It's back to the drawing board for state officials working to reach an agreement on Medicaid Expansion with the federal government.
Governor Dennis Daugaard's plan to expand Medicaid coverage to working adults making 100 percent of the Federal Poverty Level has been denied under the Affordable Care Act.
So what's next? And what does it mean for the March 31 sign-up deadline that is rapidly approaching?
It's estimated that 48,000 South Dakotans could benefit from health coverage if the state expands its Medicaid program to people making up to 138 percent of the Federal Poverty Level, or about $15,852 a year. Governor Daugaard had proposed to reduce that number in half by offering Medicaid only to those making 100 percent or about $11,490 a year. This week the Feds said partial expansion wasn't enough. That leaves the question of what to do next.
"We have to have the discussion about what we do with adults in this state who fall in that gap. If we're not going to cover them through Medicaid expansion, then they are exposed. They're exposed to entering the healthcare system at the most expensive point, which is the emergency department in most cases," Avera Vice President of Community Relations, Bob Sutton, said.
The bad news is the federal government's deadline for being enrolled on the Marketplace is less than three weeks away. The good news is the Feds say they won't impose a penalty on individuals who aren't enrolled by March 31 if their state hasn't made a final decision on Medicaid expansion.
"The advice I would give is for those folks to go visit with either a navigator in South Dakota or advocates who can help walk them through the process. Those folks can help people as we make our way through this period during the open enrollment," Sutton said.
In the meantime, there is another prospect for the state's Medicaid hopeful, state Democratic legislators say they plan to introduce an amendment next week adding funding for Medicaid expansion into the state's budget. Without GOP support, it's not likely to go far on the capital floor in Pierre. The Governor has said he is hesitant to put another proposal on the table without legislator support. The current session ends in just nine days.
"It's disappointing; there's no doubt about it. Some folks probably thought there's a chance that I can get enrolled. Those are the folks who really need to contact their elected leaders," Sutton said.
If no decision is made before state lawmakers head home, it's likely the March 31 deadline will pass with Medicaid expansion still at an impasse. Should there be a change of heart in Pierre, officials with the regional Centers for Medicare and Medicaid office in Denver say the state would still qualify for the initial 100 percent reimbursement for Medicaid expansion if it later decides to expand the program to the 138 percent level or an agreement can be reached with the Feds on a new partial expansion waiver in the future.
If you have questions about the Affordable Care Act you can get them answered on a special edition of inside KELOLAND.
Representatives from the Office of Medicaid and Medicare will be here to address all of your questions.
Please send your questions by next Wednesday.