Here's the tough call of the morning. Jonathan Ellis reports that South Dakota implemented a new rule on September 1 requiring Medicaid patients to get authorization from the state to seek medical treatment more than 50 miles from South Dakota (with the exception of folks headed to Bismarck for service, which makes perfect sense for folks all along lonely Highway 12). The rule is a reasonable cost check, used by many states as well as private insurers. The state hasn't been wielding it too avidly: Ellis says in the first two months of the rule, the Department of Social Services denied only 14 of 483 requests for out-state care.

Enter Nicole Cook, 31, mom of six, from Madison:

Cook originally went to Mayo in August after repeated doctor and hospital visits in Madison and Sioux Falls, she said. She was rapidly losing weight, was exhausted and in pain.

Testing at Mayo determined that she has a lung tumor, scarring in her lungs, bone lesions and other health problems. She was scheduled to return to Mayo in October with the hope that doctors there could find a cause for her maladies.

But this time, she was unable to go because the Department of Social Services would not authorize payment for the visit [Jonathan Ellis, "Medicaid Rule Drives Woman from S.D.," that Sioux Falls paper, 2014.12.01].

Cook says the state says South Dakota doctors can provide the care Cook needs. But South Dakota doctors evidently couldn't provide the diagnosis Cook needed. Nicole's husband Ryan says on his fundraising page that Nicole's local doctor actually dropped her, saying her case is too complex for him. One can thus understand her lack of confidence in her local docs and her preference to seek treatment from the Mayo docs. According to Ellis, Cook's Sioux Falls doctors are recommending Mayo for treatment.

But who gets to pick the piper: the patient or the payer? Cook or us, the taxpayers?

Cook is relieving us of that choice. She is moving to Minnesota and applying for Medical Assistance. As far as I can tell, Minnesota has no rules against moving primarily to qualify for public benefits. Minnesota's residency rules say that once she's physically present in the state and made clear her intention to stick around, she can qualify.

So how do we feel, South Dakota, about driving away someone who needs help?

p.s.: Cook's fundraising page shows about $4,800 raised toward a $150,000 goal. Please don't tell me that private fundraising is an effective way to pay for everyone's medical bills.