PIERRE - Federal officials don't have a deadline to decide waivers, such as the one South Dakota seeks, to require some Medicaid recipients to work for benefits, a member of Gov. Dennis Daugaard's administration indicated Wednesday.
"The timelines of the process are not defined," state Health Secretary Kim Malsam-Rysdon told members of South Dakota's Healthcare Solutions Coalition.
The panel, on which Malsam-Rysdon is a co-chairwoman, has been finding ways to spread Medicaid funding into more services. The governor announced in January he would pursue the Medicaid work requirement.
State Social Services Secretary Lynne Valenti submitted the waiver request Aug. 10 to the federal Center for Medicare and Medicaid Services.
Medicaid is a shared federal and state program that pays health care providers to serve people below certain income levels who are younger than age 65. In South Dakota, the state pays about 45 cents of a typical Medicaid dollar for medical and pharmacy services.
The proposed work requirement, called Career Connector, would apply in Minnehaha and Pennington counties, the home areas respectively for Sioux Falls and Rapid City, the state's two largest cities.
Demographics used in the waiver showed 732 households in Minnehaha and 569 in Pennington would potentially be affected, with 1,183 single-parent households and 118 with two parents.
There are 169 men and 1,132 women heading the households, with 2,324 children in them.
The five-year trial would apply to people less than age 60. They would have to work at least 80 hours per month or reach monthly milestones in their individualized plans, unless they were found deserving a good-faith exemption.
Each adult would have an employment assessment and be assigned a resource team, including a case manager, to assist the person. The application said the first emphasis would be on maintaining health care coverage of some type, including assistance with insurance premiums.
Seven other states have applied for Medicaid work waivers, according to Malsam-Rysdon.
Deb Fischer-Clemens, senior vice president for Avera health system in Sioux Falls, said on the coalition's teleconference there is concern about who "really foots" the bill when people are dropped from Medicaid and show up at emergency rooms needing care.
Bill Snyder, state director for medical services, and Valenti tried to reassure the former legislator. "We built in a lot of exemptions," Valenti said. "We don't anticipate very many people would lose coverage."
The waiver application estimated about 15 percent might become ineligible. "We want to use this to help folks," Malsam-Rysdon said.
The coalition, an assembly of state, federal, tribal and health care officials, began in 2015 looking for ways to expand Medicaid eligibility and services in South Dakota and to identify patients that the federal Indian Health Service refers outside its system.
Daugaard later declared he wouldn't pursue expanding Medicaid eligibility. Since then the coalition has focused on Indian Health Service patients. Their services are reimbursed 100 percent within the IHS system but often become partially the state's responsibility when they're referred to non-IHS providers.
The coalition's work has paid off. The state fiscal year that ended June 30 saw more than $4.6 million in savings to state government from coordinated-care agreements between the Indian Health Service and three major health care providers and two dialysis providers.
The money is being reinvested in health programs. Starting this budget year, some savings also will be shared with participating health care providers, according to Brenda Tidball-Zeltinger, a social-services deputy secretary.
Tidball-Zeltinger told Fischer-Clemens that results from the Medicaid work pilot would help the department decide whether to pursue work requirements in other areas of South Dakota.