Melanie Boetel

This document outlines SD Medicaid's plan to implement a value-based payment model within primary care. The initiative aims to support rural primary care practices by providing flexible payment structures and incentives for both providers and patients. Key strategies include utilizing Rural Health Transformation grant funding for upfront infrastructure, emphasizing case management (including shared models), offering operational flexibility, and incorporating recipient-level incentives. The approach will transition from initial pay-for-reporting to performance-based benchmarking specific to South Dakota.

The committee held an introductory meeting that included a presentation on the Medicaid program, a discussion on the role of the committee in reviewing State Plan Amendments, and an overview of Medicaid disenrollment data. The committee reviewed and approved the draft bylaws. Additionally, members discussed potential future meeting locations and topics for consideration, such as the Rural Health Transformation Program, rate studies for healthcare organizations, hospital reimbursement changes, and the legislative process.

The meeting provided a comprehensive overview of the Medicaid program, covering its vision, mission, and administrative structure within the South Dakota Department of Social Services. Key topics included eligibility criteria, federal and state financial partnerships (FMAP), coverage groups, and service requirements. The committee also discussed Medicaid authorities, the process for state plan amendments, and the function and types of waivers. Additionally, the roles and distinct functions of the Beneficiary Advisory Council and the Medicaid Advisory Committee were outlined alongside available provider resources.

This State Plan Amendment (SD-25-0016) for South Dakota's CHIP program provides federally required assurances regarding the eligibility of Targeted Low-Income Children who are or become incarcerated. It ensures compliance with juvenile justice federal requirements outlined in Section 5121 of the Consolidated Appropriations Act, 2023. Key provisions include assurances for not terminating eligibility for incarcerated children, suspending CHIP benefits during incarceration, redetermining eligibility prior to release, and providing screenings, diagnostic services, or case management services within 30 days before release to facilitate improved healthcare coordination for incarcerated youth.

The Rural Health Transformation Program is a federal initiative, funded for $50 billion under the Big Beautiful Bill Act/HR 1, designed to support rural health across participating states, with South Dakota expecting at least $100 million annually from federal fiscal year 2026 through 2030. This program, led by the State of South Dakota's Office of the Governor, sets strategic goals focused on making rural America healthy again through preventative care, ensuring sustainable access to care, developing a high-skilled healthcare workforce, fostering innovative care models, and leveraging technological innovation for efficient care delivery. The document serves as a tribal consultation update, outlining public comment opportunities and the next steps for the program's application and implementation.