South Dakota Passes Historic Bill To Create Indian Medicaid Managed Care Task Force

Tribal sovereignty and smarter healthcare spending just found common ground in South Dakota.

HB 1006 Could Shift Medicaid Costs From State To Federal Government

South Dakota’s HB 1006, delivered to the Governor on March 12, 2026, establishes a 20-member task force to study the creation of Indian Medicaid Managed Care Entities under 42 U.S.C. § 1396u-2(h). The legislation passed the House 60–7 and the Senate 32–2 with bipartisan sponsorship from Representatives Will Mortenson (R), Eric Emery (D), Peri Pourier (R), and Senators Jamie Smith (D) and Tamara Grove (R). Under current Federal Medical Assistance Percentage rules, South Dakota state government pays 49.33% of Medicaid expenses in fiscal 2027 — a share that has risen five consecutive years. If tribal entities manage Medicaid for Native populations, the federal government would pay 100% FMAP.

Tribal Leaders Champion A New Model For Indian Country Healthcare

Rosebud Sioux Tribe President Kathleen Wooden Knife and Sisseton Wahpeton Oyate Chairman J. Garret Renville have been central voices behind this effort. During the annual State of the Tribes address, President Wooden Knife urged lawmakers to support tribal-managed Medicaid, noting it would increase federal healthcare resources for Our Relatives while reducing state expenditures by millions of dollars. Medicaid is projected to surpass K-12 education as South Dakota’s largest general fund expense in fiscal 2027, making this task force critically urgent for state and tribal budgets alike.

What The Task Force Means For Native Health And IHS-Served Communities

The task force includes representatives from all nine federally recognized tribes in South Dakota, three state departments, a Bureau of Indian Affairs official, and healthcare industry members. Findings and proposed legislation are due to the Governor by December 1, 2028. For Indian Health Service facilities, tribal health programs, and Native practitioners serving elders and families across Indian Country, this model could transform how culturally competent Medicaid care reaches Indigenous communities statewide!

Ellsworth, a Native owned small business and ISBEE-certified medical staffing company, stands with tribal nations advancing self-determined healthcare. As tribal Medicaid managed care entities take shape, staffing those systems with qualified, culturally aware professionals will be essential. Contact Ellsworth to learn how we support IHS facilities, tribal health programs, and rural hospitals across Indian Country.