RAPID CITY, S.D. — South Dakota is one of 14 states that has not expanded Medicaid under the Affordable Care Act, a move that would improve healthcare services for the state's large American Indian population, according to one expert.

Nurse Margaret Moss has spent 30 years researching and educating the public about the health of indigenous people. South Dakota has the fourth-largest percentage of Native Americans in the U.S., with rates of death from heart disease, diabetes, pneumonia and other causes that are significantly higher than non-Hispanic whites. And Moss said the numbers have been static for three decades.

"People think American Indians are the past, they're not around anymore,” Moss said. “And if you don't have a very good understanding or view of the history or politics, or culture of American Indians in a state, then you're not going to vote for things."

Gov. Dennis Daugaard appointed a coalition four years ago with the goal of improving healthcare for American Indians. But opposition from fellow GOP lawmakers led him to decide against applying for Medicaid expansion, and the coalition was disbanded last month.

In South Dakota, 36 percent of the 50,000 state residents who would qualify for expanded Medicaid are Native Americans. The state's Argus Leader newspaper recently reported the median life expectancy for Native Americans in South Dakota is 21 years shorter than the state average.

Moss said a huge obstacle for improving healthcare is patient misidentification, which is higher for American Indians than any other group.

"So, if the numbers are all wrong, we don't even really know what are the true death rates, what are the true cancer rates, or admission rates, access rates,” she said. “We don't know a whole lot because nobody asks, or they guess."

In the 1800s, the U.S. government promised to provide health services for tribes in exchange for their land. But Moss said the federal Indian Health Service is chronically underfunded. She noted there are now 573 federally recognized U.S. tribes. But when addressing policymakers, she's found few are familiar with their own state's demographics.

"'Do you know the tribes that are there, and what are they, and whatever?' And no one ever knows!” Moss said. “I said, if you don't know that, how can I even get to the intricacies of their specific problems."

The Indian Health Service is one of several agencies affected by the current government shutdown.


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The Jackson-based group Native American Jump Start has been providing grants to Native students, interns and young workers for decades and this year, has added an ambassador program.

Nine ambassadors across the country will help spread the word on Native American Jump Start opportunities, up to 100 microgrants per year to help, among others, students at any level of higher education.

Wicahpi Chaddlesone-Yankton, grant and operations coordinator for the group, said they want to highlight more student voices and half of ambassadors in the first cohort are current students.

"We wanted to have our ambassadors work with their Native student centers or organizations on their campus and just help bring NAJS's voice into a bigger light," Chaddlesone-Yankton explained.

The group is funded by private donations and therefore will be directly affected by cuts from the Trump administration. Meanwhile, the Native American Rights fund in March sued the U.S. Interior Department and the Office of Indian Affairs over the federal administration's cuts to the Bureau of Indian Education.

O'Shay Birdinground comes from the Great Apsaalooke Nation and will graduate this spring from the University of Montana. He first used Jump Start funding to attend a conference. Now as an ambassador, Birdinground encouraged "future Indigenous leaders" to take advantage of educational opportunities.

"There are a lot of opportunities out there for education and leadership development," Birdinground emphasized. "I wouldn't hesitate to jump on any one of those opportunities that is provided to you."

The application period for Native American Jump Start's education grant funding for this fall opens April 1.

Support for this reporting was provided by Lumina Foundation.

Indigenous people have made great contributions to the state of Wisconsin yet the alarming rates of violence against them remains a public health crisis.

A new study showed intimate partner violence disproportionately impacts Indigenous women more than any other ethnic or racial group in the U.S. The murder rate for Native American women and girls is up to 10 times higher than the national average, according to the U.S. Department of Justice, yet they account for less than 1% of the population.

Desiree Tody, outreach program coordinator at the Center Against Sexual and Domestic Abuse and a member of the Red Cliff Band of Lake Superior Chippewa, said violence against Native women is underreported and unaddressed.

"There's jurisdictional issues that come into play as to how things are investigated, how things are tried, and there's always racism," Tody observed. "There's less attention paid to the individuals that some of these things happen to."

The Wisconsin Department of Justice created a task force to combat violence against Native women across the state after legislation which would have addressed the issues failed to pass. There are currently no upcoming task force meetings listed on the newly updated DOJ website.

Poor tracking and data collection are among the many issues contributing to the epidemic among Indigenous women. During a multistate march last month, Tody read a list of names of Indigenous people from Minnesota who had died from domestic violence. No such list currently exists for Wisconsin and Tody noted she is working to change it.

She emphasized the great need to address the systems in place, which continue to fail Native people.

"I have three daughters that I want them to grow up as strong Native women and I want them to grow up safely as strong Native women," Tody explained. "This is their futures on the line. This is their ability to walk down a street safely."

Research shows Indigenous women also face significant barriers when seeking help after experiencing domestic violence. A survivor of domestic violence herself, Tody works with the Center Against Sexual and Domestic Abuse to provide resources for those affected in Bayfield and Ashland counties. Gov. Tony Evers has proposed a $20 million funding increase for domestic abuse services in his current executive budget.


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Three Montana bills regarding Native rights and culture advanced from the Senate to the House this week, despite some previous setbacks. Bills to revise the Montana Indian Child Welfare Act and Indian Education for All laws, both tabled within the last month, were this week both passed the Senate and were transmitted to the House. The education bill would require more tribal consultation, more work with language and culture specialists, and more accountability from the state's Board of Public Education.

Keaton Sunchild, director of government and political relations for Western Native Voice, says understanding historical context is critical.

"I think it's hugely important that we continue to teach the history and the culture of Native Americans here in Montana," Sunchild said. "It's pretty hard to do any sort of Montana history without talking about Native American history."

Senate Bill 147 would expand the 2023 Indian Child Welfare Act to include more frequent and robust tribal participation, in recognition of the cultural losses an Indian child placed in a nonnative foster home may experience. In 2020, American Indian children made up 9% of all Montana children, but were 35% of kids in foster care, according to the state's judicial branch.

A bill to make voting more accessible for Native communities was heard last week, but still requires a vote. Sunchild said the major arguments he's heard against the bill are around the costs of implementing more resources for voters, but added that those one-time government costs would save many individuals' repeated costs.

"Between gas, food, child care, days off work, we have voters who are paying $200 sometimes, if not more, to go vote. Voting's inherently supposed to be free," Sunchild continued. "And we're saying that it's really not for Native American communities."

A bill to recognize Indigenous People's Day as a legal holiday in Montana passed the Senate on Wednesday almost unanimously. Sunchild said this version received more support than its predecessors because it calls for the holiday in conjunction with, instead of replacing, Columbus Day.