What Does South Dakota Owe Children?

Deb Soholt served in the South Dakota Senate for eight years, representing District 14 in Sioux Falls. She was Chair of the Senate Health and Human Services Committee and led the Jolene’s Law Task Force for six years, which eventually funded the Center for the Prevention of Child Maltreatment (CPCM) to end child sexual abuse in South Dakota. 

A registered nurse, Soholt was the Director of Women’s Health at Avera McKennan and a Fellow in the American Academy of Nursing. Currently she heads up InfluentialSHE, which includes podcasting and working to help women accelerate their influence. She is a Children’s Home Society board member and has served in numerous leadership roles in the community. 

Q: Families care for their children. But when they can’t, for whatever reason, whose responsibility is it?

Deb: The issue with kids is—they're everything. They’re our complete and total future. Sometimes we might think that it’s just the kids who come from really solid family structures where there isn't a lot of vulnerability, but it's really all the kids, even those who are in difficult situations through no fault of their own. 

It has to be a state and private sector partnership. And so what does that look like?  And what are the obligations of the taxpayers of South Dakota in relationship to nurturing and lifting up the most vulnerable? It’s not just because they’re vulnerable, but because of what they represent. Without them, we’re nothing.

So it really needs to be an infrastructure of shared responsibility. And that requires defining—what is the state's role, what is the people's role through their taxpayer dollars? And then, what is the role of private partnership?

Q: Let’s start with the state’s role.

Deb: As a legislator, you're very focused on what's happening right now. When you look at trying to balance a budget every year, you have to take a strong look at what's  before you.

Everybody wants better for our kids. It's just that there are so many competing variables for precious tax dollar appropriation. And then, to think 20 years, 30 years ahead, what will be the return on investment? Are we going to invest in children’s well-being, or do we just watch child abuse, drug abuse and juvenile crime continue to increase?

We're talking about culture shifting; we're talking about shared responsibility shifting. How does the health of people improve? How do we have less vulnerable children? How do we have less domestic violence? Because these aren’t tangible outcomes that we can really wrap your arms around today, it's difficult to arrive at a shared vision ofthe future.

Q: What is the role of the private sector? Does that also include charity and nonprofits?

Deb: Yes, and so often, we think that philanthropy should just take care of children—churches, organizations and people donating their money. That’s good, but it can’t be depended on and it means children are not a priority, which I don’t think any of us believe.

What we know now is based on epigenetics and what happens during pregnancy. Stress upon the mom in pregnancy and the early vulnerabilities in children when they're under high stress, particularly in the first couple years of their life, become embedded at the cell level. I think that’s one of the things people don't understand. We think, “Well, you should just be able to pull yourself up from your bootstraps.” And yes, you can, but someone with a childhood marked by trauma will have to overcome many, many hurdles.

So it's the responsibility of everyone in South Dakota to provide a framework in order to punch through all of those things that are embedded in these children— through no fault of their own. We're at a point in time now where we really have to level set what is that primary obligation on behalf of the state in relationship to these children.

Q: Can you tell us about the Medicaid funding issue that the state’s youth care providers are facing?

Deb: Well, I’m familiar with the challenges that Children’s Home Society (CHS) faces in that regard, so I’ll use them as an example. This is where kids come that have psychiatric issues, that have safety issues within their family. They have decades upon decades of lifting up these kiddos who just need the most help possible.

This year, CHS is requesting that the Medicaid rate—what the state pays for the care of the children—be increased. Right now, there is a large gap between what the state pays and the actual costs of caring for the children. The current Medicaid rate is based on data from 2016.

What’s happened is that providers like CHS are forced to use philanthropy dollars for day-to-day operations. Any other Medicaid support provider—hospitals, nursing homes, community service providers—would be astounded if they had to use philanthropic dollars for 31% of their operational cost. No one else receiving Medicaid is being asked to do that.

Q: What happens if organizations like CHS cannot continue caring for these children?

Deb: Well, what will happen is what's happening right now. The children are being sent out of state at a very much higher cost to the state of South Dakota. In 2022, the state spent $9.4 million sending children to out-of-state providers.

This is significant because we do have enough beds in South Dakota for those kids. But it’s the domino effect: the state doesn’t pay enough to cover care, so the providers cannot keep fully staffed, so beds can’t be filled. 

In the end, the answer is that if youth care providers are not doing this work, it lands right on the doorstep of the state because, ultimately, South Dakota is responsible for these children.

Q: Is it difficult work?

Deb: It is. Think of the hard work of taking care of kiddos who are having psychiatric issues as a 24/7 proposition, and then think about the lesser pressure of working at a fast food restaurant. You just do not have the same emotional engagement. 

Yet, I would counter that the work is soul searching, and it is work that has meaning and allows you to see tangible outcomes. But you can’t expect that people will sacrifice better wages to take care of children. That's just unreasonable. 

And again, who do we want caring for vulnerable children? Should they have the same qualifications as fast food workers? Should we be willing to pay more for a certain level of experience or education?

We are looking for the state to catch up with what is a reasonable payment platform, especially when CHS takes care of children nobody else does, the four-to-nine year olds. In addition, CHS is Joint Commission certified, which means meeting very high quality standards.

Q: Do you think the drive for rebasing the Medicaid rate fairly will succeed?

Deb: I hope so. Now, when I say that, I don't mean the legislators don't care; they care deeply. It's just difficult with all of the different funding priorities, and it’s not as exciting or interesting as some other business propositions.

Yet it makes such a difference in outcomes for these children. And it’s the only way to ensure that we have the proper quality, safety and non-retraumatization of the children. 

These are kids. They are not adults who can make decisions for themselves. It's up to us to stay committed to a reasonable infrastructure based on our current market, our current workforce and our current situation with these children. It's up to all of us to stay focused on the infrastructure needed to make that happen.

Q: Any additional thoughts?

Deb: Just that the more I'm involved in the direct day-to-day with CHS, I'm just so incredibly impressed with the caliber of leadership all the way through the organization, the caliber of commitment and the caliber of outcomes. These are measured and are tangible, for all to see. What an amazing organization CHS has been, is, and continues to be as they grow and change for the future. It's incredible.