South Dakota
Medicaid unwinding deals blow to tenuous system of care for Native Americans • South Dakota Searchlight
About a year into the process of redetermining Medicaid eligibility after the COVID-19 public health emergency, more than 20 million people have been kicked off the joint federal-state program for low-income families.
A chorus of stories recount the ways the unwinding has upended people’s lives, but Native Americans are proving particularly vulnerable to losing coverage and face greater obstacles to reenrolling in Medicaid or finding other coverage.
“From my perspective, it did not work how it should,” said Kristin Melli, a pediatric nurse practitioner in rural Kalispell, Montana, who also provides telehealth services to tribal members on the Fort Peck Reservation.
The redetermination process has compounded long-existing problems people on the reservation face when seeking care, she said. She saw several patients who were still eligible for benefits disenrolled. And a rise in uninsured tribal members undercuts their health systems, threatening the already tenuous access to care in Native communities.
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One teenager, Melli recalled, lost coverage while seeking lifesaving care. Routine lab work raised flags, and in follow-ups Melli discovered the girl had a condition that could have killed her if untreated. Melli did not disclose details, to protect the patient’s privacy.
Melli said she spent weeks working with tribal nurses to coordinate lab monitoring and consultations with specialists for her patient. It wasn’t until the teen went to a specialist that Melli received a call saying she had been dropped from Medicaid coverage.
The girl’s parents told Melli they had reapplied to Medicaid a month earlier but hadn’t heard back. Melli’s patient eventually got the medication she needed with help from a pharmacist. The unwinding presented an unnecessary and burdensome obstacle to care.
Pat Flowers, Montana Democratic Senate minority leader, said during a political event in early April that 13,000 tribal members had been disenrolled in the state.
Native American and Alaska Native adults are enrolled in Medicaid at higher rates than their white counterparts, yet some tribal leaders still didn’t know exactly how many of their members had been disenrolled as of a survey conducted in February and March. The Tribal Self-Governance Advisory Committee of the Indian Health Service conducted and published the survey. Respondents included tribal leaders from Alaska, Arizona, Idaho, Montana, and New Mexico, among other states.
Tribal leaders reported many challenges related to the redetermination, including a lack of timely information provided to tribal members, patients unaware of the process or their disenrollment, long processing times, lack of staffing at the tribal level, lack of communication from their states, concerns with obtaining accurate tribal data, and in cases in which states have shared data, difficulties interpreting it.
Research and policy experts initially feared that vulnerable populations, including rural Indigenous communities and families of color, would experience greater and unique obstacles to renewing their health coverage and would be disproportionately harmed.
“They have a lot at stake and a lot to lose in this process,” said Joan Alker, executive director of the Georgetown University Center for Children and Families and a research professor at the McCourt School of Public Policy. “I fear that that prediction is coming true.”
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Cammie DuPuis-Pablo, tribal health communications director for the Confederated Salish and Kootenai Tribes in Montana, said the tribes don’t have an exact number of their members disenrolled since the redetermination began, but know some who lost coverage as far back as July still haven’t been reenrolled.
The tribes hosted their first outreach event in late April as part of their effort to help members through the process. The health care resource division is meeting people at home, making calls, and planning more events.
The tribes receive a list of members’ Medicaid status each month, DuPuis-Pablo said, but a list of those no longer insured by Medicaid would be more helpful.
Because of those data deficits, it’s unclear how many tribal members have been disenrolled.
“We are at the mercy of state Medicaid agencies on what they’re willing to share,” said Yvonne Myers, consultant on the Affordable Care Act and Medicaid for Citizen Potawatomi Nation Health Services in Oklahoma.
In Alaska, tribal health leaders struck a data-sharing agreement with the state in July but didn’t begin receiving information about their members’ coverage for about a month — at which point more than 9,500 Alaskans had already been disenrolled for procedural reasons.
“We already lost those people,” said Gennifer Moreau-Johnson, senior policy adviser in the Department of Intergovernmental Affairs at the Alaska Native Tribal Health Consortium, a nonprofit organization. “That’s a real impact.”
Because federal regulations don’t require states to track or report race and ethnicity data for people they disenroll, fewer than 10 states collect such information. While the data from these states does not show a higher rate of loss of coverage by race, a KFF report states that the data is limited and that a more accurate picture would require more demographic reporting from more states.
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Tribal health leaders are concerned that a high number of disenrollments among their members is financially undercutting their health systems and ability to provide care.
“Just because they’ve fallen off Medicaid doesn’t mean we stop serving them,” said Jim Roberts, senior executive liaison in the Department of Intergovernmental Affairs of the Alaska Native Tribal Health Consortium. “It means we’re more reliant on other sources of funding to provide that care that are already underresourced.”
Three in 10 Native American and Alaska Native people younger than 65 rely on Medicaid, compared with 15% of their white counterparts. The Indian Health Service is responsible for providing care to approximately 2.6 million of the 9.7 million Native Americans and Alaska Natives in the U.S., but services vary across regions, clinics, and health centers. The agency itself has been chronically underfunded and unable to meet the needs of the population. For fiscal year 2024, Congress approved $6.96 billion for IHS, far less than the $51.4 billion tribal leaders called for.
Because of that historical deficit, tribal health systems lean on Medicaid reimbursement and other third-party payers, like Medicare, the Department of Veterans Affairs, and private insurance, to help fill the gap. Medicaid accounted for two-thirds of third-party IHS revenues as of 2021.
Some tribal health systems receive more federal funding through Medicaid than from IHS, Roberts said.
Tribal health leaders fear diminishing Medicaid dollars will exacerbate the long-standing health disparities — such as lower life expectancy, higher rates of chronic disease, and inferior access to care — that plague Native Americans.
The unwinding has become “all-consuming,” said Monique Martin, vice president of intergovernmental affairs for the Alaska Native Tribal Health Consortium.
“The state’s really having that focus be right into the minutiae of administrative tasks, like: How do we send text messages to 7,000 people?” Martin said. “We would much rather be talking about: How do we address social determinants of health?”
Melli said she has stopped hearing of tribal members on the Fort Peck Reservation losing their Medicaid coverage, but she wonders if that means disenrolled people didn’t seek help.
“Those are the ones that we really worry about,” she said, “all of these silent cases. … We only know about the ones we actually see.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Part 2 of a 3-part series.
South Dakota’s weak open records law gives police agencies full discretion on whether to release footage from body or dashboard cameras, and in most cases, the videos of officer conduct are never shown to the public.
South Dakota News Watch made formal public records requests to obtain video footage of use of deadly force incidents from eight separate law enforcement agencies in November, and all of the requests were quickly denied.
On a few occasions, South Dakota law enforcement agencies have released video footage of their own accord but not necessarily in cases where officer conduct is in question.
The Watertown Police Department released a video on Facebook in early November showing officers responding to a possible break-in with their guns drawn only to find a whitetail buck that had made it into a bedroom.
In 2016, the Rapid City Police Department posted a dash cam video to its public Facebook page showing the chief’s nephew proposing to his girlfriend in a mock traffic stop. “This one is too good not to share,” the Facebook post noted.
The Rapid City Police Department rejected News Watch’s request for videos of a May 30, 2023, incident in which an officer fatally shot 25-year-old Kyle
Whiting, who brandished a fake gun during a foot chase. A bystander inside a nearby home was also shot in the abdomen by the officer and survived. The state ruled the shooting was justified.
Still images tend to clear officers
Some police agencies will occasionally release still images from body or dashboard camera videos, typically when the screenshots show an officer facing a clear threat that appears to justify use of deadly force.
In August, the state released an image from video of a July 5 chase in which a Sioux Falls police officer shot and wounded 24-year-old Deondre Gene Black Hawk in the 100 block of Garfield Avenue.
One still image released to the public shows the gun Black Hawk fired at police. Another image shows Black Hawk pointing the gun toward a pursuing officer prior to the shooting, which was ruled justified by state investigators.
In 2022, the Rapid City Police Department took the unusual step of inviting local media to privately view body camera footage showing the shooting of Barney Leroy Peoples Jr., who was killed after pointing a rifle at officers. The video was not released to the public, and the shooting was ruled justified by the state.
“This was done for public interest and public safety to dispel a false narrative circulating on social media that could have led to civil unrest,” spokesman Brendyn Medina wrote in an email to News Watch.
In a move that appeared to have political overtones, videos were released in 2021 showing former South Dakota Attorney General Jason Ravnsborg being pulled over by officers for suspected traffic violations. The videos and audio showed Ravnsborg informing officers of his status as attorney general during the traffic stops, some of which did not result in tickets.
The videos were released during a period when Ravnsborg was facing possible removal from office for striking and killing a pedestrian in September 2020.
Ravnsborg was eventually impeached, an action supported by then-Gov. Kristi Noem, whose office also made the unprecedented move of releasing videos of Ravnsborg being interviewed by detectives during the investigation into the 2020 fatal accident.
Federal agency released SD shooting video
In general, the federal government provides more public access to police videos than states like South Dakota, and that access was expanded in a May 2022 executive order from President Joe Biden.
That order included a requirement to expedite public release of videos from officers’ body-worn cameras. As a result, in October 2022, the U.S. Department of Interior issued a new policy that required federal officers to wear body cameras and sought to make it easier and faster for the media and public to obtain videos captured by federal authorities.
Due in part to that policy, video of a June 2023 police-involved shooting in South Dakota was released by the federal Bureau of Indian Affairs. In that incident, 39-year-old James Schneider of Watauga fired a weapon and then led authorities on a vehicle chase that ended at the Bullhead Community Center parking lot.
According to the dashboard video, Schneider was waving his arms and holding a handgun in an area where people were present. After he turned to flee into a residential neighborhood, he was shot in the back by an officer. Schneider was found guilty in August of assault and weapons charges after a jury trial and is awaiting sentencing.
In releasing the video, the BIA said it was doing so to be transparent in its operations. To protect the privacy of all involved, faces were blurred in the video.
“The community briefing video is intended to help members of the community gain a better understanding of what occurred,” the BIA said in a release. “We are committed to being transparent with our community.”
Privacy a top concern for agencies
Rapid City police do not routinely release department videos, largely due to privacy concerns of anyone captured in the footage, said Medina, the department spokesman.
“Much of the information collected by (body-worn cameras) is confidential and involves personal information, including that of victims, juveniles, and vulnerable individuals involved in critical and traumatic incidents,” Medina wrote in an email. “It’s important to note that we have had requests from victims and families specifically not to release photos or videos of their encounters with police. Additionally, juvenile and victim information is protected by state statute.”
Almost all states that allow for public video releases do so with caveats that privacy issues and often concerns over protecting prosecutions are met prior to release.
Rapid City shares the management of its video program with the Pennington County Sheriff’s Office, which recently spent about $48,000 to buy 68 Axon body cameras, said sheriff’s spokeswoman Helene Duhamel.
The Sioux Falls Police Department has an extensive video policy that does not typically allow for public release of videos, said Sgt. Aaron Benson.
“Granting public access to dash and body camera video potentially involves numerous issues relating to the rights of all persons in those videos. These rights include but are not limited to general privacy concerns of victims, suspects, witnesses and others, to statutory and constitutional rights of those same individuals,” Benson wrote in an email. “Additionally, release of video can detrimentally affect ongoing investigations, prosecutions and other legal matters related to those videos.”
McPherson County Sheriff David Ackerman, president of the South Dakota Sheriff’s Association, said body and dash cameras are important tools for police agencies in both urban and rural areas, even though his camera program costs about $60,000 a year, roughly 10% of the overall departmental budget.
“These are very valuable tools, and it’s something that in this day and age, every office and agency needs to have,” Ackerman said. “I’m glad where we are today because they’re for the protection of the public as well as the officers.”
Assistant police chief on body cam: ‘I enjoy wearing it’
Monty Rothenberger, assistant police chief in Yankton, said he supports the use of dash and body cameras as a way to increase accountability for officers and to aid in resolving public complaints.
“I wouldn’t do this job without a body camera, and I enjoy wearing it,” Rothenberger said. “I don’t have anything to hide. And because everything is on video, I feel like Big Brother is watching and I support that.”
The Yankton Police Department bought new cameras last year at a cost of about $80,000, he said.
Rothenberger said that while he is aware of South Dakota public records laws that do not require the department to release videos to the public, he said he personally would support the release of videos in a high-profile or controversial case.
“I’m only speaking for myself, but I would never hide anything like that,” Rothenberger said. “That’s not up to me. … (But) releasing that stuff, it’s good that agencies release things when something has gone wrong and they are being transparent.”
Read part 1 of the 3-part series:
Police videos in SD: Public pays costs but cannot see footage As more states begin to provide public access to videos captured by law enforcement agencies, South Dakota continues to keep a tight lid on them.
Publishing Friday, Dec. 19, part 3: A 2020 legislative effort to regulate body camera videos never made it to a vote, maintaining South Dakota’s national reputation for law enforcement secrecy
This story was produced by South Dakota News Watch, an independent, nonprofit organization. Read more stories and donate at sdnewswatch.org and sign up for an email to get stories when they’re published. Contact content director Bart Pfankuch at bart.pfankuch@sdnewswatch.org.
SIOUX FALLS, S.D. (Dakota News Now) – The governor’s Correctional Rehabilitation Task Force, which aims to determine the best path forward for expanding services, will hold its second meeting on Wednesday.
The meeting will continue the dive into what programming should look like for the new prison. Officials in the Department of Corrections say they appreciate the attention to the issue shown over the year.
“The focus is in the right place. I think people are asking the right questions. I think that it’s being noticed that reentry in totality is a group effort,” Justin Elkins, DOC Chief of Behavioral Health, said.
Sitting at 43%, lawmakers and the Rhoden administration have dedicated a substantial amount of time to addressing recidivism in the state.
“I think people are starting to see that reentry is something our department needs help within terms of collaboration and relationships. Because we only determine part of the equation when it comes to reentry,” Elkins said.
Corrections Reentry Program Manager Scott Day says this change in perspective regarding inmates is needed.
“95% of these individuals are going to come back into your community. They’re going to be your neighbors. They’re going to work at your local fast-food restaurant or at your local store. You’re going to see them walk down the street. We just need to see as a culture that these aren’t bad people; these are just people who need an opportunity to show that they can succeed.”
The prison reset task force, which focused on the structure of the new prison, ensured that programming space increased from what is currently available, even when the location changed from Lincoln County to Sioux Falls.
“There’s not a day that goes by that I don’t constantly think about what we could do more. And the new prison is needed. We need the space, we need the opportunity to get more programming in there,” Day said.
Day says the investment into programming space is not a matter of being soft on crime but rather smart on public safety.
Copyright 2025 Dakota News Now. All rights reserved.
Link to the listing: https://www.frrmail.com/…
For more information, contact: Cory Busse, Farm & Ranch Realty, Inc., at 785-332-8345 or frr@frrmail.com
KENTUCKY, Hopkins County. Five tracts of river-bottom cropland totaling 597.9 acres sold at auction for $5.39 million, or $9,015 per acre. Tracts ranged from 16 to 255 acres, with much containing drainage tile. Soil types were primarily Karnak silty clay and loam with some Belknap and Robbs silty loam. Structures included a tool shed and a 5,000-bushel grain bin. Tracts ranged in price from $7,800 to $11,500 per acre.
Link to the listing: https://www.kurtzauction.com/…
For more information, contact: Joseph Mills, Kurtz Auction & Realty Co., at 800-262-1204 or jmills@kurtzauction.com.
SOUTH DAKOTA, Dewey County. A contiguous, 1,529-acre farm sold to a single bidder at auction for $2,600 per acre, or $3.98 million. The property was offered in four parcels, two of which were historically in crop production (wheat, oats, corn and sunflowers) and boasted Soil Productivity Indexes of 70 or higher. Another highly productive parcel was planted in grass and alfalfa but could be converted to row crops. The remaining parcel included a blend of cropland, pasture and an updated home with a steel barn, shop, two Quonset-style buildings, continuous panel corrals and water tank.
Link to the listing: https://glcland.com/…
For more information, contact: Kristen Gill, Gill Land Company, at 701.934.2732 or 605.848.4502 or kristen@glcland.com.
**
— These sales figures are provided by the sources and may not be exact because of rounding.
— Submit recent land sales to landwatch@dtn.com
Katie Dehlinger can be reached at katie.dehlinger@dtn.com
Follow Katie on social platform X at @KatieD_DTN
(c) Copyright 2025 DTN, LLC. All rights reserved.
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