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Gov. Daugaard set to seek expansion of Medicaid in South Dakota, if certain conditions met


PIERRE, South Dakota — Gov. Dennis Daugaard wants to make an additional 55,000 South Dakota residents eligible for Medicaid if he can get assurances that the plan's cost would be offset by budget savings and would improve health care for Native American residents.

During a recent interview with The Associated Press, Daugaard said he plans to propose the expansion in his budget address next month, provided the conditions are met, before sending it to the Legislature for approval. A coalition he established to explore the viability of expanding Medicaid is set Wednesday to review new projections about the number of eligible residents and the potential cost.

Such a proposal would be a departure from many other Republican governors around the country, who have steadfastly resisted expanding the Medicaid program for low-income and disabled people, in part because of opposition to the federal health overhaul.

"I would say I've never been, I don't think, an ideologue about expansion," Daugaard said of the measure, which would go into effect for the 2017 fiscal year.

The updated numbers project about 55,000 people could be eligible for the program if it's expanded. The state's share would be offset by savings to make up for the expected annual cost of between roughly $33 million and about $45 million starting in 2020, said Kim Malsam-Rysdon, a senior adviser to Daugaard.

The projections have built in cushions to ensure that the state isn't underestimating the fiscal impact of expanding the program, Malsam-Rysdon said.

The proposal pays for the state's share of the expansion in part by expanding access to services that are fully funded by the federal government, with the goal of freeing up enough state funding to pay for the addition of more residents to the Medicaid program.

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 U.S. Department of Health and Human Services has said that the administration is willing to work with any state interested in expanding Medicaid. Federal officials are working at what they've described as "warp speed" on potential changes to policy that could allow South Dakota to move forward with the expansion, Malsam-Rysdon said.

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