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North Dakota long-term care providers call federal rule an 'impossible staffing mandate'

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North Dakota long-term care providers call federal rule an 'impossible staffing mandate'


BISMARCK — North Dakota health care providers are scrambling to meet new federal standards set for long-term care facilities. Put in motion by a 2023

executive order,

the series of mandates go into effect Aug. 8 despite nationwide concerns — including a lawsuit filed in June by the American Health Care Association against the Department of Health and Human Services and Centers for Medicare and Medicaid Services.

The rule comes in response to high death rates during the COVID-19 pandemic, citing a Centers for Medicare and Medicaid Services, or CMS,

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study

that links fatality rates to high turnover and chronic under-staffing in nursing homes.

Medicare- and Medicaid-certified facilities will be required to have a registered nurse on site 24/7 and increase the number of nurse aids available daily. Rural communities have a year longer to implement the standards than urban communities. Proposed last September and finalized in April, the rule received over 46,000 comments during the 60-day national comment period that closed in November.

“This rule does not only impact nursing facilities, it will impact all sectors of health care and the cost of care in our state,” Nikki Wegner, president of the North Dakota Long Term Care Association, testified in a state Health and Human Services committee meeting on Thursday, July 11.

The association is affiliated with two plaintiffs involved in the CMS lawsuit.

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“This, for us and for the rest of the nation, is really an impossible staffing mandate. There are simply not enough RNs to fulfill this requirement. While the intent behind the rule is to improve care quality, it presents really significant challenges,” Wegner said.

Rep. Kathy Frelich, R-Devils Lake, responded to Wegner’s testimony, referencing her professional experience with long-term care as an outreach specialist at the

North Dakota School for the Deaf and Resource Center for Deaf and Hard of Hearing.

“I would say that quality of care generally isn’t related to your RN. It’s usually related to your CNA (Certified Nursing Assistant) on that level. So, I’m concerned that this is just adding a cost,” Frelich said. “Ultimately, that goes back to the residents.”

Long-term care residents pay an average of $403.19 per day — over

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$12,000 monthly

— a rate Frelich said would “drastically” increase.

Since the height of the COVID-19 pandemic, the number of nursing homes across the state has been in decline. Six facilities closed in just under three years.

According to the

Bureau of Labor Statistics,

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North Dakota would need to add 1,313 nursing home workers to return to pre-pandemic levels.

Data

from the Payroll Based Journal indicates 79% of the state’s facilities would not comply with the registered nurse mandate and only 17% would meet nursing requirements.

The same data shows rural communities in the state would be disproportionately impacted, where 86% wouldn’t meet requirements compared to 65% in urban areas. North Dakota would have to spend a minimum of $4.5 million per year to comply.

Individuals 65 and older make up over 16% of the state population with approximately

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8,220 people

receiving care every day, according to the Long Term Care Association.

Some facilities could be considered exempt from the mandates. The

final ruling

states facilities would have to prove the local workforce is 20% or more below the national average and that administrators made “good faith” efforts to hire and retain staff.

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Tanya Schnabel, administrator for the Wishek Living Center, said most rural facilities would have to apply for an exemption, including hers. She said the process would add to her already full plate of managing the already “concerning” worker deficit.

“We have housing issues here. So, even if somebody wants to move to town to come work for us, there’s no place for them to live that’s affordable. We wouldn’t be able to do it without contract companies right now, because they’re moving here and giving their time to help care for our residents,” Schnabel told Forum News Service.

“This will just probably be the straw that broke the camel’s back,” she said.

Rep. Kelly Armstrong, R-N.D., and 33 other Republicans cosponsored a joint resolution of congressional disapproval introduced by Rep. Michelle Fischbach, R-Minn., in May. Additionally, Sen. Kevin Cramer, R-N.D., sought to delay the rulings by introducing the VA Report on Proposed CMS Staffing Ratios Act, which would require the Veterans Association to study the risks to elderly veterans posed by the new requirements.

North Dakota’s Long Term Care Association is affiliated with the American Health Care Association and Leading Age. Last May, both entities joined four other plaintiffs in filing a

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lawsuit

against the Secretary of the United States Department of Health and Human Services and CMS. According to the filing, CMS exceeded its authority by overriding congressional directives and employing “sweeping” new mandates.

“Hopefully they realize that this will probably kill off some rural facilities. If they close, then people would have to drive to Bismarck or Fargo or Jamestown to see their loved ones. That would be devastating,” Schnabel said.





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North Dakota

How two property tax credits could reduce — or eliminate — 2026 tax bills

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How two property tax credits could reduce — or eliminate — 2026 tax bills


DICKINSON — Property tax bills are arriving, and as inflation, taxes and property values continue to rise, many North Dakota homeowners are feeling the strain of higher household expenses.

Two state programs — the primary residence credit and the homestead property tax credit — aim to ease that burden by reducing, and in some cases eliminating, property taxes for eligible homeowners.

The primary residence credit provides a flat credit of up to $1,600 for qualifying homeowners, regardless of age or income. The homestead credit, meanwhile, reduces the taxable value of a home for seniors and individuals with disabilities, significantly lowering or eliminating their tax bill.

Eligible households may apply for both credits, further reducing the amount owed.

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Primary residence credit: Who qualifies and how much is available

The primary residence credit was originally capped at $500 in 2023. In 2025, lawmakers increased the credit to $1,600 after Gov. Kelly Armstrong signed House Bill 1176 into law on May 3, 2025.

To qualify, a homeowner must own and occupy a home in North Dakota as their primary residence. Eligible properties include houses,

mobile homes

, townhomes, duplexes and condominiums. Homes held in trust also qualify. There are no age or income limits, and only one credit is allowed per household.

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The credit may be applied up to the amount of property tax owed.

“We’re asking the public to take just a few minutes — please come to us, tell us who you are,” State Tax Commissioner Brian Kroshus said during a press briefing at the Capitol on Dec. 19. “That is the difference between applying the credit across the board and diluting it for everyone or having a larger credit amount of $1,600.”

Armstrong also highlighted the impact of the expanded credit in an

opinion column

.

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“Since we more than tripled the credit to $1,600, the number of households paying no property taxes in 2025 has increased to 50,000,” he wrote.

Homestead property tax credit: Using health expenses to qualify

Unlike the primary residence credit, the homestead credit reduces the taxable value of a qualifying home.

To be eligible, applicants must be 65 or older or have a permanent or total disability, own and occupy the home as their primary residence, and have a household income of $70,000 or less. There is no age requirement for individuals with disabilities. Only one spouse may apply if a married couple lives together.

Households earning $40,000 or less may qualify for a 100% reduction in taxable value, up to $9,000. Those earning between $40,001 and $70,000 may qualify for a 50% reduction, up to $4,500.

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Out-of-pocket medical expenses can be deducted when calculating household income. Eligible expenses include unreimbursed medical costs paid during the prior year for the homeowner, spouse or dependents. Subtracting those expenses may move applicants into a lower income tier or help them qualify.

Stark County Auditor and Treasurer

Karen Richard

said the credit has eliminated tax bills for many approved applicants.

“Out of the 725 approved homestead credit applications, there were 355 applicants who had a zero-dollar tax bill just from receiving the homestead credit,” Richard said.

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She added that participation remains low.

“There are most likely many more seniors who qualify but do not realize the homestead credit exists,” Richard said. “Any way possible to get the word out could really help individuals living on fixed incomes.”

Applying for both credits

Some households qualify for both programs. The homestead credit is applied first, followed by the primary residence credit.

“By applying for and receiving both credits, an additional 149 applicants received a zero-dollar tax bill,” Richard said. “Out of 725 approved homestead applicants, 504 owed nothing for 2025 property taxes.”

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It’s also important to note that either credit applies to special assessments, which may still result in a balance owed.

Applications for both credits must be submitted to a local assessor or county director of tax equalization between Jan. 1 and April 1 of the year the credit is requested. For 2026 taxes, the deadline is April 1, 2026.

Sarah Ruffin, who processes homestead and veterans credit applications for Stark County, encouraged seniors to seek assistance if needed.

“If you are over 65, own your home and earn under $70,000 per year, come talk to me about the homestead credit,” Ruffin said.

Homestead credit applications are available at

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tax.nd.gov/homestead

.Primary residence credit applications must be completed online at

tax.nd.gov/prc

.

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“The pen is mightier than the sword.”
As a professional writer with more than 10 years of experience, Kelly lives by these words. With a bachelor’s degree in communication, majoring in broadcasting and journalism, and a fiery passion for writing that began in childhood, she uses the power of words to make an impact in the community — informing, educating, and entertaining a wide range of audiences.
As a journalist, what Kelly loves most about her job is the ability to bring unique stories to the public and give people a voice that can be heard around the world. Whether through print or digital platforms, her goal is to share stories people enjoy reading while spreading valuable information that supports the welfare of southwest North Dakota and its people.





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North Dakota U.S Rep. Julie Fedorchak announces reelection campaign

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North Dakota U.S Rep. Julie Fedorchak announces reelection campaign


North Dakota U.S. Rep. Julie Fedorchak, R-N.D., announced her reelection campaign Monday in a video posted to social media. In the video, Fedorchak is described as someone who supports the “America first” agenda and will keep North Dakota as her “top priority.” “As a fourth-generation North Dakotan, I want the very best state and nation […]



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Letter: Why do North Dakota Republican politicians fear ethics?

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Letter: Why do North Dakota Republican politicians fear ethics?


Ethics is a system of moral principles guiding behavior, defining what’s right, wrong, fair, and good for individuals and society, essentially asking, “What should we do?”

A commission is a group of people officially charged with a particular function.

The citizens of North Dakota voted for and passed an Ethics Commission measure. The Ethics Commission has infuriated the North Dakota Republican legislators and North Dakota government in general. (NOTE: Every elected state government official in North Dakota is Republican.) They have denied that any monitoring of ethics is needed.

North Dakota Republicans have done everything possible to make sure the Ethics Commission has virtually no teeth, no say, and remains invisible under constant attack by the Attorney General’s Office.

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Why do Go. Armstrong, Attorney General Wrigley and the Republican members of the North Dakota Legislature fear ethics?

Henry Lebak lives in Bismarck.





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