South Dakota Gov. Dennis Daugaard (R) discussed Indian health and Medicaid expansion plans during his State of the State address on January 12, 2016. Photo from South Dakota State News

Gov. Daugaard Backs Away From Medicaid Expansion
By Brandon Ecoffey
Lakota Country Times Editor
www.lakotacountrytimes.com

RAPID CITY -- South Dakota Governor Dennis Daugaard (R) seems to have heavily weighed the merits of Medicaid expansion prior to announcing that he would not pursue it during this legislative session.

Daugaard emphasized that his reason for not pursuing the expansion came down to a belief that the South Dakota legislature did not have the adequate time necessary to examine the issue.

Daugaard also stated that the expansion must be able to save the state $12 million in its first year for him to consider calling a special session to debate the policy that would provide healthcare coverage to tens of thousands of South Dakotans who live just above the poverty line.

"This does not mean that we are done; we are continuing to work on a plan to implement the federal policy,” stated Governor Daugaard.

South Dakota Public Broadcasting on YouTube: Governor Dennis Daugaard's Medicaid Press Conference

Part of Daugaard's solution to generating the savings was to have the state be reimbursed for its expenditures made on behalf of Native people who have been referred to non IHS facilities paid for by the federal government.

He seemingly got his wish when the Centers for Medicaid Services issued a letter that announced a new policy that will help to cover the costs of Native patients.

"Today the Centers for Medicare & Medicaid Services (CMS) issued a letter to states and Tribes providing guidance to update our policy regarding the circumstances in which 100 percent federal funding would be available for services furnished to Medicaid-eligible American Indians and Alaska Natives (AI/AN) through facilities operated by the Indian Health Service (IHS) or Tribes under the Indian Self-Determination and Education Assistance Act, P.L. 93-638. Through this letter, CMS is re-interpreting its payment policy with respect to services “received through” an IHS/Tribal facility, and is expanding the scope and nature of services that qualify for this matching rate," wrote CMS.

Advocates for tribal-nations had argued that the previous policy was interpreted to strictly and did not reflect the trust responsibilities of the federal government.

Centers for Medicare and Medicaid Services on YouTube: Tribal State Health Official Letter on 100% Federal Medical Assistance Percentage for Service

"That is, 100 percent FMAP [Federal Medical Assistance Percentage] will be available for services that are either furnished directly by the facility to a Medicaid-eligible AI/AN patient or by a non-IHS/Tribal provider when certain conditions are met. Specifically, when the service is provided at the request of an IHS/tribal facility practitioner on behalf of his or her patient and the patient remains in the Tribal facility practitioner’s care in accordance with a written care coordination arrangements. This policy is intended to help states, IHS, and Tribes improve the delivery of health to AI/AN Medicaid beneficiaries by increasing access to care and strengthening continuity of care," the letter read.

A percentage of the medical costs accrued by Medicaid covered native patients who have accessed healthcare providers outside of the IHS network had not been covered by Medicaid in the past. These unpaid bills have up until this point been covered by the state, but Gov. Daugaard has argued that it is the responsibility of the federal government to provide healthcare for Native people. He has suggested that if the federal government would cover these costs the state would save enough money to expand Medicaid.

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The departure from the Governor's seemingly inevitable expansion of Medicaid was unexpected as both federal and tribal officials have traveled to South Dakota multiple times to help clear up any roadblocks that might have come up.

Jerilyn Church, Great Plains Tribal Chairmen’s Health Board Chief Executive Officer, said: “The health board, along with the South Dakota Healthcare Solutions Coalition, will continue to work with the governor to develop a comprehensive implementation plan that benefits South Dakota tribes and the state as a whole.”

(Contact Brandon Ecoffey at editor@lakotacountrytimes.com)

Federal Register Notice:
Payment for Physician and Other Health Care Professional Services Purchased by Indian Health Programs and Medical Charges Associated With Non-Hospital-Based Care (March 21, 2016)

Related Stories:
Brandon Ecoffey: Treaties guaranteed health care for our people (02/11)
Lakota Country Times: Indian health at center of Medicaid debate (02/09)

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