Gov. Dennis Daugaard can expand Medicaid without consulting with lawmakers, the governor said Thursday.
But Daugaard said if he did pursue Medicaid expansion, he would at least informally make sure the Legislature was on board with his plan, first.
That’s because even a unilateral Medicaid expansion would need to be retroactively approved by the Legislature in the following year’s budget revision.
"I would be a little bit cautious about (expanding Medicaid) without the Legislature’s overt agreement to change the budget," Daugaard said. "But we could evaluate when that was needed and whether a special session would be necessary."
The Affordable Care Act asks states to expand their Medicaid programs to cover low-income people earning up to 133 percent of the federal poverty line — $15,521 for an individual or $31,721 for a family of four. Under the law, the federal government promises to pay 90 percent or more of the cost, including 100 percent for the first several years.
Daugaard has asked the federal government for flexibility to do a partial expansion of Medicaid to just the poorest South Dakotans earning less than 100 percent of the poverty line — $11,670 for an individual or $23,850 for a family of four. People earning more than that are eligible right now to buy subsidized private insurance on the new health care exchanges.
The governor has also asked the federal government if South Dakota could impose a work requirement on Medicaid eligibility.
He made the request at the end of January. So far, Daugaard said the state has received neither formal nor informal word on its request.
Earlier Thursday, Republican legislative leaders suggested they were okay with Daugaard expanding Medicaid without formal approval from lawmakers.
"If that’s something that the governor and the departments decide to do, they have a right to do that," said Rep. Justin Cronin, assistant leader of the House Republicans. "We can always have a special session, if we decide to do so and don’t agree with the policies."
House Speaker Brian Gosch, R-Rapid City, and Senate Majority Leader Tim Rave, R-Baltic, agreed.
"It’s an adminsitrative decision at this point. It’s not a legislative decision," Gosch said. "So the administration, if granted that waiver, could go through with it without a special session."
Lawmakers this year have voted, largely along party lines, to kill multiple Democratic bills calling to expand Medicaid. But in so doing, many Republicans have expressed a willingness to expand Medicaid — if it can be done on South Dakota’s terms.
The first year of Medicaid expansion would have only a few million dollars in administrative costs, which Daugaard could pay for out of a $20 million Medicaid reserve fund he established several years ago. And the state’s practice has been to resist defining the state’s Medicaid program in law, giving the administration flexibility to make changes without legislative approval for each one.
Amending the budget to allow for spending hundreds of millions of dollars of federal money could be done after the fact, leaders said.
Democrats, who have pushed for Medicaid expansion, said they’d prefer the Legislature approve Medicaid expansion during its current session, which ends in March. But House Democratic Leader Bernie Hunhoff said he’s fine with Daugaard moving on his own.
"I don’t care how it happens, as long as it happens," said Hunhoff.
Daugaard said if he did decide to pursue Medicaid expansion, he would likely consult with lawmakers to make sure he had backing before going ahead.
"I would have to visit with the Legislature about that," Daugaard said. "This is a decision I should not unilaterally make… I think the Legislature has to play a part as well."