North Dakota House Bill HB1623

North Dakota 2026 1st Special Session

• Introduced: 1/21/26
• Refer: 1/21/26
• Report Pass: 1/21/26
• Engrossed: 1/22/26
• Refer: 1/22/26
• Enrolled: 1/23/26
• Passed: 1/23/26

Caption

A rural health loan program under the medical facility infrastructure loan fund; to provide an exemption; to provide for a legislative management report; to provide for application; to provide a report; and to provide an effective date.

Summary

HB 1623 creates and funds a rural health financing package tied to North Dakota’s federal Rural Health Transformation Program. The bill appropriates nearly $397.9 million in federal funds to the Department of Health and Human Services to support rural health transformation activities through June 30, 2027, and it also appropriates $600,000 from the Bank of North Dakota operating fund to administer a new rural health loan program. In addition, the Bank of North Dakota is directed to transfer up to $40 million from its current earnings and undivided profits into the medical facility infrastructure loan fund for use only in the rural health loan program. The bill amends the state’s medical facility infrastructure loan law to add a separate rural health loan program. Under that program, the Bank of North Dakota may provide short-term gap financing to entities that receive federal rural health transformation grants and can show financial need. These loans are capped at 2% interest, may run for up to three years, and are backed by the medical facility infrastructure loan fund, which remains a revolving fund with continuing appropriation authority. The bill also authorizes four full-time equivalent positions at the Bank to administer the program. HB 1623 also creates several procurement and administrative exemptions to help recipients use the federal funds more quickly and flexibly. It allows transfers between the new appropriation and existing HHS budget lines, permits certain public-building and real-property purchases without normal statutory restrictions, and relaxes some procurement rules for consultants, cooperative purchasing, and certain standardized software or training-related purchases. The bill requires grant recipients to acknowledge that the federal funding is temporary, allows HHS to collect process and outcome measures, and requires periodic reports to the Legislative Management during the interim. The overall sentiment appears strongly supportive and noncontroversial. The bill passed the House 90-2 and the Senate 46-0, indicating broad bipartisan approval. No committee transcript was provided, and the vote totals suggest the measure was viewed as a practical implementation bill for federal rural health funding rather than a contested policy change. The main points of potential contention are limited and procedural rather than ideological. The bill gives HHS and the Office of Management and Budget broad authority to move funds and adjust appropriation authority, and it creates multiple exemptions from standard state purchasing and public-improvement rules. Those provisions could raise oversight or accountability concerns, but the near-unanimous votes suggest those concerns did not generate significant opposition.

Impact

HB 1623 expands North Dakota law by adding a new rural health loan program to the existing medical facility infrastructure loan fund statute and by authorizing the Bank of North Dakota to administer that program. It creates a continuing appropriation structure for loan repayments and fund balances, directs a large transfer from Bank profits into the loan fund, and establishes new reporting, audit, and administrative provisions. The bill also temporarily overrides or exempts several state procurement, public-building, and appropriation-transfer rules for projects funded through the federal rural health transformation program, affecting HHS, the Bank of North Dakota, OMB, and eligible rural health grant recipients.

Sentiment

The bill appears to have been received very favorably. It passed the House overwhelmingly, 90-2, and the Senate unanimously, 46-0. That voting pattern suggests broad bipartisan agreement that the measure was needed to implement federal rural health transformation funding and to provide state-level financing support for rural health providers and facilities.

Contention

There was little visible contention in the available record. The most notable issues are the bill’s broad exemptions from normal state purchasing, public-improvement, and transfer rules, along with the authority for OMB and HHS to move funds and adjust appropriation authority. Those provisions could be viewed as reducing legislative control or standard oversight, but the near-unanimous votes indicate that any objections were minor and did not coalesce into organized opposition.