Since July 2023, more than 21,500 South Dakota residents have opted into Medicaid expansion, accounting for about 16% of the state’s total enrollees. This program, a collaboration between the federal and state government, provides medical coverage to adults, children, pregnant women, seniors and those with low incomes.
The expansion became possible after South Dakota voters approved a constitutional amendment in 2022, extending Medicaid to individuals whose incomes reach 138% or less of the federal poverty level, equivalent to $43,056 for a family of four or $20,783 annually for an individual in 2024.
Although the state Department of Social Services anticipated an enrollment of 57,000 people, the reality has shown a lower figure. About 40,000 enrollees are expected for 2025, a reduction of 17,000 from the initial projections.
New Enrollees Could Apply Now For Medicaid
Efforts to reach eligible patients include a new online enrollment system, designed to streamline the process and reach people where they are, according to Heather Petermann, director of Medicaid. Although a gradual increase in enrollments has been observed, some critics point to the department’s lack of outreach and publicity as a contributing factor to the lower-than-expected numbers.
Matt Althoff, secretary of the department, defends the constant flow of applicants and highlights that many enrollments come from medical referrals and the proactive search for eligible patients.
Brenda Tidball-Zeltinger, assistant secretary and chief operating officer, mentions that the Medicaid expansion is linked to other programs such as SNAP benefits (formerly known as food stamps). The strategy includes addressing other applicant needs to facilitate enrollment in expanded Medicaid.
The focus on preventive health care and screening is shaping up to be another Medicaid enrollment driver. The department has launched an online enrollment system on March 4 to streamline processes, with plans to expand it to other benefit programs in the future.
Who Qualifies for Medicaid in 2024? Eligibility Criteria and More to Know
The Medicaid program, in conjunction with the Children’s Health Insurance Program (CHIP), provides medical coverage to more than 77.9 million Americans, covering a wide range of groups, from children to the elderly and disabled. This initiative has become the main source of health care in the United States.
Medicaid eligibility is defined by federal law, which requires states to cover certain groups of people, such as low-income families, pregnant women, children, and those receiving Supplemental Security Income (SSI). However, states have the option to expand coverage to other groups, such as people receiving home and community-based services, or children in foster care who would not otherwise be eligible.
The Affordable Care Act of 2010 allowed states to extend Medicaid to cover nearly all low-income Americans under the age of 65. This expansion included increasing eligibility for children to at least 133% of the federal poverty level in all states and offering states the option to extend coverage to adults with incomes at or below 133% of the FPL. Most states have opted to expand coverage to adults, while others have not yet done so.
A modified adjusted gross income (MAGI) methodology is used to determine eligibility for Medicaid. This approach replaced the previous method based on the methodologies of the program for Helping Families with Dependent Children. MAGI considers taxable income and tax filing ratios to determine financial eligibility. Although most children, pregnant women, parents, and adults are evaluated based on MAGI, some people are exempt from these rules, such as those whose eligibility is based on blindness, disability, or advanced age.
Non-financial eligibility is also a criteria in Medicaid: Beneficiaries must meet criteria such as being residents of the state, U.S. citizens, or certain qualified non-citizens. In addition, the effective date of the coverage varies depending on the date of application and may be retroactive up to three months earlier, in certain cases.
