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South Dakota lawmakers divided over Medicaid expansion

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PIERRE | Expanding substance abuse service to any South Dakotans eligible for Medicaid won narrow approval Monday by the Legislature’s Rules Review Committee.

The vote of three to two divided on whether broader treatment service was Medicaid expansion. Treatment service has been limited to pregnant women and adolescents. The change takes effect later this month.

Many lawmakers have opposed changing eligibility rules because they don’t want more people to qualify for government-subsidized health care in South Dakota.

Republican Gov. Dennis Daugaard has also stood against broader eligibility.

The Legislature, however, appropriated $2 million this year for the state Department of Social Services to expand substance abuse service including treatment for meth addiction.

The governor controls the department. Lawmakers gave him the additional money but didn’t expand eligibility standards.

Voting to accept broader substance abuse service within the current Medicaid population Monday were Rep. Jean Hunhoff, R-Yankton; Sen. Craig Kennedy, D-Yankton; and Sen. Alan Solano, R-Rapid City.

“This expansion does not increase the number of Medicaid eligible,” said Hunhoff, who chairs the panel.

There are reasons people are addicted to drugs and alcohol, Hunhoff said. “So it’s a matter of semantics. It’s a matter of how you look at it."

Opposing the change were Rep. Steven Haugaard, R-Sioux Falls, and Sen. Lance Russell, R-Hot Springs. Haugaard said a concern was the Legislature didn’t specifically approve the expansion.

Haugaard and Russell said providing a service to more people through a rule change was an expansion.

Said Kennedy: “I think Rep. Haugaard hit it right on the head, and I don’t think there’s anything wrong with it.”

Kennedy called more treatment “a laudable goal.”

About two-thirds of state governments expanded Medicaid eligibility in recent years. Doug Decker, the rules-review staff member, said the Legislature’s Executive Board sets rules for committees outside the legislative session.

The current version requires a majority of committee members participate for the meeting to be official, he said, and a majority of participants is necessary for an official decision.

Decker wrote a May 1 letter to a department official approving the department's proposed rules for legality.

Based on an estimate of potential users, the change would cost the federal government $1,127,795 and state government $872,905 during the budget year, according to a department document.

Hunhoff asked department officials to attend the July 9 rules-review meeting to discuss Medicaid expansion.

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