Medicaid Expansion

  • The group that would get the largest increase in benefits from Medicaid Expansion, as proposed in Article XXI, are single, non-disabled adults.

  • Article XXI states that no eligibility requirements can be imposed upon new recipients.

  • Medicaid Expansion will increase the burden on South Dakota tax payers and anyone paying for private healthcare.  It is not fair that healthy single adults, that are neither working nor trying to find work, should get their healthcare paid for by others.  Medicaid Expansion/Article XXI should be voted down.


Medicaid Expansion is proposed in an upcoming referendum to amend the South Dakota constitution by adding Article XXI.  I oppose this amendment.  The largest change that would result from the adoption of this amendment will be to make Medicaid-eligible all non-disabled, single adults making less than 138% of the poverty level income.  The Article also states that South Dakota cannot impose any new eligibility requirements on these newly eligible people.  Previously the South Dakota Department of Social Services had requested the appliable federal agency (Center for Medicare and Medicaid Services) to make non-disabled, single adults eligible for Medicaid coverage, but only if they met a work requirement.  To become eligible these single/non-disabled adults either had to be working, minimally roughly half-time, or actively trying to find work.  Recently the Biden administration ruled that such work requirements are not allowable for Medicaid eligibility—they justified this by citing the pandemic.  The proposed amendment to the South Dakota constitution has a provision that specifically states that new eligibility requirements, such as working, will not be permitted for newly eligible Medicaid recipients.  This would make the Biden administration’s order permanent.  I disagree with that provision.  Work requirements, and perhaps other requirements, for Medicaid eligibility are reasonable for single adults that do not have disabilities. Because Article XXI prohibits this I will vote “no” on this referendum.


I oppose Medicaid expansion for South Dakota as proposed in the upcoming ballot referendum .  South Dakota has 16 programs that provide residents with financial aid for health problems  These programs include financial aid to children, disabled children, pregnant women and adults who are disabled or have developmental disabilities.  About the only people that are currently not covered by programs to provide financial aid for health care are non-disabled single adults.  However, even for this group, in 2018 the South Dakota Department of Social Services proposed an expansion in Medicaid to provide financial aid for medical expenses: .  In this proposal the State offered to provide Medicaid aid for non-disabled adults if they met certain work requirements.  These requirements essentially were that they were either minimally working, about half time, or showed evidence that they were trying to become employed.  I can’t find whether this proposed revision in the South Dakota Medicaid coverage requirements was ever approved by the Federal Government.  But, if it was approved, the decision was reversed early in the Biden administration.  The Biden administration ordered that there be no work requirements for eligibility for Medicaid during the pandemic.   

The South Dakota Medicaid Expansion proposal (article XXI) includes the following statement: “ The state of south Dakota may not impose greater or additional burdens or restrictions on eligibility or enrollment standards, methodologies, or practices on any person eligible under this section than on any person otherwise eligible for Medicaid under south Dakota law.”  At present Medicaid recipients in South Dakota have no work requirements.  Consequently, if the ballot issue is approved as written, then all “non-disabled” single adults, living in South Dakota and making less than 138% of the poverty level income, will be eligible for Medicaid benefits with no work requirements.  These people, (single, non-disabled and making less than 138% of the poverty income), represent the largest group of new people that would be covered by Medicaid by the expansion.


I don’t believe the taxpayers in South Dakota should pay for the healthcare costs of non-disabled single adults that are not working and not making a serious effort to find work.  The proposed expansion in Medicaid coverage would pay for these people’s healthcare costs.  Initially the Federal government would pick up most of the added expense from the expansion.  But, over time, the addition of these newly eligible people would result in a significant increase in cost for South Dakotans.  This is partly because the percent of the cost that the Federal Government picks up will decrease with time.  The State will then be paying a higher percentage.  Another reason why costs will increase is because Medicaid reimbursement rates are less than for Medicare and smaller still than those from private insurance coverages.  More people on Medicaid means that South Dakota healthcare providers will need to charge private insurers more to make up for the reduced revenue from smaller Medicaid reimbursements.  Some people that will qualify for Medicaid currently have private insurance.  Many of those people will leave the private insurance and go on Medicaid.  This will drive up both the cost of providing Medicaid and the cost of the remaining private insurance coverage in the state.   I don’t believe that healthy adults, that make no effort to work, should get healthcare paid for by people that are willing to work.  Article XXI will make that happen.  Because of this I do not support it.