Medicaid expansion coalition preparing to shift lobbying attention to state lawmakers in Pierre



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PIERRE, South Dakota — A coalition established by Gov. Dennis Daugaard to wade into the web of federal policy revisions necessary to satisfy his conditions for expanding Medicaid in South Dakota is turning its focus back on Pierre.

The group of health representatives and state and tribal officials met Wednesday for the final time before lawmakers convene for the 2016 legislative session. Daugaard has proposed expanding eligibility for about 50,000 South Dakota residents as long as the state's share of the cost is covered by savings.

A federal answer could come in February, so members of the group are shifting their lobbying efforts to state lawmakers now since expansion is a complicated topic, said Kim Malsam-Rysdon, a senior adviser to Daugaard.

"It's a dual front fight," she said. "The governor's not saying we're going to expand, because we don't have the information yet. But you have to be prepared if that is, in fact, what we feel the policy allows us to do."

Daugaard formally proposed broadening eligibility for the health coverage program for low-income and disabled people at his budget address last month. His openness marks a departure from many Republican governors nationwide who have resisted expanding Medicaid from opposition to the federal health overhaul.

There will be people who are ideologically opposed to expanding the program, regardless of the details, Malsam-Rysdon warned the group. She said members of the coalition will help educate lawmakers.

The proposal pays for the state's share of broadening eligibility in part by expanding access to services that are fully funded by the federal government. That could reduce current state spending to be put toward expansion.

Officials are focusing on people who are eligible for Medicaid but can get services through the Indian Health Service. The goal is make services through the Indian Health Service more accessible so that people don't have to go an outside health care provider, which can happen if IHS is unable to offer a specific service.

Those services at IHS are fully funded by the federal government through Medicaid rather than through the typical split in financing between the state and the federal government.

The state is also asking for a change in the classification of some services to have them fully paid for by the federal government.

The potential expansion and changes at IHS have the potential to change thousands of Native Americans' health outcomes, Democratic Sen. Troy Heinert said.

"That totally changes our lives," he said. "People like to see, 'What does this really mean?' And to me, it means something."

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