I thought that, even if Governor Dennis Daugaard’s foot-dragging and Donald Trump’s victory mean South Dakota never cashes in on Medicaid expansion, we could still save some money with the Governor’s crafty plan to shift American Indian patients from the state’s Medicaid roll to Indian Health Service coverage.
Alas, no, Governor Daugaard says that plan is dead, too:
“Under present law, it would not,” Daugaard says. “It would not, because there’s no incentive for IHS, nor for these other providers, to jump through all the hoops that they must jump through for us to capture that money.”
Daugaard says health organizations need to create infrastructure to share medical records and patient details for IHS. He says Medicaid expansion would have offered health insurance to more people, so health systems would receive more payments. Without that money, Daugaard says they have no reason to change [Kealey Bultena, “IHS Deal to Save SD Million Not an Option,” SDPB Radio, 2016.12.06].
If I understand that explanation correctly, it’s not actually illegal for Indian Health Service to take on the cost of health care services provided to qualifying Indian patients at non-IHS facilities (care currently covered by state Medicaid dollars). It’s just too complicated and too costly for the health care providers without the offsetting benefits that would have accrued from expanding Medicaid.
The IHS swap could have saved the South Dakota budget $85 million, more than three times the revenue shortfall that has us all a-fluster. But who needs fiscal gains when we can have the joy of opposing the Obama Administration’s effort to ensure every American gets affordable health coverage?