PIERRE | Although nothing is certain yet about South Dakota's proposed expansion of Medicaid coverage, a member of Gov. Dennis Daugaard's cabinet on Monday said preparations for adding 50,000 Medicaid recipients are moving "full speed ahead."
Daugaard would call a special session of the Legislature on expanding Medicaid eligibility, and a decision on whether to do that probably will come by summer.
But Social Services Secretary Lynne Valenti said five teams of tribal, state and federal government officials are working with health care providers on the operational plans.
She provided an update to members of the state Board of Social Services.
The federal poverty level for one person is $11,670. The expansion would cover people up to 138 percent of the federal poverty level. For one person that is $16,105.
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By 2021 state government’s 10 percent share of the cost for the expansion would be $57 million.
Daugaard wants to pay for the state’s share through savings from a change in federal reimbursement for Indian Health Service care delivered outside the IHS system.
The federal Department of Health and Human Services notified state health officers in February the reimbursement would become 100 percent.
States had been paying for a percentage of non-IHS care for IHS patients. In South Dakota that was 48 percent. The cost last year to South Dakota was $67 million.
Daugaard originally opposed Medicaid expansion. He changed his position in the past year and called for expansion during his budget speech to the Legislature in December.
His condition is that expansion be budget-neutral, and the IHS reimbursement change could make that possible.
“He’s committed to Medicaid expansion," Valenti said, "but he’s wanting a very detailed plan in confidence we can generate the $57 million in savings.”
Many changes would be needed, she said, some of which are ready to start. The solicitation for telemedicine is “imminent” from Indian Health Service, she said.
Telemedicine allows a health care profession to provide care through use of video so that the patient and doctor can be in different places.
Asked about a special session, Valenti told the board: “We know the next month or two would be telling.”
The governor’s Health Care Solutions Coalition of tribal, state and medical officials and legislators issued recommendations in January. They are:
• Increase access to telemedicine more frequently and in different ways.
• Develop a community-health worker plan to engage people in their homes and their communities statewide and to reduce barriers to their care.
• Expand support for healthy birth outcomes using telemedicine and community health workers.
• Increase behavioral health, which Valenti described as “a huge area of need,” for broader and deeper reach of mental health services and substance abuse treatment.
• Expand availability of functional family therapy.
Valenti said one of the challenges is a person must be an IHS patient, and a lot of coordination would be required to receive services outside the IHS system and for those federal reimbursements to be 100 percent.
Some care is easy to convert, such as from a specialist, but geography is a difficulty for people who don’t live in an IHS area, Valenti said. “That’s kind of the detail we’re working on,” she said.
One concept is an alternative-care model through IHS-designated providers, such as federally qualified health centers, she said. There would have to be a sharing of records and information, she said.
Valenti said people couldn’t be forced to act. “We think the incentives are around better care, better access,” Valenti said.
Hugh Grogan, a board member from Sioux Falls, said the alternative service delivery approach could lead more people to qualify for full IHS reimbursement.
“We continue,” Valenti said. “This is a top priority for the state, for tribes, for providers. We’ve had amazing engagement from all levels. The coalition has forged really solid relationships.
“They really are committed and have remained committed,” she said about federal officials. “It’s been good too with that relationship as well.”