Nikki Wegner

BISMARCK – Long-term care in North Dakota will benefit from some supports in the One Big Beautiful Bill that passed Congress and was signed by President Trump on July 4, according to Nikki Wegner, president of the N.D. Long-term Care Association, Bismarck.

“Recent discussions about federal reconciliation legislation have raised questions in communities across North Dakota about how long term care services may be affected by the passing of the One Big Beautiful bill,” according to information from Wegner.

“First, the bill’s provider tax provisions have been a significant topic in national conversations. In North Dakota, however, long term care providers are not subject to these provider taxes,” she said. “It is also important to note that long-term care services remain available through a combination of Medicaid and private pay arrangements. Assisted living in North Dakota continues to be private pay, while skilled nursing facilities, basic care, and adult residential care programs are all Medicaid-eligible in our state.”

She listed a few bill provisions that support long-term care providers and residents:

– The bill pauses enforcement of new federal staffing rules for skilled nursing facilities for the next 10 years. The rules would have required 24/7 on-site registered nurse coverage and specific staffing levels based on hours per resident per day.

“While these changes were intended to improve care, they would have posed serious challenges in rural states like North Dakota, where workforce shortages force facilities to rely on contract staffing, significantly increasing the cost of care,” Wegner said.

Under current rules that remain in place, North Dakota facilities are required to provide 24-hour nursing care and to have a registered nurse on-site for at least 8 consecutive hours per day. Facilities are also required to conduct regular staffing assessments to develop individualized staffing plans tailored to resident needs.

“Even without the new federal mandate, North Dakota facilities have consistently maintained appropriate staffing levels aligned with the care needs of their residents,” Wegner said.

– The bill maintains a 60-day retroactive Medicaid coverage window, an increase from the originally proposed 30 days.

“While this is still shorter than the traditional 90-day timeframe and presents challenges for providers, it offers some relief in managing coverage approvals,” Wegner said.

– The bill includes a new Rural Health Transformation Fund. This program would allocate $50 billion in funds over five years to implement certain health-related activities.

Half of the $50 billion would be appropriated equally among all 50 states. Forty percent would be allocated to states through a mechanism determined by the Administrator of the Centers for Medicare and Medicaid Services, with consideration given to states with high rural populations and a high proportion of rural facilities.