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Related Issues : Native American Health Issues and IHS

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Bill targets lack of tribal nursing homes; Measure sponsored by Daschle and Johnson would force federal government to pay for care

September 14, 2002

Argus Leader

PIERRE - "A bill to force the federal Medicaid program to pay nursing home costs on Indian reservations could be the answer to long-term care for Native Americans, members of a State-Tribal Relations Committee said Friday.

The bill, sponsored by Democrat Sens. Tom Daschle and Tim Johnson, was introduced this summer in Congress. It's far from a sure thing because the Bush administration opposes the idea of expanding the 100 percent federal-pay feature of Medicaid, Daschle said in a letter to the committee.

"As this provision is key in overcoming the obstacles in nursing home funding created by the state moratorium, it will be necessary to convince the administration to abandon its opposition,'' the letter said. "While prospects for enacting the bill this year are uncertain, it is my hope that its introduction will help foster a comprehensive discussion about the best ways to provide for the long-term nursing care needs of South Dakota's tribes.''

Committee members said the bill puts the responsibility for reservation nursing homes where it belongs.

"As far as I'm concerned, the federal government has an obligation, and it should be at 100 percent,'' said Republican Sen. Arnold Brown of Brookings. "You can't expect the state to pick this up, and you can't expect the tribes to pick it up. But the people do need this service. We need to twist a few more tails to get it done adequately.''

Long-term care for the elderly on South Dakota's Indian reservations has been a hotly debated policy issue ever since the state Legislature placed a moratorium on new nursing home construction in 1988. The ban on new beds was set in place for three years, then extended each time it expired.

At the time, construction of new nursing homes was outrunning the need for space. The Department of Social Services wanted time to set in place a screening process aimed at evaluating elderly people to decide which ones needed the costly nursing home care and which could be served with a less-costly alternative, such as home health services, group homes or assisted living centers.

Reservation needs

While state statistics continue to show a surplus of nursing home beds, no reservation has a facility within its borders. State officials have balked at dropping the moratorium and licensing a home on a reservation because that would mean the state would pay a 35 percent match for Medicaid patients at such facilities. A tribe could build and operate a nursing home without a state license, but then it wouldn't qualify for Medicaid under current laws and regulations.

Several past legislatures have killed bills to exempt reservation areas from the nursing home moratorium. Each of the past two legislatures has adopted resolutions to Congress, saying elderly health care on reservations is a federal responsibility and should be included as part of Indian Health Service programs.

"We've been trying to work this thing out somehow, some way, since 1989," said Mike Vogel, deputy secretary of Social Services.

The Daschle bill offers a solution that would help Native American elderly without hurting either tribes or the state, he said.

"We've felt all along this would require some federal legislation," Vogel said. "This is as far as we've ever gotten.''

Democrat Rep. Paul Valandra of Rosebud agreed. 'Promises were made'

"We believe that this is a federal responsibility, that promises were made to Indian people by the treaties,'' he aid. "There's little or no services provided by Indian Health Service to older Native American citizens.''

Committee members estimated that if the state were to pick up a 35 percent share of the current need for nursing home care on reservations, it would cost about $2.5 million. The current state budget was put together using $36 million in reserve funds to fill a revenue shortfall.

"As desperately as it's needed, there's no place in the state budget to find that $2.5 million,'' said Republican Rep. Stan Adelstein of Rapid City.

The need for nursing home care on reservations is large and growing, the committee was told.

At least 30 elderly residents of the Crow Creek Indian Reservation need such care, said Wanda Wells, a tribal planner. Some older people must sell homes and land to pay for care in off-reservation facilities as far away as Sioux Falls, she said, and they lose contact with relatives and family.

"It really bothers me that everything is referring to the dollar amounts and not the value of the elderly,'' she said.

Democrat Rep. Tom Van Norman of Eagle Butte said elderly members of his tribe must go as far away as Mobridge or Pierre for nursing-home care.

"We already have a bunch of people on Cheyenne River who need this type of care,'' he said.

Distant care

The Rosebud Sioux Tribe bought an existing nursing home five years ago, off the reservation in White River. Because the facility already was licensed, it didn't run afoul of the moratorium. Valandra said the tribe is subsidizing operation at a rate of nearly $100,000 a year.

Rosebud Tribal Vice Chairman Vernon Ike Schmidt said 30 of the 32 current residents of the White River home are tribal members. Ideally, he said, the facility should be moved to Rosebud, where the IHS hospital is located.

The Cheyenne River Sioux Tribe has designed a 40-bed nursing home that it would like to build near Eagle Butte, Van Norman said. The tribe might be able to finance construction, but ongoing costs would require Medicaid funds, he said.

"If a reservation were going to go into this business, they could do that, but they couldn't afford to stay in business without access to these funds,'' he said. "It's ironic to me that the poorest people in the state have the hardest time getting into nursing homes.''

2002 Copyright Argus Leader.

State Panel Endorses Federal Measure On Reservation Nursing Homes, Saturday, September 14, 2002


PIERRE, S.D. (AP) -- "A South Dakota legislative panel voted unanimously Friday to support a congressional measure that would allow nursing homes to be built on Indian reservations.

The Legislature's State-Tribal Relations Committee decided to send a letter to Congress endorsing a bill introduced in July by Sens. Tom Daschle and Tim Johnson of South Dakota.

"We're laying this problem to some extent at the feet of Congress because that's where we believe it should be solved,'' said Sen. Jim Putnam, R-Armour, chairman of the committee.

State government cannot afford to increase spending on nursing homes, but the federal government has an obligation under treaties and other agreements to provide health care to Indians, Putnam said.

The problem arose in 1988, when the South Dakota Legislature approved a moratorium that prevents construction of new nursing homes or the addition of additional beds in existing nursing homes.

The moratorium was imposed because South Dakota had too many nursing home beds, and that meant state spending was increasing rapidly on Medicaid, a state-federal program that pays the bills for most people in nursing homes. The federal government pays about two-thirds of the cost of Medicaid, and state government pays the other one-third.

Nursing homes are needed on the Pine Ridge Indian Reservation and several other reservations because existing facilities are located too far away.

But because of the state moratorium, any nursing home built on a reservation would not get a state license. Without a state license, such a nursing home would go broke because it would be unable to get Medicaid funding for its patients.

Measures seeking to loosen the state moratorium so nursing homes could be built on reservations have repeatedly failed in the state Legislature over the past decade. But state lawmakers have passed resolutions asking Congress to solve the problem.

The bill in Congress would allow construction of nursing homes on South Dakota reservations by requiring that the federal government pay 100 percent of the Medicaid cost for patients in tribal nursing homes.

In a letter to the state legislative committee, Daschle said the Bush administration opposes the plan for having the federal government pay 100 percent of Medicaid costs in tribal nursing homes. He said the measure's prospects are uncertain, but it may at least encourage further discussion about how best to provide nursing homes on reservations.

Rep. Tom Van Norman, D-Eagle Butte, said some elderly residents of the Cheyenne River Sioux Reservation need nursing home care, but the nearest nursing home is in Mobridge, about 85 miles from Eagle Butte. They resist going into nursing homes off the reservation because relatives have a hard time traveling to see them, he said.

"It's ironic to me the poorest people in the state have the hardest time getting into nursing homes,'' he said.

Sen. Arnold Brown, R-Brookings, urged state lawmakers to contact members of Congress from other states to build support for the Daschle-Johnson bill. The effort should be done for Sen. Dick Hagen, D-Pine Ridge, who is now in poor health, Brown said. Hagen has tried for years to find a way to get nursing homes built on reservations."

Copyright 2002, Yankton Daily Press & Dakotan.

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They made us many promises, more than I can remember. But they kept but one - They promised to take our land...and they took it. -- Chief Red Cloud

Tunkashila, Let us stand Coalition strong in protection of our lands, our beliefs, our Sacred Spirituality, and our traditional Indigenous ways of life. We stand in strong support of Indigenous Rights and the Inherent Allodial title of Dakota, Lakota, and Nakota Lands. Let us reclaim what is ours and work diligently to preserve what we now have.

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