SOUTH DAKOTA’S SEXUAL ASSAULT EXAM PAYMENT SYSTEM CREATES BARRIERS FOR SURVIVORS
SIOUX FALLS, S.D. (Todd Epp / Northern Plains News) – South Dakota’s system for paying for sexual assault exams is creating problems for victims and making care uneven across the state, according to experts who met in Sioux Falls yesterday (Monday).
The University of South Dakota studied this issue last August and found that the current system, where each county pays for these exams, leaves some victims with surprise medical bills.
“Some patients get unexpected bills or are told not to get these exams due to county budget concerns,” the USD report states. “These problems come from unclear laws and placing payment duties on counties.”
State Representative Kadyn Wittman, who joined the April 14 panel at the Sioux Falls rotary meeting, expressed concern about South Dakota’s high sexual assault rate, noting the state ranks in the top ten nationally with 50 cases per 100,000 people.
“There’s not enough of us to work against each other, so seeing that collaboration and open lines of communication between law enforcement and victim services and emergency departments, that was really heartening for me,” Wittman said, Dakota News Now reported.
The South Dakota Department of Health reports that the state’s rape rate is 55.8 per 100,000, much higher than the national average of 40 per 100,000. The Compass Center notes that South Dakota has 1.5 times the national average rate of forcible rapes.
South Dakota is one of just 11 states where counties pay for these exams. Nearby, Minnesota recently changed its system so that the state government pays instead of counties. A special state fund in Nebraska covers the exam, facility fee, and testing costs.
For sexual assault victims in rural counties with tight budgets, this system creates a troubling gap in care. The USD report found that counties with limited money tend to cover only basic exam costs, which may leave victims without full treatment.
Despite these problems, some progress is being made. In February 2024, the South Dakota Senate voted 30-3 to give $5 million to sexual assault, domestic violence, and children’s shelters across the state, South Dakota Searchlight reported.
However, the state’s basic funding for domestic abuse and sexual assault programs has stayed at $225,000 per year for over a decade — which is $25,000 less than when the fund started in 1993.
These local funding issues come as federal support also faces cuts. On April 1, the Department of Health and Human Services reduced staff for teams working on sexual violence prevention, NPR reported.
The USD researchers suggest, at minimum, that South Dakota make its laws clearer to ensure all counties handle billing the same way. This would reduce confusion and help patients understand what costs are covered.
For people in South Dakota, this payment issue isn’t just paperwork — it’s a public safety concern that affects healthcare access, justice for crime victims, and the safety of every community in the state.
FEDERAL FALLOUT LEADS TO SUSPENSION OF INTERLIBRARY LOAN COURIER SERVICE IN SOUTH DAKOTA
SIOUX FALLS, S.D. (Makenzie Huber / SD Searchlight) – Checking out some books through local libraries could soon cost more than a standard library card fee.
Libraries were instructed Monday to immediately suspend use of the state’s interlibrary loan courier program.
The courier service transports books and other library materials across South Dakota from the libraries that have them to those that don’t, typically faster and more efficiently than would be possible though the U.S. Postal Service.
The State Library relies on federal funding from the Institute for Museum and Library Services (IMLS) to pay for the program.
President Donald Trump signed an executive order in March directing the head of that federal agency — which provides a federal grant that funds around half of the South Dakota State Library’s services — to cut its operations to the “maximum extent allowable by law.”
Former Gov. Kristi Noem sought to cut state library funding in her proposed budget to a level too low for the state to continue receiving federal matching funds. The state Legislature, however, approved a pared-back library budget large enough for the state to maintain access to about $1.4 million in IMLS funding.
While South Dakota hasn’t gotten confirmation its funding is cut, Department Secretary Joe Graves told the state Board of Education Standards on Monday, the federal government notified other states they’re receiving cuts.
“South Dakota, at least to my knowledge as of 8 a.m. this morning, hasn’t heard. So we don’t know what’s going on with that,” Graves said Monday.
DRUGMAKER SUES SOUTH DAKOTA OVER LAW PRESERVING BROAD ACCESS TO DISCOUNTS FOR HOSPITALS, PHARMACIES
SIOUX FALLS, S.D. (John Hult / South Dakota Searchlight) – A drugmaker is suing South Dakota over a law that bars the company from limiting drug discounts used to prop up providers who serve Medicaid patients.
The lawsuit is from Chicago-based AbbVie Inc., which sells the wrinkle-remover Botox and the arthritis drug Humira, among other products. The litigation challenges the legality of a bill signed into law by South Dakota Gov. Larry Rhoden on March 11.
Senate Bill 154 bars drug companies from limiting the number of pharmacies that hospitals and clinics can contract with to distribute drugs through the federal 340B program.
The bill’s supporters called 340B a lifeline for rural health care providers and pharmacies. Those providers are kneecapped by Medicare and Medicaid reimbursements too low to keep the lights on, they said, and they need the supplemental income.
The bill’s opponents, however, argued that the way providers use 340B to recoup their expenses — by getting drugs on the cheap and marking them up — is unsustainable, harmful to patients and interferes in the free market.
The Legislature sided with providers.
In its lawsuit, AbbVie Inc. alleges that South Dakota’s new law amounts to an illegal “taking” of the company’s products by forcing it to provide them at a discount through contract pharmacies without any say in which or how many pharmacies are involved.
The company also argues that SB 154 alters the terms of a federal law South Dakota legislators did not write and cannot legally modify, and that it seeks to regulate interstate commerce in a way only Congress has the power to do.
The bill “places an improper thumb on the scale and tilts the bargaining power in favor of in-state pharmacies and covered entities at the expense of out-of-state manufacturers,” the lawsuit says.
Other states have passed similar laws and faced similar lawsuits.
AbbVie filed its lawsuit Thursday in U.S. District Court in South Dakota. Six days ago, a federal judge in Minnesota dismissed a similar case challenging the legality of a similar law in that state.
The Eighth Circuit of Appeals ruled in favor of Arkansas for its version of the law.
The pharmaceutical industry has also won some victories, though. Last summer, in a case filed by United Therapeutics Corporation in Washington, D.C., a three-judge panel upheld a lower court’s ruling that the law behind the 340B program doesn’t bar drugmakers from imposing limitations on how it distributes drugs through the program.
Attorney General Marty Jackley is a named defendant in the South Dakota case, as is Larry Deiter, director of the state Division of Insurance.
Jackley’s office defends state law in court, regardless of Jackley’s status as a named defendant in a case. His spokesman, Tony Mangan, told South Dakota Searchlight on Friday that the state had not yet been served with a copy of the lawsuit.
History, changes to program
The 340B program requires drugmakers who want to participate in Medicaid and Medicare to discount their prices for hospitals, clinics and other providers that serve low-income patients. Those “covered entities” can then sell those drugs at a higher price and use the difference to help fill budget gaps and keep the doors open for patients.
When it became law in 1992, 340B was limited to a small subset of hospitals and clinics, like those serving mostly Medicaid patients. The Affordable Care Act of 2010 expanded 340B to a wider range of providers, roping in places that act as “sole community hospitals” for Medicaid patients who reside in rural geographies. Since then, according to a report from the American Hospital Association, the number of rural providers using it has more than doubled.
What’s also happened, according to the lawsuit from AbbVie, is an expansion of access to lower prices by contract pharmacies.
Commercial pharmacies don’t qualify as “covered entities” under 340B, meaning they don’t have access to discounted drugs unless they contract with a health care provider who does.
The lawsuit paints the agreements between Medicaid-serving providers and their contracted pharmacies as a way to make money on the backs of drugmakers and low-income patients.
“Instead of serving the covered entities’ uninsured and low-income patients, the for-profit contract pharmacies acquire manufacturers’ drugs at the federally discounted price, sell them to patients (including indigent patients) at full price, and pocket the difference,” the lawsuit says.
South Dakota providers: Program keeps us afloat
Lobbyists for South Dakota’s health care systems, rural hospitals and pharmacists offered a different perspective on the arrangements.
Mobridge Regional Hospital Director John Ayoub told lawmakers in February that his nonprofit system serves clients across North and South Dakota.
“We are the only hospital providing obstetrical services and delivering babies, as well as the only hospital providing general and trauma surgery services in at least a 100 mile radius in every direction,” Ayoub said.
Many of its patients qualify for Medicaid, Ayoub said, and low reimbursement rates mean the Mobridge system often operates in the red. It lost $600,000 last year, he said, and $1 million the year before.
Without the financial prop-up of 340B — funded by drugmakers, not taxpayers — some services might have to end and “people will die.”
“This is not hyperbole,” he said. “It’s just a fact.”
Dillon Kjerstad operates independent pharmacies in Philp and Custer. He said the ability to collect a “reasonable fee” through 340B helps him keep the doors open. If drug companies were able to limit contract pharmacies, it might make it impossible for him to continue offering drugs to Medicaid patients.
“Driving 90 miles to Rapid City in the dead of winter just isn’t an option for my pharmacy’s senior diabetic patient who needs medications now,” Kjerstad said Feb. 19.
Drug company lobbyists and the lobbyist for a free-market political organization told lawmakers that the bill seeks to solve a problem that ought to be solved by Congress.
Sen. Sydney Davis, R-Burbank, voted in favor of SB 154. Before casting her vote, though, she offered a nod to the notion that 340B fills a gap created by low federal reimbursement rates.
“Hospitals and clinics and pharmacies are playing the cards that they’ve been dealt,” Davis said. “And Congress needs to take action.”
EDUCATION BOARD VOTES TO FINALIZE PHONICS-BASED READING INSTRUCTION FOR SOUTH DAKOTA
RAPID CITY, S.D. (Makenzie Huber / South Dakota Searchlight) – It’s out with the new and in with the old again for students in South Dakota’s English and Language Arts classrooms.
The South Dakota Board of Education Standards approved revisions to the English and language arts state standards Monday in Rapid City, aligning them with a once-abandoned instructional approach in hopes of improving students’ reading comprehension.
The revision follows a global debate — often called the “reading wars” — about how best to teach children to read. One camp advocates for phonics, which focuses on the relationship between sounds and letters. The other prefers a “whole language” approach that puts a stronger emphasis on meaning, with some phonics mixed in. A phonics-based approach was widely used in the 20th century until a “balanced literacy” approach that includes phonics but favors whole language gained favor in the 2000s.
Low reading scores in recent years led to a push to reconsider the merits of the phonics-based “science of reading” methodology.
Just under 50% of South Dakota students didn’t meet English and language arts standards last year, according to the state report card.
School district credits science of reading for 50-point jump in proficiency
Studies in recent years have re-ignited interest in phonics as a learning tool, and one South Dakota school district presented results Monday that suggest it can work.
Douglas School District leaders presented the district’s increased literacy rates since implementing science of reading curriculum district-wide in 2021.
Fifty-five percent of Douglas elementary students in the spring of 2019 did not meet expected standards for reading ability, according to district student assessments. The district made systemic changes, such as hiring instructional coaches and allowing all students to apply for Title I interventions, in addition to implementing science of reading methodology.
In the same year the district implemented the science of reading strategy, rates above expected standards increased to 64% of students. That grew to 72% district-wide by the spring of 2024.
“Our teachers are working tirelessly to meet the needs of all students, and this success doesn’t happen overnight,” said Ann Pettit, Douglas executive director of elementary curriculum and instruction.
Board of Education Standards Board President Steve Perkins said the data shows “things can be done” to address English and language arts proficiencies in the state.
The state put $6 million toward training teachers in phonics during the 2024 state legislative session. Part of the funding will go toward courses to train teachers in phonics-based teaching methods, and some will be used to pay for a literacy conference on Science of Reading strategies.
A $54 million Comprehensive Literacy State Development federal grant awarded, meanwhile, is set to help local school districts implement a phonics-based approach over the next five years. The grants will be awarded based on the number of low-income students in a district, and can be used for literacy coach salaries, teacher training or curriculum reviews.
On Monday, Perkins said the changed standards are a “big deal.”
“If kids can’t read — or don’t read to standard is a better way to put it — then we’re shortchanging them,” Perkins said.
The unanimous vote came after a fourth public hearing on the standards.
Board approved Indigenous content standards despite opposition
Board members also approved optional content standards for computer science and the Oceti Sakowin Essential Understandings, which educate students on the culture and traditions of Indigenous South Dakotans.
Several opponents with connections to South Dakota’s tribal nations borders spoke against the Oceti Sakowin Essential Understandings revisions.
Opponents criticized the underrepresentation of Dakota and Nakota tribes in the revised standards, and said there should be a more concerted effort to involve tribes.
“The problem with this process is it was conducted without meaningful, reciprocal, formal tribal consultation,” said Sarah White, founder and executive director of the South Dakota Education Equity Coalition.
White and others asked the board to hold off and reach out to tribal government leaders. But board members unanimously approved the revisions.
South Dakota Department of Education Secretary Joe Graves told board members the revision “was not a rushed process,” and incorporated opinions from a 34-member review committee, as well as tribal education leaders on the Indian Education Advisory Committee.
Perkins told opponents before casting his vote that the changes move the state in the “right direction.” He added that he takes direction from Gov. Larry Rhoden to press “reset” on tribal-state communications.
“What I hear is that what we may have isn’t perfect, and we clearly need to work harder on communication,” Perkins said.
The standards will be available for use by the South Dakota teachers who choose to teach them in fall 2026.
