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[MM Curator Summary]: After a year or so of drama, shiny new Medicaid cards will be issued starting tomorrow.
Medicaid expansion begins in South Dakota on July 1, a move sparked by a successful ballot initiative last November in which 56% of South Dakotans voted for the expansion.
That means, according to the South Dakota Department of Social Services website, that “an estimated 52,000 new individuals” will qualify for Medicaid.
The expansion of Medicaid, which has rolled out on a state-by-state basis since the Affordable Care Act, was originally part of the ACA, with the federal government financing the expansion at 100% initially, and at 90% by 2020. But in 2012, when the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act, the Court also limited the federal government’s ability to enforce a Medicaid expansion provision, according to the Kaiser Family Foundation and other sources.
That left the decision to expand Medicaid up to the states.
“I expect more preventive care will be able to be received,” said Michaela Seiber, CEO of South Dakota Urban Indian Health. Seiber said that expansion could be especially helpful for people who need to follow up initial appointments with additional care.
The DSS website notes that South Dakota applicants must be between 19 and 64 years old, must live in South Dakota, must be “a U.S. citizen or qualified immigrant,” and must either possess or have applied for a Social Security Number.
With the expansion, adults with incomes of up to 138% of the Federal Poverty Level will be eligible for Medicaid. That means single adults making up to about $20,120 per year will be eligible, and a family of four earning up to $41,400 will be eligible.
Applications for the expanded program began on June 1, and people who are already receiving Medicaid do not need to reapply.
Shelly Ten Napel, CEO of Community Healthcare Association of the Dakotas, said the expansion of Medicaid falls closely in line with its mission of serving underserved populations.
Shelly Ten Napel
“Our mission for over 40 years has been access to high-quality healthcare for all Dakotans,” she said. “This moment is a big one for us because adding another piece to the coverage puzzle is going to have an impact on the healthcare system in our state, on people’s lives, and it’s going to save lives.
The Community HealthCare Association of the Dakotas, as its website states, “is a non-profit membership organization that serves as the primary care association for North Dakota and South Dakota.”
Penny Kelley, outreach and enrollment services program manager for CHAD, also noted that the expansion could help patients obtain preventive care.
“For someone not able to get preventive care, oftentimes that can lead to a small problem being a big problem,” she said.
Kelley said the presence of health insurance creates “a ripple effect through the entire community,” preventing serious illnesses by allowing medical professionals to treat patients early.
“They’re not having to go to the ER because they were able to take care of (the problem) with their doctor ahead of time,” she said.
Seiber, with South Dakota Urban Indian Health, noted that federally qualified health centers offer sliding scales for people who don’t have insurance. The problems can surface, though, when those initial visits reveal conditions that require specialists.
“If they have something that’s more complex than we can provide for, they get referred out,” Seiber said. That sort of specialized care, along with the medications, may not be accessible on a sliding scale, she said.
Kelley stressed the importance of spreading the word about Medicaid expansion.
“There’s continued work to be done in order to let people know that they may be eligible,” she said. “They have received letters from the DSS letting them know, but that doesn’t always get someone’s attention. So we have been trying to do a lot of outreach.”
Kelley said, too, that efforts to reach people to tell them about Medicaid expansion can also create avenues to inform them about other areas of health.
“If they’re not eligible for Medicaid expansion, they could potentially be eligible for low-cost healthcare on Healthcare.gov,” she said.
Seiber noted that there’s a navigator working at South Dakota Urban Indian Health in Pierre who can help people with applications and other administrative tasks – such as applying for Medicaid. The position is funded by a federal grant received by the Community HealthCare Association of the Dakotas and applied to SDUIH’s navigator position.
The South Dakota Department of Social Services’ website notes that “90% of the cost of providing healthcare to the Medicaid expansion population will be funded by the federal government ($512,587,699)” – a provision of the Affordable Care Act – “and the state is required to pay for the remaining 10% ($66,385,019).” The American Rescue Plan provides additional funding.
South Dakota is among 40 states, along with Washington, D.C., that have expanded Medicaid. According to the Center on Budget and Policy Priorities, “Expansion has produced net savings for many states. That’s because the federal government pays the vast majority of the cost of expansion coverage, while expansion generates offsetting savings and, in many states, raises more revenue from the taxes that some states impose on health plans and providers.”
More information from the South Dakota Department of Social Services is available at https://dss.sd.gov/economicassistance/medical_eligibility.aspx, and people can contact the office in Pierre, at 912 E. Sioux Ave., with a phone number of 605-773-3612.
Kelley said people with questions about Medicaid expansion can also call the 211 helpline.