Initial Medicaid Implementation: South Dakota began their Medicaid program in October of 1967. When the program began the state did not provide coverage for people who were “medically needy.” As of 1963 South Dakota had not participated in the Kerr Mills program that proceeded the Medicare program. The state had submitted a plan to begin a program that would provide medical aid to seniors using federal funding, however the program had not been approved by the federal government by the time that conversations about beginning the Medicare program were in full swing. The plan proposed by the state would provide people who were eligible for coverage under the MMA program health insurance rather than directly paying for the services and expenses that these beneficiaries accrue.
Key Medicaid Political Issues: South Dakota has a high portion of the population living in rural parts of the state. This makes access to health care services difficult. South Dakota also has a high portion of the population who are Native Americans and receive Medicaid through categorical eligibility. South Dakota provides one of the lowest eligibility levels for pregnant women, infants, children and lower-middle income families through CHIP. South Dakota has a high rate of providers who accept Medicaid coverage with 100% of primary care physicians and hospitals accepting Medicaid in 2009. Most nursing homes and dentists in the state also accepted Medicaid patients. The state ranks second lowest in Medicaid administration expenditures. Due to the state’s small population, pilot programs in long-term care are able to affect a small population of beneficiaries that represent a larger share of the state’s expenditures.
Medicaid Expansion Implementation: As of January 2019, South Dakota has not expanded their Medicaid program under the Affordable Care Act. The state has been controlled by both a Republican governor and legislature since the option was made available in 2012. It is estimated that roughly 26,000 people are in the coverage gap or fall below 100% of the federal poverty level. The issue has been at the center of statewide politics in both the 2014 and 2018 gubernatorial elections. In 2014 Governor Daugaard requested an expansion of Medicaid up to 100% of the federal poverty level, or what is known as a partial expansion. CMS decided that Medicaid expansion was only available to states that expanded Medicaid up to the 138% of FPL. At the same time that Governor Daugaard was making this request, the state was running a budget surplus because the Medicaid enrollment was 10% lower than expected in the existing Medicaid program, even following the expansion of coverage due to the implementation of the Affordable Care Act. In 2014 a state panel also decided that South Dakota would not become the first state in the nation to allow people to vote on whether or not the state could expand Medicaid coverage. The Senate Affairs committee must determine whether or not ballot initiatives can appear before the voters.
General facts about South Dakota Medicaid:
Medicaid program name: Medicaid
CHIP Program name: CHIP
Separate or combined CHIP: Combination
Medicaid Enrollment: 116,000 (2018 estimate)
Total Medicaid Spending: $859 million (FY 2017 estimate)
Share of total population covered by Medicaid: 15% (estimate)
Share of Children covered by Medicaid: 33% (estimate)
Share of Medicaid that is Children and Adults: 76%
Share of Spending on Elderly and people with disabilities: 63%
Share of Nursing Facility Residents covered by Medicaid: 50% (Estimate)
Expansion state: No
Number of people in expansion:N/A
Work Requirement: Under review