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2005 Testimony

Testimony Before the House Appropriations

Human Resources Subcommittee
Representative Delzer, Chairman

HB 1012 - DHS Budget - Long Term Care - Home and Community Based Services Budget Area

January 13, 2005

Chairman Delzer and members of the House Appropriations Human Resources Committee, my name is Linda Wright, Director of the Aging Services Division, Department of Human Services. I am here today to provide an overview of a portion of the Long Term Care budget.

The Aging Services Division provides administration of the following home and community based funding sources: Service Payments for Elderly and Disabled (SPED), Expanded SPED, Medicaid Waiver for Aged and Disabled, Medicaid Waiver for Traumatic Brain Injury and Targeted Case Management. Services are provided to persons who would otherwise qualify for skilled nursing home care, basic care, or require assistance due to functional limitations and financial criteria. Individual and agency qualified service providers (QSPs); including County Social Service Boards, deliver the services to qualified older persons and persons with physical disabilities.

The other program areas within the Long Term Care budget have been presented by David Zentner. The other areas of the Aging Services Division budget are presented in separate testimony.

Customer Base

  • For Service Payments for the Elderly and Disabled (SPED), the program has been budgeted for an average of 1,749 individuals per month.
  • For Expanded Service Payments for the Elderly and Disabled (EX-SPED) the program has been budgeted for an average of 272 individuals per month.
  • For Medicaid Waiver for the Aged and Disabled, the program has been budgeted for an average of 364 individuals per month.
  • For Targeted Case Management for the Aged and Disabled, the program has been budgeted for an average of 1,931 individuals per month.
  • For Traumatic Brain Injury Waiver, the program has been budgeted for an average of 40 individuals per month.


  • The number of people ages 65 and older is expected to increase significantly in North Dakota. The number of individuals ages 65 to 84 is projected to increase by 113% from 15,849 in 2000 to 33,754 twenty years later. The oldest of the old - those 85 and older - is projected to increase by over 100% from 2853 people in 2000 to 5710 in 2020.
  • According to the 2002 North Dakota Needs Assessment of Long Term Care, conducted by UND and NDSU, "The number of seniors in North Dakota with functional limitations, a measure of the level of assistance required for basic activities of living (e.g. bathing, dressing, eating, walking, and using the toilet), is higher than the national norm and indicates a greater demand for caregiving. The number of services residents report as available declines as one moves from urban to rural areas of the state. In general, availability of services is a major issue that needs to be addressed."
  • The 2002 North Dakota Needs Assessment of Long Term Care further states; "priority needs to be given to legislative efforts in the form of program incentives and tax incentives for home and community based services. Elderly who are in greatest need for services reside in the states rural areas and small communities. These areas lack facilities, resources, and professional staff. The communities need to be empowered to take a more active role in caregiving. Program incentives and tax incentives that create or enhance the care of elderly in the home or through community based efforts will reduce the demand for institutional care and, in turn, the financial burden on the state."
  • According to the 2000 Census, 44,634 persons ages 21 to 64 years old in North Dakota had a disability. The population age 65 and older included 36,276 people with a disability.
  • The results of a 2004 AARP North Dakota Member survey are as follows:
    • "Three in five North Dakota members are extremely concerned with staying independent as they age, and over half are extremely concerned with having choices in long term care."
    • "More than nine in ten North Dakota members rate having a range of support services available in their community to be very or somewhat important."

The trend nationally, and in North Dakota, is decreased reliance on institutional care and increased consumer demand for home and community based service options.

Performance Measures

1.9% of the 118,985 individuals age 60 and older will receive SPED, Expanded SPED, Medicaid Waiver for Aged and Disabled, or Traumatic Brain Injury services.

Home and Community Based Services

Home and Community Based Services

Overview of budget changes:

  2003-2005 Budget 2005-2007 Request Increase / (Decrease)
SPED 14,703,198 14,423,230 (279,968)
Expanded SPED 834,541 1,188,889 354,348
Aged and Disabled Waiver 9,478,112 2,573,636 (6,904,476)
TBI Waiver 2,274,072 2,330,357 56,285
Targeted Case Management 1,107,750 3,789,824 2,682,074
Total 28,397,673 24,305,936 (4,091,737)
General 18,703,873 17,728,123 (975,750)
Federal 8,966,141 5,867,930 (3,098,211)
Other 727,659 709,883 (17,776)
  • This portion of the long-term care budget has been reduced overall by $4,091,737 from the current biennium. The majority of the reduction is due to moving personal care to the Medicaid State Plan as required by legislation passed in the last session. Please refer to David Zentner's testimony regarding this change.
  • Qualified service providers (QSPs) have not received an increase in their rates for at least 3 years. An inflationary rate increase of 2% per year is included in the budget. The provider increase for these areas is just over $600,000 total funds of which approximately $500,000 is general funds. Aging Services has received concerns from several QSPs regarding their inability to continue to provide services without a rate increase.

I would be happy to answer any questions you may have at this time.


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