

I'm simplifying this, but basically, that's it.

So that there would be some coverage, but the state needs to step up and make sure that there's some base level healthcare being covered.

We're spending a lot of money to balance the public employee's retirement system, a lot of money to cover that deficit.

And I brought it up today in committee.

I'm a little concerned about doing that, which I know is terribly important.

But what are we giving up someplace else when we need to think of the people that cannot afford care for themselves for one reason or another.

And we're not providing it.

Medically fragile individuals who are graduating from the Anne Carlsen Center, which is a wonderful facility, and they're full and they have people who are 21 and have aged out, graduated from the school there.

And we are working right now to find places for them to live in the community that would be able to handle those that are particularly medically fragile, because the Anne Carlsen Center can do that, but none of the independent community facilities can do that.

So how do we make that happen?

And it's important because those beds that the individuals are still occupying at Anne Carlsen Center, there are young children who are waiting to occupy those beds who need their services in the schools, but they need the medical care that's available.

So we have wonderful facilities, but we have to see what happens next, you know, for those folks coming out of some of those programs.

And we're doing our best to try to figure it all out right now.

It's lots of balls in the air as they say.

- I was gonna say a thousand piece puzzle.

- [Judy] It is - At this point.

- [Judy] Yes.

- And then I'm just going to ask this question, because I was thinking about this.

How do potential federal cuts fit into this whole discussion?

- Well, as one of my senate colleagues says, we wait and pray, but it's really, it's really a challenge because we don't know what's going to happen.

And I sort of hate to say it out loud, but Medicaid expansion is terribly important, not only for people who are above the traditional Medicaid income level, but for the critical access hospitals in North Dakota, because we have 36 out of our 53 hospitals, or counties, 36 out of our 53 counties have hospitals that are critical access hospitals.

And they are the ones who are providing uncompensated care because the law and humanity means you should treat anybody who comes to the emergency room.

So there is no insurance for them, but they have to be treated.

And that's uncompensated care.

Medicaid expansion has covered a lot of that care, because when they come, they can also enroll them in Medicaid expansion.

So we wouldn't have some of those small town hospitals who have very small average daily census figures, to take care of that rural healthcare we talked about earlier, if we don't have those critical access hospitals.

So that's part of the challenge.

And the federal match for Medicaid, for Medicaid expansion is 90% federal and 10% state.

And traditional Medicaid's about 50/50.

So if the Feds decide that that's not fair, we are going to have a big bite to chew here, because that's a big part of our human services budget.

- I know that I've been talking to leadership in both houses and they say that they are cautiously optimistic, but preparing for the possibility of having you folks come back into a special session, depending on what the cuts are going to roll out.

- Exactly.

Because we just don't know.

And since I don't think they think in Washington about the fact that not every state legislature is full-time, it does create issues.

And especially for us, since we're every other year.

So we'll do whatever we need to do.

That's why we're trying to save days and we're working long days.

Well, we always do, but it's longer even, to try to get through the business at hand, so that we can save some of our 80 days, in case we need a special session.

- I do have to ask about one thing that just came back to mind and I was gonna ask about it, because the house when they passed the budget for HHS, expanded the lease, where they can lease state lands, and there's a proposal to have part of the state hospital grounds in Jamestown leased for a 99 year period for a theme park.

- [Judy] Oh, really?

I hadn't heard about that one.

Well, I learned something new this afternoon.

- This came in toward the end of the session and they said it was approved and there was another part of the budget, it doesn't come directly out of the Medicaid budget, comes out of the tobacco settlement money, to build an animal shelter in Fargo.

- Absolutely, I didn't hear about that one either.

- Yeah, so the there some that things are gonna be facing you.

- Well, I am going to have to go and read every bill and not just the ones in my own committees.

- Sorry about that.

- No, no, no.

Thank you for telling me.

I need to be tuned in so.

Well, I think what happens too is, and I'm not, I don't even know what the sponsors are there, so I'm not picking on anybody, but one observation I have about some of the bills that we've had is that if someone is a new legislator and we're new or enthusiastic and we wanna be sure we're responsive to our constituents.

And so if somebody comes up with a concern, an easy response is, oh, there ought to be a law.

And they call legislative counsel and they draft a bill and it's submitted.

Whereas if you were calling me because you had something going on now that was, whether it was human services or transportation or something else, I would tell you at the beginning of the conversation, I want you to tell me all about what your concern is.

I am not taking any notes, because I can't write as fast as you're telling me, and I don't want anything to be wrong.

So when we're finished with our discussion, I would like you to send me a message.

Doesn't have to be fancy, either an email or a yellow pad with a pencil, and tell me in your words what the chronological events are that you're telling me about here.

And then give me permission to share it and I will find the right person in the capitol that can help us understand why it's happening the way it is.

Nobody has ever objected to that.

Not everybody does it, because sometimes there's a little more to the story than they start out with, but not always.

But when somebody does, and I can find someone, let's say it's in Medicaid, and I call the person who's responsible for Medicaid and we find out is there a problem with paperwork someplace that somebody hasn't, maybe there was an application filed on that individual's behalf that doesn't have everything complete.

It was a mess after COVID because everybody who was on Medicaid in skilled care facilities, even though they weren't cheating, they were there because they had been qualified for it.

They all had to be requalified again.

So those kinds of things happen and we want to make sure that we wrinkle, iron out some of those wrinkles, but if we talk to somebody in the department and find out what the deal is, and sometimes it's a federal rule, and then I say what I call a person back and they're on the phone too though, but darn, now we know what that is.

What can we do differently in order to address this situation?

So you don't have this roadblock here.

And maybe it's something that the department person hadn't thought of before.

Maybe there's a simple thing they can do to make that process easier.

So start by asking the people who run the program.

Don't assume they're doing it badly because, you know, we made the law, we might have messed it up too.

- Well, we're all human.

- [Judy] Yeah, exactly.

- Things like that.

We have about 90 seconds left.

- Oh my gosh.

And we just have a couple of questions for you very quickly.

Yay or nay to annual sessions now?

- I'm non-committal and that hardly ever happens.

We'll do whatever it takes.

I think there's a rhythm that comes with the 80 day session.

You know, we're in it, we know what we've got going on.

We work hard to get them out of our own committees on our side, and then we move them over and deal with the other side.

I don't know how you divide it up.

South Dakota, I believe it is, has a 40 day financial session.

How do you separate human services policy from appropriations?

I don't know.

- That's a good question.

I don't either.

- That's my response to that one.

Tell me how it's gonna work and then we'll talk about it.

- Absolutely.

One issue that you're really watching in your other, in your B committee is?

- Oh wow.

We're talking about elections a lot.

- Election, okay, sure.

- We have some term limits bills.

We have a variety of different things.

And I was thinking about them as I came over, because I left that committee, but it's sort of water, a thought of my brain now.

- [Dave] There's an awful lot going on, I got it.

- There's a lot with that too.

But that deals with local political subdivisions and what's happening with townships, counties, and all of the things that have to do with roads and policies in county commissions and city councils and all that kind of stuff, and zoning.

- [Dave] Oh yeah.

- Lots of fighting about that kind of stuff now and then.

So that's where we are there.

- Well, Senator, we've run out of time and I thank you very much.

- [Judy] It's my pleasure, thank you.

- Our guest today is Senator Judy Lee of West Fargo and for Prairie Public, I'm Dave Thompson.

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