REFORM (SD)- Medicaid work requirement proposal passes South Dakota House committee

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A resolution looking to allow the legislature to consider work requirements on the newly expanded Medicaid program is one step closer to the 2024 ballot.


PIERRE, S.D. — An effort to allow South Dakota to consider work requirements on “able-bodied” members of the newly expanded Medicaid program in the state passed its first legislative hurdle by an 11-2 party-line vote at a House State Affairs hearing on Jan. 30.

While opponents relayed concerns about the implementation of work requirements and the supposed inefficacy of similar experiments in other states, Rep. Tony Venhuizen, a Republican from Sioux Falls, said he brought the amendment as a way to begin a work requirement conversation currently prohibited by the language of the Medicaid constitutional amendment passed by voters last year.

“The costs of administering it would likely be outweighed by the savings we would see by incentivizing work,” he told the committee. “But again, I don’t want to get too far into the detail of how this would be implemented because we are several steps away from that.”

As written, the proposed amendment would make an exception to the Medicaid constitutional language — which says the state “may not impose greater or additional burdens or restrictions” on those newly eligible for the Medicaid expansion program — allowing the legislature to consider imposing work requirements on “any person, under this section, who is able-bodied.”

The proposal to offer voters an opportunity to impose work requirements on able-bodied individuals carries the support of 30 lawmakers.

The legislature can refer ballot measures and amendments to voters with a majority vote in each chamber. Were Venhuizen’s proposal to succeed this session, it would go onto the ballot in the 2024 general election.

The Medicaid program, as it currently stands in the state, is a federal-state cost-share health care program available to children, low-income families and disabled adults.

However, upon the successful expansion of Medicaid last election, the eligible population grew, raising the eligible income levels for low-income families and allowing any adult under 138.5% of the federal poverty line to access the program.

Unlike the populations that Medicaid traditionally serves, Venhuizen argued, many in the expanded population are able to work.

Still, opponents to the proposal, many of them representing health care organizations in the state, expressed concern that the definition of “able-bodied” in the relatively general amendment offered by Venhuizen could have negative consequences.

“I think the lack of definition around the word able bodied [is a concern.] We saw this in North Dakota actually a lot when I was spending some time up there with the legislature, folks that deal with mental health issues,” said Tim Rave, the executive director of the South Dakota Association of Healthcare Organizations. “They’re probably physically able to work if that was the definition, but the challenges that they’re having with their mental health problems could be prohibiting them from being active in employment.

Other opposing arguments cited research from Arkansas that work requirements created “substantial coverage loss” among expanded populations and the infeasibility of implementation due to federal opposition.

While the Biden administration has struck down work requirements in every case — as Medicaid is a program with federal oversight and states must seek approval to change certain rules — Venhuizen noted that 13 states imposed these requirements under the Trump administration, and nine more, including South Dakota, pending approval.

“I do think it’s fair to assume that, if there’s a change in administration, this could be back on the table,” he said.

Venhuizen and the members of the committee in favor of moving the proposal to the House floor argued that several of the points brought up by the opposition were well-founded; however, he argued that giving the legislature the option to discuss the proposal would be the better venue for discussing the specifics.

“I thought that line of argument raised an important concern,” Venhuizen said, specifically referencing a point raised about the seasonal nature of parts of the state economy. “I can see arguments on both sides, but that’s exactly the kind of thing we should be thinking about [as a legislature.] It’s a little concerning to me that the Medicaid amendment in its current form makes that decision for us.”