(bright band music) - This is "Legislative Review" on Prairie Public.

I'm Dave Thompson.

Thanks for joining us.

Our guest today is West Fargo, Senator Judy Lee.

She's a Republican and she chairs the Senate Human Services Committee.

So thank you Senator Lee for being here.

- Thank you for the invitation.

Happy to join you.

- Since we're talking about human services, two years ago, if my memory is correct, the legislature passed a bill that combined the Health Department with the Human Services Department into one department.

Is that working?

- Yes.

And interestingly enough, perhaps the viewers would be interested in knowing that we built together a fairly non-specific bill so that the employees who were there had the right to have some input on how this is all going, because we aren't the ones who should be experts about what their policy areas are.

But we made this possible and they needed to have one budget by this fall, which they did.

So we now have a Department of Health and Human Services.

But there are twenty two hundred and sixty five employees in the Department of Human Services, or were, and 210 in the Health Department.

So we didn't really need two separate parcels there.

But how it's working and the reason it's working well is that it's sort of a plug and play.

We've got the Division of Health, which was just moved over from being all by itself.

So it's an independent, autonomous part of the Department of Health and Human Services.

And the state Health Officer, Dr. Wiebe is in charge of all things health related, but he no longer has to be an administrator of some of those things that might be able to be handled by a combined administrative, like human resources, that kind of thing.

So there still are a few things that are being worked out, but it's working pretty well.

And we're hoping that this will streamline the whole operation, not only for the departments, but most importantly for the people who need the services.

- So it might help get services out to people faster perhaps.

- Faster and more accurately.

And we're hoping that it'll be less cumbersome.

We're working on application times and processes.

Part of the issue for everybody in the state, of course, is workforce, and they're short of people too.

So we've had some challenges in some of those areas that have caused delays with fingerprinting for childcare facilities and other things like that where we, during COVID, the law enforcement people were unable to do those fingerprinting services that we needed.

And we've never really been able to get back to where we needed to be.

But now more and more of them are doing electronic transfer of fingerprints.

So we are relying on the Bureau of Criminal Investigation to do the background work on the people in North Dakota who are applying for those jobs.

But if they're from out of state, we could have two or three months before another state will give us the information we need.

And there's nothing we can do about that.

They don't wanna lose those people, we want them here.

- But again, it shows how things are intertwined in North Dakota because you're talking about health and human services, fingerprinting for childcare workers, childcare is a big issue when it comes to workforce development.

It all kind of fits together nicely.

- Oh, no doubt about that.

And the thing is that we were finding more and more that there were services that had one foot in each camp.

So for example, long-term care facilities, any kind of construction project, remodeling project, all the federal and state inspections were done through the health department.

But all of the services are provided to the residents of senior care facilities by the Department of Human Services.

And they weren't able to easily talk to one another all the time.

Suicide data are in the Health Department, the services are in behavioral health in the Department of Human Services.

So we are removing some barriers and allowing the people to spend less time on the paperwork kind of thing.

That's an antiquated word, but administrative work, and more in providing services to the people so that we have fewer issues with that.

And we are still working on that.

- Now you mentioned behavioral health because that's a huge issue.

It may not have gotten much of a spotlight this time because of all the tax and the workforce and the childcare development.

But I understand there's been some movement toward providing more behavioral health services in underserved areas.

- Absolutely.

And the only good thing about COVID was the growth of telehealth services.

So behavioral health in particular we're short of providers, especially in the western, almost two thirds of the state.

So what has what has happened is that we have been able to provide telehealth services to people of all ages throughout the state from providers who might not be in their locale.

And that really has made a difference.

And the other thing is, even though we all agree that there should not be a stigma to seeking that service, for some people it still feels that way.

So if I live in a little town and you're the mental health provider in west whatever, North Dakota, and I have my car parked in front of your clinic, they already know that I'm going into talk to you about services.

Sometimes people will feel uncomfortable about that.

I had a provider tell me a couple weeks ago that I'd be surprised at the number of people with whom she visits that are sitting in their combines or tractor cabs with an iPad in front of them as they're driving down the road in the field because they're multitasking.

- Oh.

- [Judy] And it's private.

- And that's really interesting that it has expanded to that level.

- Absolutely.

And it's also working reasonably well for children.

We don't wanna only rely on this, but the goal right now for behavioral health is to make sure that, well all of the Department of Health and Human Services, is to deliver all the services to everybody in North Dakota that needs them, but they might not all be provided in exactly the same way.

So people are adapting to some of these new ways of providing it.

We all know that face-to-face is good, but if we can't do that, or if people won't come for a face-to-face appointment, but they will for a virtual one, we wanna meet them there.

- I also have to ask you about the state hospital and what the future of the state hospital is, because there were many people who were expecting that the governor would've recommended money for a new state hospital in Jamestown, but that he put in more money for a study.

- Well, the acute psychiatric interim committee was primarily made up of appropriators except for Senator Kathy Hogan.

But they recognized after a meeting or two that maybe they needed some policy people in there because all they thought their mission was, or that was the purpose in the beginning, was to determine how much money to allocate for a new state hospital.

And what we needed to talk about more was how do we spread the services around the state.

Now there's-- (clears throat) Excuse me.

There's a federal limitation on facilities that have more than 16 beds.

And the original purpose was noble.

It was meant to make sure we weren't having institutionalization, but we no longer have 1100 people in what now is the Life Skills and Transition Center in Grafton.

We have 63, and it's not always the same 63, but that's the number now.

And it's a safety net.

The same with the state hospital.

People would be there for years.

And right now that would be an extremely unusual situation.

And it's really for those who are seriously mentally ill or have behavioral challenges that we cannot meet, sexual aggression, that we cannot meet in community facilities.

And we're still trying to move people out of both of those facilities, but a placement of those individuals is really hard.

So anyway, knowing what the state hospital's needs are based on what the needs of the state of North Dakota are, and then looking at perhaps enabling some facilities of 16 beds or fewer for short-term residential stabilization of people where they might be evaluated, they might be able to participate in their own treatment then if they can be stabilized so that they can recognize that the medication they don't think they want to take cuz they're afraid of side effects, actually will make their lives better if they work together with the doctors to determine what the right thing is for them.

And they'll be able to go back to families that are in the same neighborhood, that can be part of this treatment program.

And that's really what the goal is.

- And that is part of the reason why they wanted to move the women's prison facility closer to a bigger city like a Bismarck or a Fargo, because there's available treatment.

And a lot of these people are there because they lived in Bismarck and Fargo and had issues.

- Well, and probably the majority of the residents of the women's prison are from the Red River Valley, just because there are more people there.

But a lot of them have children, and if it's too far away, they don't get to interact with their children and families.

So that's an unfortunate situation as well.

And the providers who were coming up were coming from Dickinson or Bismarck because it was a noble idea in the beginning.

And Senator Bill Bowman was among those people who sponsored that.

Why don't we have some of these facilities to serve North Dakotans out in the rural areas?

So I was in the Senate at that time, and we bought into this idea.

But the challenge really has been providers.

The workforce was not easy to find then, but it's really, really hard to find now.

So they were commuting all the time, and it does become a problem.

And when they were walking out the door, they were kind of falling off the cliff and not getting the services they needed.

So we wanna make sure we're not doing that.

Interestingly enough, behavioral health services are the only reimbursable service by Medicaid, which is for low income people, only one in which reimbursement is determined by the location in which the service is provided.

Isn't that dumb?

- That's very interesting.

I did not know that.

- Well, the feds did that.

So this 16 bed limit that we have is a federal rule.

And the reason is they didn't want us to be putting people in high capacity institutions, which is not here now and isn't gonna happen again.

That's old history and we're glad that's over, but they haven't changed it on the federal level.

So it's hard to be financially sustainable with fewer than 16 beds.

And being totally independent of another facility that's near enough to have the same medical director.

They won't let us do that either.

Can't have the same board, you can't have any of the same people involved with it as another one that might be geographically nearby.

So we're wrestling with that.

But as a part of that plan then with the state hospital, we wanna see what we can do to make sure we're incorporating those rural settings that would be helpful so that families can be involved in treatment too.

- So it looks like there's a development of a broader plan for behavioral health in North Dakota.

- And may I also mention the substance use disorder vouchers?

That has been a very successful plan.

- And that was two years ago, correct?

- Well, we first funded it, we started in 2019.

And it was, I hate to say a dartboard guess, but we had no idea what kind of uptake there would be on this.

So I believe it's $8 million that we appropriated then.

And, in essence, budget wise, we ran out of money several months ahead of time.

However, nobody went without, because the department anticipated that that was going to happen because so many people were signing up.

And they stopped taking new people briefly and put them on a waiting list.

And then they put together grant money and other roll up money from other programs that wasn't being used and they ended up taking care of everybody.

And then we've appropriated much more since that time.

But just an example of how, so we're not just using acronyms here, but telling about how it works.

If I lived in Valley City and you did too, and you were a counselor and I was somebody with an addiction, before the SUD vouchers, substance use disorder vouchers, I would either have to drive to Fargo or Jamestown to get treatment, which would be at least once a week for most people.

Now, I might not have the money for gas, I might not have a reliable car.

I might not be able to get off work.

I might not have a babysitter.

I might say I'm not gonna do that and I don't do it.

But now with the SUD voucher, I get a voucher that says Medicaid will pay for my care.

And you as a provider have registered with the Department of Human Services as a licensed provider of counseling services.

So I can make an appointment at your office in Valley City and I can go in weekly or whenever you think is appropriate to have counseling sessions with you.

And my family can be involved in this treatment plan as well.

And it's been highly successful.

So we have, was at the end of December now about 1200 and some people who are involved with this program.

And it's growing.

Unfortunately it's growing because we have greater need.

But the good news is that people who have the need are participating in greater numbers than we've ever had before.

So that's really a very encouraging thing.

- What do you think are the next steps that are going to come out of this session then?

- Well, we're certainly going to be looking at some things with tax reform.

We have a little conflict between whether it's important to do property tax reductions or income tax reductions.

And this will all work out.

I happen to be a particular fan of the Homestead tax credit because of all the people who are affected by the increase in home price values and all property values, it is the people on fixed incomes.

And I had people who I was going to door to door who mentioned that.

So the benefit of the Homestead tax credit is that there's a sliding scale of exemption based on the value of the house, which has increased and the income of the individuals who own it.

And as of today, it would be a household of two people could only earn $42,000 and have any kind of benefit with the Homestead Exemption.

And the exemption only went to $125,000 of value, which except for a really small town, means almost nothing.

And now thanks to the Finance and Tax committee and the Appropriations committee in the Senate, we have a much more generous scale for that.

And that has been moved to the House.

So we hope that they'll be receptive to this.

But it is the best way to help those people who are on fixed incomes remain in their homes, which is what they want to do.

We don't want people to have to sell because their property taxes are too high.

So I'm much less worried about overtaxing, and that's not even the right word, about having higher taxes for high income people who are out of state.

That is not my concern.

But I really do care about the people who are living here and wanna stay in their homes.

In addition to that, we are in North Dakota in a settlement agreement with the Department of Justice about home and community-based services being available so people can remain in their homes and not be in a senior living or other kind of institutional setting.

So it's a win-win if we can improve this homestead tax credit.

And it's been well received so far.

- It has.

There seems to be the perception that the House is more in favor of income tax cuts.

The Senate is really focused on property taxes.

And talking to both leaders just recently they said they think they're gonna meet in the middle and probably put it into one package.

- Well, and I think that would be great.

I don't think any, in fact, I visited briefly in the hallway today with a couple of people as I walked in the building who said, "I really like your homestead cat tax credit thing."

And I said, good.

So anyway, we had a 30 second conversation about it.

But yes, there are good things about both.

I personally would hate to see us remove the income tax leg of the stool.

We've talked before about three legs in the tax stool, property, sales and income tax.

And if you cut off one leg, it doesn't balance very well.

We're very fortunate to have the oil tax income that we have right now.

We recognize that.

It's a big part of what we're working with today.

However, we know there are ups and downs in that too.

We've experienced them more than once.

You and I have both seen that happen.

So to eliminate something that does need to be a leg on that support for the various services that North Dakotans need, I think would be a mistake.

That doesn't mean that we can't adjust it, but it's very hard to return it if it goes away.

And I just read an article today about the states that have no income tax or very low income taxes, and North Dakota's number one in the states that have it, as far as low income taxes.

However, their property taxes and sales taxes, there ain't no free lunch.

So you're gonna pay it somewhere.

And those are, especially sales tax, that's a very regressive tax.

Everybody has to pay it no matter how much money they have.

- Well, another issue I wanted to get into, and we touched on briefly, is childcare, which is part of the whole workforce development type efforts in the legislature.

Up until recently, there was a lot of resistance to putting state money into childcare.

But now the resistance seems to be easing because businesses have come in and said, we need good childcare.

We can't get these people to come to work for us, and we don't have good childcare options.

- Exactly.

And the workforce influence has really made a difference for us in the same sense that 20 years ago nobody wanted to do behavioral healthcare either.

But now we do, because we all know somebody who's affected.

But the childcare side is important.

(clears throat) Excuse me.

Providers need to have the ability to charge enough to pay people well, because they're short of workforce too.

And not having benefits for a lot of the people who work in childcare is an issue.

So we're asking businesses to be partners in some of this.

My church actually donates 14,000 square feet for a childcare facility during the week.

And the salaries that are paid to the childcare workers there is better than some of the other childcare providers in the community, but they're on the healthcare plan for the church.

So there are some businesses who might be able to look at something like that as a part of the support that they can provide to a childcare provider to have some slots for their workers in that particular facility.

So we need to assist, we need to have one of those P3 deals like the Red River diversion Public Private Partnership here.

The businesses need to be a part of it.

The state needs to be a part of it as far as quality, as far as providing some resources to the providers as well as the families.

And we've got some fairly generous provisions for families now if they go on the Department of Human Services... Health and Human Services website and look up childcare, they will find easily what the provider links and the the family support links are and see whether or not they might qualify.

It's up in the $62,000 family income range.

So it's not bad, but we're looking at enhancing that too.

So it it will make a difference, I think if we just make sure we're all working together on this.

- Yes.

One thing that I've heard people talk about is pointing to Watford City.

Watford City, as the mayor of Minot put it to me, treats childcare as infrastructure.

And he said, "Maybe that's the model everybody "should really take a look at."

- If we all were an oil county, we would be able to do that.

But their Wolf Pup facility there is a model for all the rest of us.

And there is business engagement as well too in that.

But they have had the definite benefit of having some additional funding that non oil counties have not been able to have.

That doesn't mean the rest of us can't do it.

We've just got to find a way to make it work in other ways.

And that's why the state is engaged in this whole thing too.

- So there really isn't one answer but there might be many answers depending on the community.

- There's a whole bouquet of options here.

And we just need to pick out which flower works for each situation, you know?

- I'm going to change subjects a bit because one thing that's still pending is the Red River Valley Water Supply Project.

And you're from West Fargo.

This affects you as well.

And this is to bring Missouri River Water in case there is a drought that the Red River itself is frightfully low.

It appears that that might be headed to fruition now.

- I certainly hope so because it is really important.

This started a long time ago when Garrison Diversion was started and it got slowed down and the McClusky Canal was not finished and all that kind of thing that would've made this move forward.

But now it's time for us to be looking at it.

There are people with lots of knowledge about this that are helping us.

Representative Jim Schmidt, who is not in the House anymore, but he is working as a consultant and available.

The House put him on board and the Senate has access to his expertise as well.

Senator Ron Sorvaag is really sharp on the water issues for us in the Senate as well.

And we really do need to move this forward.

What we need to recognize too, and actually there are legislators who didn't think about this when I was a part of a panel a few weeks ago.

Legacy Fund money, in my opinion and in the legislator's opinion in general of so far, has been it should not be for operating costs, but it should be funding some of these larger projects.

So the money, some of that is gone and should go to the Minot project for flood control.

The Red River diversion is now fully funded, state, federal and local money.

And the Red River Water Supply Project, same thing.

Because if we put Legacy Fund earnings into those big projects, it frees up the dollars we have for the general fund for projects that would be a bit smaller but were equally important to communities.

A lot of smaller towns have a need for additional improvements for their water systems or their sewer systems or whatever.

And they really don't have the tax base to be able to do that.

So if we can improve those situations by using our general funds for that, and those big ones that were taking a big bite out of our state funds, can be done with Legacy Fund earnings, then both of those areas of need can be addressed.

- Two things we have going for us in North Dakota, the Legacy Fund, the Bank of North Dakota also for financing.

- [Judy] Yes, absolutely.

- And I have not heard the word bonding this time.

- Well that doesn't mean we shouldn't.

Some of us who have been around for a while, and of course I am the poster child for term limits.

But anyway, for many years we bonded.

I mean, if we had $12 million that we anticipated as our ending fund balance, we were excited at the end of the session.

And now that's nothing.

And it is nothing.

It's terrible to say that.

Everett Dirksen said, "A million here, a million there.

"Pretty soon you talking big money."

Many years ago for those of us who may recall that name.

But it's the same thing here.

We need to look at how we might save money.

And we did bond in the last session because it saved us a ton of money because interest rates were lower.

On the Red River diversion it was a really big deal.

And I don't have an opposition to bonding if we're going to be able to figure out a way to do it, and we're going to be able to capture some good interest rates and be able to pay things off sooner.

I believe it's six years sooner for Red River diversion because we're bonding and that's why it isn't a bad word.

But we hit a little window in there where we didn't do it.

And we need to not think that it's a, we can't think that it's a bad thing because it's a tool in the box.

- And it's a nice hedge against construction inflation.

- Exactly.

Exactly.

- Which is another thing that I'm hearing a lot of.

- Oh my goodness.

Yes.

- People complain about that.

Look at what's happening with the career academies.

- Oh, absolutely.

- And that whole effort.

But apparently the legislature's addressing that too.

- Well in career academies, they've been promised money from the feds, but they keep changing the rules.

So then the districts who are doing these projects, they have to send in a new plan that adapts to the new rules.

So what the legislature has done is the Bank of North Dakota, speaking of them, will be advancing the money to the districts so that they will repay it when the federal money comes in, but they don't miss another construction season.

That is a big issue in a snowy North Dakota.

- Absolutely.

And West Fargo is waiting on the one that is a partnership between NDSU and the North Dakota State College of Science.

- Yes, and it'll be-- - And there's another one too, right?

- Oh, yes.

Well, and that one's going to serve Fargo and West Fargo and other schools that may be interested.

We were going to be a partner with Moorhead because we were taking so long in North Dakota, they had an opportunity to buy a building in Moorhead and they have a very successful one up and running.

- We have about a minute left so I wanted to ask you, are there any other pet bills that you're really watching at this point or a couple of subjects?

- Oh my goodness.

I don't know.

I should have thought of that.

I should have thought you're gonna ask me something about it.

There just are so many areas of interest and I think people...

Here's the deal that it doesn't even have to do with bills so much.

But it disappoints me that because we have so little strong news coverage and not with you, of course, but people don't know what's happening.

And all we see are messages from people who are reading social media about some really unusual bills, social issues, personal issues.

And it concerns me that they think that we're all being foolish and are all tied up with this.

We're working on some really important stuff like we've just spent time talking about.

But we are going to have to deal with those bills because in North Dakota, every one of them gets a hearing and gets to be voted on.

But I think it's important that your viewers know that the legislators are all working hard, that we come from different places, we have different opinions.

We finally come together and we try to figure out something that's gonna be the best for everybody.

And please don't think it's all foolishness.

There's a lot of hard work being done.

- Well, Senator, thank you very much.

We've run our time.

- Thank you.

- Appreciate it.

Senator Judy Lee of West Fargo was our guest on "Legislative Review".

Thanks for joining us.

(bright band music)