South Dakota’s citizens have been working for a long time to get Medicaid expansion in their state, and they got it done Tuesday, becoming the seventh state where citizens had to overrule their elected officials to get the same access to health coverage enjoyed by millions of their fellow Americans.
The organizers there also learned from the experience of their six predecessors—Maine, Idaho, Utah, Nebraska, Oklahoma, and Missouri—where state legislators and governors have fought every step of the way to try to entirely disregard, toss, or undermine the voters’ will on this. South Dakota voted to put the expansion in their state constitution, 56% to 44%
The Kanas constitutional amendment extends Medicaid eligibility to anyone making less than 133% of the poverty level, which is about $18,000 for a single person and $36,900 for a family of four. This would bring about 45,000 South Dakotans into Medicaid coverage, about 14,000 of whom have no other option at all for other access to health coverage. The measure calls for the state to get it done by July 1, 2023, and also bars the state from making it harder for people to qualify with extra rules like work requirements, which the state has been trying to get approval from the federal government to do.
Currently, Medicaid coverage is only available to children, elderly, pregnant, disabled, or very low-income parents/caretakers of minor children. By low-income, they mean a household of three making less than $14,500/annually. The Medicaid program is a federal/state partnership, and states set the rules on income eligibility. One of their rules is that low-income childless adults who are not disabled are blocked from getting assistance. Or had been. That’s supposed to change under this constitutional amendment.
It’s a smart way around Republican lawmakers’ and Gov. Kristi Noem’s opposition to expansion; they will have much less room to sabotage it. That doesn’t mean, however, that they won’t take a page out of Missouri’s playbook and just make the roll-out of the program slow and painful. Or that the process won’t just be slow and painful because South Dakota is way behind in the whole technology thing.
Tricia Brooks, a Georgetown University research professor who studies Medicaid, told Kaiser Health News that the state probably isn’t prepared to handle it logistically. The Medicaid process and particularly the computer system it uses “has a long way to evolve,” Brooks said. “Unless they’re going to really boost their eligibility [processing] capacity, then I think we’re in for a rough or rocky start to expansion.”
“South Dakota is not advanced in their use of technology,” Brooks said. “I worry if it’s too manually driven that the state will be overwhelmed. And that will slow down the processing, and you could potentially see what we’ve seen in Missouri.”
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