Gov. Dennis Daugaard said Thursday he still hopes federal officials will eventually decide to let the state expand its Medicaid program in a way that would provide medical services to fewer poor people than envisioned in the federal health overhaul.
Federal officials indicated in a phone call this week that they are not willing to approve South Dakota's request for a partial expansion of Medicaid, but Daugaard said federal officials have repeatedly relaxed requirements of the new health care law.
"So I think there is a potential down the road that the federal officials will take a look at the proposal we've put forth and support it. We'll see," Daugaard said at his weekly press conference.
The federal health overhaul gives states the option of expanding Medicaid to cover people earning up to 138 percent of the federal poverty level. Daugaard and the South Dakota Legislature's Republican majority want to expand eligibility only up to 100 percent of the poverty level because those above that mark can buy subsidized private insurance through the health care law.
Daugaard sent a letter in late January asking U.S. Health and Human Services Secretary Kathleen Sebelius if she would consider such a partial expansion of Medicaid. Daugaard noted that this week's phone call was not a formal rejection of his request, but he said it's unlikely any move to expand Medicaid will be approved before the main run of this year's legislative session ends March 14.
Senate Majority Leader Tim Rave, R-Baltic, said this week's phone call among federal officials, state lawmakers and members of the governor's staff means nothing will happen during this year's legislative session.
However, Rave said he believes it's possible federal officials will decide to grant the state's request for a waiver in the next few months. If that happens, a special legislative session could be held to approve changes in the state budget so the extra state and federal money could be spent on an expanded Medicaid program, he said.
House Minority Leader Bernie Hunhoff, D-Yankton, said the Legislature should just go ahead and approve a full expansion of Medicaid to cover everyone up to 138 percent of the poverty level. Such an expansion would improve health care for up to 48,000 people, many of whom now delay getting medical care until they are so sick they go to hospital emergency rooms, he said.
Hunhoff said South Dakota will eventually expand Medicaid. He said Democrats will propose putting money to cover a Medicaid expansion in the state budget that will be passed next week.
"It's just such a short-sighted and foolish mistake not to have done it last year or today," Hunhoff said.
Senate Minority Leader Jason Frerichs, D-Wilmot, said Democratic lawmakers will keep working with federal officials to find agreement on a partial expansion.
"We're not giving up," Frerichs said.
South Dakota's Medicaid program now covers about 116,000 children, adults and disabled people. The full expanded eligibility would add an estimated 48,000 people, mostly adults without children.
People earning up to 138 percent of the poverty level - about $16,000 for a single person or $33,000 for a family of four - would be covered by a full expansion. The federal government would fully cover those added to Medicaid rolls through 2016, and the state's contribution would rise in stages to 10 percent of the costs by 2020.
An expansion to 100 percent of the poverty level would cover a single person earning up to about $11,700 and a family of four earning $23,850.
Daugaard said he hopes people earning between 100 percent and 138 percent of the poverty level will sign up for private insurance through the exchange created in the health care law. The federal subsidies mean those people would pay very little for that insurance, he said.
Rave said Republicans want a Medicaid expansion to help people who are working but cannot afford insurance.
"The working poor, that's who we're looking at," he said. "We're really focusing on the adults that are struggling to make it and obviously have no capacity to buy health insurance."
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