The 2014 South Dakota Legislature is sure to address whether to expand the Medicaid program in South Dakota as allowed by the Affordable Health Care Act (Obamacare). Governor Daugaard appointed a 29 member “Medicaid Opportunities and Challenges Task Force” following the 2013 Legislature whose charge was two-fold. First was to analyze the most current information available and to gather public input on the “pros and cons” of expanding the Medicaid program in South Dakota. Second, they were asked to develop recommendations for the Governor and Legislature on how to go about expanding Medicaid if the Governor and Legislature decided to do so. The Task Force’s final report was issued this week and is a 45 page report that can be found online at http://sd.gov/governor/medicaidtaskforce.aspx.
The Task Force was comprised of a diverse group of stakeholders including bipartisan legislators, physicians, behavioral health providers, dentists, community health providers, hospital representatives, and state agency personnel. The Task Force held four meetings from May-August, 2013 (two in Pierre and one each in Rapid City and Sioux Falls) and heard public testimony from 36 individuals/organizations.
Medicaid expansion is expected to allow an additional 48,500 South Dakotans to become eligible to apply for Medicaid. The federal government would reimburse the costs of Medicaid expansion to South Dakota at 100% from 2014 through 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and thereafter. Concerns are whether the federal government has the ability to maintain this enhanced reimbursement indefinitely. The anticipated cost of this expansion through 2020 in South Dakota would be bore by the federal government at $ 2.1 billion and the state’s share would be $102.1 million.
The recommendation of the Task Force was that South Dakota implements the Medicaid expansion with a built-in sunset clause based on the federal funding levels. The sunset clause would be if the federal government is committing to a minimum of 90% funding in the year 2020 and beyond, the legislation should state that if the federal match falls below this level (doesn’t follow through with their commitment), South Dakota will immediately terminate the program. It was noted that currently 25 states have approved the expansion and that this approach of immediate termination if the federal government falls below the minimum of 90% has been adopted by a number of states. The Task Force also identified if the Governor and Legislature approve the expansion, approximately six months would be needed to successfully launch the expansion program in the state.
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