PIERRE — If Medicaid services are ever to be expanded in South Dakota, state Secretary of Social Services Deb Bowman told legislators Tuesday, her first priority would be to help more financially strapped mothers-to-be during their pregnancies.

The goals of working with more pregnant women would be improving the chances that children will be born healthy and reducing the risks of premature births that often require intensive care and other expensive medical services initially and additional care for years during childhood.

Bowman said South Dakota’s economy would need to improve substantially, or someone would need to provide a major gift, for the state treasury to afford its share of the additional cost, currently estimated at $3 million annually as state government’s share of the $8 million-plus total.

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Speaking to the Legislature’s special committee studying Medicaid reimbursement, Bowman said Medicaid now covers pregnant women whose income is no more than $14,404 for a single-person household — 133 percent of the federal poverty level.

She would like to expand the eligibility to 200 percent of poverty, which would be $21,660 for that same single-woman household. The income amounts increase for each additional family member.

Bowman described the women currently served as “poor, very poor.”

Several committee members clearly were receptive. Rep. Paul Dennert, D-Columbia, suggested the Department of Social Services conduct a financial analysis that would estimate the potential benefits.

“You’d like to look at the long-term return,” Dennert said.

Rep. Darrell Solberg, D-Sioux Falls, led Bowman through a series of questions that illustrated the connection between paying more for services during pregnancy and needing to pay considerably less later for children’s health care.

“I just know we spend a great deal of money on neo-natal (medical care),” she said.

In 2008, South Dakota averaged 102,310 people monthly who were eligible for Medicaid. Of those, pregnant women were 2,682. The largest number were children of low-income families at 55,045.

State government spent $720.2 million on medical services for Medicaid recipients during the 2008 budget year.

State tax revenues covered $266 million, while the remainder was paid by the federal government.