Members of the North Dakota House of Representatives participate in a special session of the Legislature on Jan. 22, 2026. (Photo by Michael Achterling/North Dakota Monitor)
BISMARCK, N.D. (North Dakota Monitor) – North Dakota’s Rural Health Transformation Program budget bill along with four related policy bills passed their first floor votes in the Legislature Thursday morning.
The budget bill, House Bill 1623, is the reason the North Dakota Legislature reconvened this week for the special session. It gives the North Dakota Department of Health and Human Services the authority to spend incoming federal Rural Health Transformation Program dollars.
The program was created by Congress last summer as part of its budget reconciliation bill. It was advertised as a way to partially make up for funding rural states will lose from Medicaid cuts included elsewhere in the legislation.
North Dakota received $199 million from the federal government for the first year of the five-year program. Qualifying organizations will be able to apply for a slice of that funding in the coming months.
Rep. Todd Porter, R-Mandan, said on the House floor he thinks the money will make the greatest difference to the state’s strained health care workforce.
“We are hearing absolute horror stories across all of North Dakota, not just in the rural areas, of the shortages of EMS providers,” Porter, who owns an ambulance service, said. He said EMS services rely on a “system of volunteerism” that no longer exists.
Given his background, Porter declared a conflict of interest and was excused from voting on the legislation.
“I’m gonna be chasing this money myself,” he said.
The budget bill allows the North Dakota Department of Health and Human Services the ability to spend roughly $397.9 million for the 2025-2027 budget cycle — the amount the state expects to receive for the first two years of the Rural Health Transformation Program.
Lawmakers also approved an amendment to the bill to enable the state-owned Bank of North Dakota to provide up to $40 million in stop-gap loans to approved grant applicants awaiting reimbursement from the federal government.
The bill passed the House by a vote of 90-2.
The two no votes came from Rep. Jeff Hoverson and Rep. Lori VanWinkle, both Minot Republicans.
“I think there’s a better way to go about rural health,” Hoverson said on the floor. “At some point, we’ve gotta stop saying ‘yes’ to federal dollars.”
In addition to the budget bill, legislators approved four policies that the Trump administration incentivized states to adopt by promising extra Rural Health Transformation Program money.
The federal government can rescind some of North Dakota’s award if the state doesn’t follow through with passing the proposals. Lawmakers said on the floor Thursday that based on scoring information provided by the federal government, they estimate that each policy gets the state a few extra million dollars each year in grant money.
One proposed policy, Senate Bill 2402, would allow pharmacists to prescribe some medications to patients and order some lab tests.
Sen. Judy Lee, R-West Fargo, said the legislation would make it easier for North Dakotans to receive basic health care services.
“You can usually walk into a drugstore and find a pharmacist,” Lee said. “But you can’t always walk into the clinic and see the physician.”
The Senate approved an amendment to the bill that would require pharmacists to notify primary care providers of the results of any tests they perform and any prescriptions they write.
The amendment also puts restrictions on some of the prescriptive powers the bill would give pharmacists.
Senate Bill 2402 passed unanimously.
Another of the four policy proposals, Senate Bill 2401, would mandate that doctors receive one hour of education on nutrition and metabolic health as part of their continuing education. It passed in the Senate by a vote of 44-2.
The House on Thursday morning unanimously passed House Bill 1622, which allows the state to join a physician assistant licensure compact.
It also voted 90-2 in favor of House Bill 1621, which would require North Dakota students to participate in the presidential physical fitness test. The bill as amended in committee on Wednesday allows the North Dakota Department of Public Instruction to set the criteria for the fitness test in coordination with the federal government.
Also on Thursday, legislation proposed to support a hospital in danger of closing in Elgin passed the Senate unanimously.
Senate Bill 2403 would authorize the Bank of North Dakota to issue emergency operating loans of up to $5 million to nonprofit hospitals in financial distress.
The Jacobson Memorial Hospital in Elgin is believed to be the only health care facility in the state that would meet the loan criteria, bill sponsor Sen. Donald Schaible, R-Mott, has said. An amendment reduced the bill’s funding from $10 million to $5 million.
“This situation was unique. They made some mistakes, but now is not the time to point fingers,” Schaible said on the Senate floor Thursday. “We allowed the Bank of North Dakota to be the gatekeeper on reviewing these applications. They will do the deep dive into the financial situation to ensure that they are a viable product going forward.”
The bills will swap chambers Friday morning for another floor vote.
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