54,000 South Dakotans disenrolled in Medicaid unwind; 52,000 expected to be eligible with expansion

By: - July 26, 2023 6:38 pm
(Getty Images)

(Getty Images)

Roughly 54,000 South Dakotans have lost Medicaid coverage since the end of pandemic protections in March.

At the same time, 52,000 South Dakotans are estimated to be eligible for enrollment in a voter-approved Medicaid expansion that took effect on July 1, state officials told legislators at an appropriations meeting Wednesday in Pierre. Voters approved the expansion in November.

Medicaid is a federal-state health insurance program for low-income people. Between 5 million and 14 million people across the country were expected to lose Medicaid coverage during the “unwinding” of continuous enrollment requirements that were imposed by the federal government during the COVID-19 pandemic, according to the Kaiser Family Foundation.

South Dakota was one of five states that began culling April 1, the earliest date possible. Other states decided to wait until May, June, July and even October.

Some South Dakotans kicked off Medicaid have faced a kind of whiplash: seeking private coverage in the months before expanded Medicaid took effect, and then turning around to reapply this month.

But state officials told legislators those individuals would have had to reapply for expanded Medicaid no matter what. It’s a discussion legislators have had with the state Department of Social Services many times, said Rep. Linda Duba, D-Sioux Falls. Duba added that appropriators don’t expect as many South Dakotans to enroll in expanded Medicaid as DSS predicted.

Rep. Linda Duba, D-Sioux Falls, during the 2022 legislative session at the Capitol in Pierre. (Makenzie Huber/South Dakota Searchlight)
Rep. Linda Duba, D-Sioux Falls, during the 2022 legislative session at the Capitol in Pierre. (Makenzie Huber/South Dakota Searchlight)

“I’m expecting for them to make it as seamless as they can for the people they’re unwinding to re-enroll,” Duba told South Dakota Searchlight.

Department of Social Services Deputy Secretary and Chief of Operations Brenda Tidball-Zeltinger told legislators that the department has seen an uptick in applications. Although the department will not have July expansion enrollment data until mid-August, she said about 1,700 people applied for Medicaid in June who would be eligible for expanded Medicaid. 

“We won’t know for another few months how many of those 54,000 who lost coverage will re-enroll,” Tidball-Zeltinger said.

DSS has helped re-enroll those who applied early and were eligible for expansion, she added.

South Dakota finished fiscal year 2023 at the end of June with an average yearly Medicaid and Children’s Health Insurance Program enrollment around 146,000 — peaking at nearly 154,000 in March and ending around 123,500. Roughly 115,000 South Dakotans were enrolled in Medicaid and CHIP in March 2020 when COVID-19 was first detected in the state. CHIP provides health coverage to eligible children through both Medicaid and separate CHIP programs.

In a separate presentation to legislators, Bureau of Finance and Management Commissioner Jim Terwilliger said the drop in Medicaid enrollment likely contributed to a surplus of cash in the state’s general fund.

The state DSS did not spend $34.6 million of its fiscal year 2023 budget, primarily due to less caseloads and less use of medical services, Terwilliger said. The Department of Human Services didn’t spend another $24.4 million due to similar reasons in long term care services.

“Over the last three years, we’ve dealt with quite a bit of volatility, which has made it pretty challenging to budget for,” Terwilliger said.

Terwilliger expects that budgeting will be easier in the coming years.

Unspent general fund dollars contributed to the fiscal year-end budget surplus of $96.8 million.



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Makenzie Huber
Makenzie Huber

Makenzie Huber is a lifelong South Dakotan whose work has won national and regional awards. She's spent five years as a journalist with experience reporting on workforce, development and business issues within the state.