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In search for better care for older citizens, legislators realize more money is necessary

PIERRE -- South Dakota should offer more services to help older people live in their homes rather than move to nursing homes or other care facilities that are more expensive, a national consultant told a committee of legislators Thursday.

PIERRE - South Dakota should offer more services to help older people live in their homes rather than move to nursing homes or other care facilities that are more expensive, a national consultant told a committee of legislators Thursday.

Allan Bergman also advised the lawmakers that Medicaid could look "very different" in a year because of changes that U.S. House speaker Paul Ryan, R-Wisconsin, supports such as state block grants and spending caps.

Bergman said South Dakota doesn't get its fair share from the federal Medicaid program while the state of New York gets more than its share.

One of the legislators, Rep. Leslie Heinemann, R-Flandreau, said the committee must find more funding for Medicaid providers in South Dakota if there are going to be more home-based services.

Heinemann asked where the savings are from a change in federal policy that was supposed to eliminate the need for state governments to provide co-payments for Indian Health Service patients outside of the IHS system.

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The savings were projected at $67 million annually for South Dakota, according to Heinemann, who is a chiropractor.

But, he said, he hasn't received a continuing care contract that would eliminate the need for a state government co-payment for care of Indian Health Services patients at his clinic, which he said is six blocks down the street from an IHS facility.

The committee, whose purpose is to study payment methodologies for Medicaid providers and make recommendations to the full Legislature for action next year, had agreed it wouldn't discuss the topic of Medicaid-eligibility expansion for the working poor.

Gov. Dennis Daugaard considered asking the Legislature this year for the eligibility expansion and had pursued the IHS savings as a way to cover state government's additional cost for covering more people.

But the plan didn't come together in time for the 2016 legislative session, which was focused on Daugaard's priority of a sales-tax increase to pay for higher teacher salaries.

He floated the idea of holding a special legislative session on Medicaid expansion but backed away after conservative Republicans won many victories in the June primary elections for legislative seats.

Medicaid expansion now appears to be a dividing issue for the 2017 session. Heinemann's comments opened the curtain Thursday for a preview.

Sen. Deb Peters, R-Hartford, said "a lot of work" has gone into making arrangements with the federal Indian Health Service but, she continued, the federal agency that oversees Medicaid and Medicare won't work with South Dakota until there is Medicaid expansion.

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"That's where we're at," Peters said.

House Democratic leader Spencer Hawley, of Brookings, agreed the Medicaid expansion discussion isn't part of the committee's scope of work.

Hawley said the Legislature has to decide if it is going to expand. He said the tribal governments wouldn't approve the IHS plan to eliminate the state co-payment without South Dakota proceeding on Medicaid expansion.

"You are not going to see any changes until we deal with the issue," Hawley said.

The legislative committee plans two more meetings in the next two months, according to its chairwoman, Rep. Jean Hunhoff, R-Yankton.

"I don't want this to lead us astray," Hunhoff said about the discussion of Medicaid expansion.

Hunoff said she agreed with Heinemann that funding must be considered but the committee needs "some kind of idea" of the cost for expansion of home-based services for older people.

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