North Dakota
North Dakota joins states challenging health care protections for transgender Americans
A federal rule seeks to add protections to a section of the Affordable Care Act that prevent health care providers who discriminate on the basis of gender identity or sexual orientation from receiving federal funding, including through Medicaid and the Children’s Health Insurance Program (photo illustration by Ross Williams/Georgia Recorder).
BY: ANNELISE HANSHAW
BISMARCK, N.D. (North Dakota Monitor) – North Dakota has joined a coalition of seven states challenging a rule by the Biden administration that would preempt state restrictions on gender-affirming care.
The legal challenge, which is led by Missouri Attorney General Andrew Bailey, was filed in United States District Court for the Eastern District of Missouri on Wednesday. The states are seeking to block the regulation and prevent the federal government from enforcing similar mandates.
The rule seeks to add protections to a section of the Affordable Care Act that prevent health care providers who discriminate on the basis of gender identity or sexual orientation from receiving federal funding, including through Medicaid and the Children’s Health Insurance Program.
The rule was set to go into effect July 5, with some provisions beginning later. But another coalition of attorneys general succeeded in their petition to block its implementation just two days prior. The judge in that case cited the recent U.S. Supreme Court decision to overturn “Chevron Deference,” a precedent that gave regulatory authority to federal agencies when statute is unclear.
Bailey, along with attorneys general from Utah, North Dakota, South Dakota, Iowa, Idaho and Arkansas, argues that the rule conflicts with their states’ restrictions on gender-affirming care for minors. Each has varying restrictions on payments for gender-affirming treatment, with Missouri blocking payment for all treatments for medical transition through Medicaid and CHIP.
“… states will be unable to enforce these duly enacted laws and longstanding policies without coming into conflict with the rule,” the attorneys general wrote in the lawsuit.
The American College of Pediatricians joins the attorneys general as a plaintiff. The ACPeds is a group of 400 physicians and other healthcare professionals in 47 states with a history of anti-LGBTQ advocacy.
“ACPeds members categorically do not provide medical interventions or referrals for, and do not facilitate or speak in ways that affirm the legitimacy of, the practice of ‘gender transition,’” the attorneys general wrote.
The lawsuit alleges that the organization’s pediatricians would suffer “significant financial harm to lose eligibility to participate in federal healthcare programs such as Medicare, Medicaid, and CHIP.”
One pediatrician in Utah is quoted in the lawsuit saying he would not “self-censor his opinions on transition efforts if the rule goes into effect.”
Predicting his noncompliance with the rule, the Utah pediatrician “faces the prospect of no longer caring for his patients, being fired from his employment and being unable to practice medicine in most settings,” the attorneys general wrote.
The rule violates physicians’ freedom of assembly, the lawsuit states, “by coercing them to participate in facilities, programs, groups and other healthcare-related endeavors that are contrary to their views and that express messages with which they disagree.”
The lawsuit also says it “coerces ACPeds members’ speech.”
“By forcing ACPeds members to tell patients directly, on their walls, and on their websites that they do not discriminate on the basis of gender identity, the rule forces ACPeds members to speak falsely, and it forces ACPeds members to fatally undermine their communication of their own medical ethical standards,” it says.
Beyond questions of constitutionality, the attorneys general allege that the rule goes beyond congressional authorization.
The rule interprets gender identity as protected by both including gender dysphoria as a disability and interpreting sex discrimination to include gender identity. The attorneys general disagree with this application.
Key to the case will be the judge’s interpretation of the 2020 U.S. Supreme Court Case Bostock v. Clayton County, in which a majority of justices ruled that gender identity was protected under Title VII, which is on employment discrimination.
The rule leans on some courts’ interpretation that transfers the Bostock decision to Title IX and the Affordable Care Act, according to its publication in the Federal Register. But the attorneys general cite decisions from judges in red states that do not allow Bostock to apply outside of Title VII.
The Department of Health and Human Services, which is the defendant in the litigation, did not respond to a request for comment.
North Dakota
Challengers declare victory after ND Supreme Court rules against Legislature’s attempt to alter term limits
BISMARCK — A constitutional ballot measure to amend the state’s term limits law as proposed by the Legislature will not appear on November’s ballot, the North Dakota Supreme Court ruled Thursday, siding with petitioners who argued the Legislature exceeded its authority and violated the state constitution in proposing the changes.
“The people’s voice was heard,” Grand Forks County Commissioner Terry Bjerke said in reaction to the news.
Bjerke was a member of the sponsoring committee behind the successful 2022 effort to pass a term limits initiative, which amended the state constitution by capping legislative term limits to eight years in the House and eight years in the Senate. The amendment, which became article XV of the state constitution, also included a clause barring the Legislature from making constitutional changes to term limits.
During the 2025 session, however, lawmakers narrowly approved Senate Concurrent Resolution 4008, in which the legislature proposed Constitutional Measure 1, a ballot measure to amend the term limits language to allow legislators to decide in which chamber they want to serve their 16 years, and to repeal the clause limiting the legislative assembly’s authority to propose an amendment to alter or repeal term limits.
Bjerke and former Minot legislator Oley Larsen brought the lawsuit challenging the validity of the Legislature’s action in January, and the state Supreme Court
heard oral arguments in the case
this spring.
“Those term limits may only be altered by a measure proposed by the people rather than the Legislative Assembly. And yet a few years later, the Legislative Assembly is doing what they are prohibited from doing,” attorney Zachary Wallen argued on Bjerke and Larsen’s behalf.
Tanner Ecker / The Bismarck Tribune
The Legislature’s attorneys argued the clause prohibiting legislative proposals to alter the constitutional term limits language “infringes on our republican form of government” by “limiting the people’s ability to vote on amendments proposed by their elected officials.”
Justice Jon Jensen seemed skeptical of that argument during the April 2 hearing, questioning whether a second vote was appropriate.
“The public did speak on this. The public spoke on it when it passed the original constitutional amendment and they said, ‘Legislature, you don’t even get to propose a change.’ They have already spoken on it,” Jensen said. “You want a second shot, or a second bite at the apple, not a first one, a second.”
In Thursday’s ruling, all five justices sided with Bjerke and Larsen.
“We … conclude the Legislative Assembly’s adoption of S.C.R. 4008 violated N.D. Const. art. XV … and declare S.C.R. 4008 and Constitutional Measure 1 void … We enjoin the Secretary of State from placing Constitutional Measure 1 on the November 2026 general election ballot,” the ruling said.
Bjerke thanked the legal team that worked on behalf of their lawsuit, and said he was grateful the court reached the conclusion it did.
“I’m thrilled that what the people voted on and approved has been validated,” Bjerke said.
He added that the Legislature had “multiple opportunities” to address term limits prior to 2022’s initiated measure and chose not to, and gave a nod to the country’s coming milestone and the process by which voters expressed their support for term limits.
“We’ve lasted 250 years,” Bjerke said. “I have two words for those elected leaders who think they aren’t: everyone’s replaceable.”
North Dakota
Fargo woman convicted in North Dakota fraud case now faces charges in Minnesota: A deeper dive
FARGO, N.D. (Valley News Live) – A North Dakota woman who was sentenced to 180 days in jail in Cass County for defrauding healthcare providers and Medicaid programs is now facing additional fraud charges in Minnesota.
Christine Marie Pryor, 55, pleaded guilty in November 2024 to theft by deception involving more than $50,000. She was sentenced to first serve 180 days with a 3-year sentence suspended. She received credit for 44 days already served.
Pryor was ordered to pay $82,584.78 in restitution to Southeast Human Services in Fargo, where she worked between 2018 and 2019.
How the scheme unfolded
According to court documents, Pryor worked at multiple healthcare facilities in North Dakota and Minnesota between 2018 and 2023, using the identities and credentials of three licensed professionals without their knowledge. She submitted fraudulent Capella University diplomas and transcripts to gain employment.
Investigators say Pryor admitted she searched state licensing websites for therapists who shared her first name, then used those therapists’ last names and license numbers when applying for jobs.
At Southeast Human Services, where she worked as a Licensed Addiction Counselor, Pryor earned $55,584.82 while providing therapy services to approximately 150 patients. She also opened her own counseling center, NIAM Brain Injury Center, in Fargo between 2020 and 2021, and worked at The Lotus Center in Moorhead, Minnesota, from 2021 to 2023.
Court documents say the three licensed professionals whose identities were used told investigators they had no knowledge of Pryor’s actions and did not give her permission to use their information.
Two additional charges against Pryor in North Dakota, unauthorized use of personal identifying information, were dismissed on motion of the state.
Additional charges in Minnesota
Pryor is also facing charges in Minnesota. Minnesota Attorney General Keith Ellison announced on Tuesday charges against Pryor in Clay County District Court for six theft offenses and six identity theft offenses related to defrauding Minnesota’s Medicaid program of more than $150,000.
According to the Minnesota complaint, Pryor claimed to provide psychotherapy and alcohol and drug counseling services to Medicaid recipients despite having no license or credentials to do so. Prosecutors allege she used the credentials and identities of three licensed professionals while claiming to provide Medicaid-funded services to 169 clients.
The Minnesota charges were filed as part of National Health Care Fraud Takedown Day, a joint effort involving the Department of Justice and more than 40 state Medicaid Fraud Control Units.
Copyright 2026 KVLY. All rights reserved.
North Dakota
NCAA Set to Change Unpopular Football Rule Just in Time for North Dakota State’s FBS Jump
North Dakota State playing in the FCS playoffs and College Football Playoff in back-to-back years? It’s likelier than you think.
That’s because on Wednesday, according to a report from Ross Dellenger of Yahoo! Sports, the NCAA Division I cabinet voted to repeal a rule that effectively barred teams transitioning from FCS to FBS from playing in postseason games in their first FBS seasons. The Bison are making that move along with Sacramento State in 2026.
The reported change has been a long time coming; the rule has hampered teams from immediate bowl eligibility for decades. Its good intentions of dissuading teams from rashly making the FCS-to-FBS leap have been rendered obsolete in recent years by the fact that programs generally arrive in FBS more prepared than ever before.
Consider the number of new FBS teams that have had to work within the provision in the past decade alone
That list includes: Liberty (home for the holidays at 6–6 in 2018), James Madison (8–3 in 2022 under coach Curt Cignetti, and barely able to play in a bowl at 11–1 in ’23 due to a lack of bowl-eligible teams), Jacksonville State (8–4 in ’23 before backing in like the Dukes), Missouri State (7–5 in 2025, also backed in) and Delaware (6–6 in ’25, ditto).
James Madison in particular became a cause célèbre in ’23 because it started the season 10-0, climbing as high as No. 18 in the AP Poll in mid-November. Then-Virginia attorney general Jason Miyares bandied about suing the NCAA before the Dukes lost 26–23 to Appalachian State, an event that caused the program to back off and accept a bid to play Air Force in the Armed Forces Bowl. James Madison lost that game 31–21, by which time Cignetti had left for Indiana.
There was a time when the FCS-to-FBS jump was an imposing one, and the NCAA did not want to incentivize making it lightly—not even a proud Florida A&M program could make a mid-2000s attempt at a jump stick. However, the Flames, Dukes and other teams have shown it’s not so great a climb for programs with the right resources and management.
Now the Bison and the Hornets stand to benefit.
How far can North Dakota State and Sacramento State go in the near term?
The Bison opened 12–0 last year before a shock loss to Illinois State in the FCS playoffs’ second round, so that question may answer itself. North Dakota State does not play a single Power 4 team—a potential strength-of-schedule albatross if it has designs on really surging. A potential roadblock: the fact that the Bison have to visit the Mountain West’s two favorites, UNLV (Oct. 10) and New Mexico (Oct. 24).
It’s a different story for the Hornets, a 7–5 squad a year ago whose move to the FBS is widely seen as a gamble on their growth potential. Sacramento State also does not play a major-conference team, but has a breakneck travel schedule ahead of it—the Hornets will visit Ypsilanti, Mich.; Bowling Green, Ohio; Muncie, Ind.; Mount Pleasant, Mich. and Honolulu. Combine that with a first-year coach—Oakland native and ex-MC Hammer choreographer Alonzo Carter—and it could be a long FBS debut in California’s capital.
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