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House Republican Leader David Lust, left, of Rapid City, talks with Senate Republican Leader Tim Rave, of Baltic, before the start of Gov. Dennis Daugaard’s State of the State speech Jan. 14 at the State Capitol in Pierre. (Sean Ryan/The Daily Republic)

GOP leaders open to partial Medicaid expansion

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By Chet Brokaw

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PIERRE (AP) — Republican leaders in the South Dakota Legislature say they hope federal officials will grant the state a waiver allowing expansion of the Medicaid program to provide medical services only to those people most in need.

Senate Republican Leader Tim Rave of Baltic said he doubts the Legislature would expand Medicaid to the full extent envisioned in the federal health care overhaul, but that lawmakers will likely talk about seeking federal approval to extend coverage to a smaller group of low-income people.

The federal government has so far refused to give South Dakota that flexibility, but House Republican Leader David Lust of Rapid City said he hopes federal officials will change their minds.

"I do think we could craft a resolution that is appropriate and effective for our situation in South Dakota," Lust said.

Leader of the Democratic minority have said they will continue to push for a Medicaid expansion, despite resistance from Republican Gov. Dennis Daugaard.

Senate Democratic Leader Jason Frerichs of Wilmot said he's pleased that Republicans haven't completely rejected a Medicaid expansion.

Daugaard says he's not recommending the Medicaid expansion — available to states as an option under the federal health care overhaul — in next year's state budget, but that he's not ruling it out altogether. He said the federal government is having trouble putting the overhaul into effect and wonders whether it can meet its promise to pay most of the cost of the Medicaid expansion.

South Dakota's Medicaid program now covers about 116,000 children, adults and disabled people. The expanded eligibility would add an estimated 48,000 people, mostly adults without children.

People earning up to 138 percent of the poverty level — $15,451 for a single person or $31,809 for a family of four — would be covered by an 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.

Federal officials earlier rejected Daugaard's request that South Dakota be allowed to expand Medicaid eligibility only up to 100 percent of the poverty level because those over that mark can qualify for subsidized private insurance. He has said he likely will renew that request.

Rave said he could back a plan to expand Medicaid to those who need it most, for example a single mother working two part-time jobs to support two children. The kids likely are already covered by a Medicaid program but the mother might not qualify for Medicaid and cannot afford private insurance, he said.

"I think most South Dakotans would go: 'Gosh, that seems the right thing to do. Let's figure out a plan to do that.'"

Lust said both sides in the debate have compelling arguments. Expanding Medicaid would help low-income people, but the state also has to consider whether the federal government can afford to pay for the expansion, he said.

The best solution would be to cover those most in need of insurance, Lust said.

"Unfortunately, the federal government has prohibited that kind of flexibility. I'm hopeful that will change," Lust said.

Rep. Susan Wismer, D-Britton, said she hopes South Dakota will seek a federal waiver to at least partially expand the program, suggesting the expansion could be passed with the provision it would be stopped if the federal government failed to meet its promise to pay for it.

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