Advocates express patience as Medicaid expansion enrollments trail projections

By: - October 19, 2023 4:40 pm
(Getty Images)

(Getty Images)

Expanded Medicaid eligibility is attracting fewer enrollments so far than the state anticipated, but some industry insiders say that’s to be expected.

Projections indicated about 52,000 people would be eligible for coverage under the expansion.

The number of expansion enrollees reached somewhere between 11,000 and 12,000 as of Tuesday’s Board of Social Services meeting in Pierre, according to Department of Social Services Secretary Matt Althoff. He said that’s fewer than anticipated.

Tim Rave is the president of the South Dakota Association of Healthcare Organizations. He’s not concerned.

“It’s actually tracking with the studies that we’ve seen showing how implementation would go,” he said. “We knew from the start that it would take a year or two to get to the numbers we expect.”

Medicaid is a federal-state program that helps pay the health care expenses of low-income people. South Dakotans voted last November to expand Medicaid eligibility, and the expansion went into effect July 1. That kicked in soon after the expiration of federally funded protections for Medicaid recipients, which were implemented during the COVID-19 pandemic. 

The co-founder of the group that submitted the petitions to get Medicaid expansion on the ballot said he’s not worried yet.

“It doesn’t happen overnight,” said Rick Weiland with Dakotans for Health. “Sure, you’d hope it would be higher. Sometimes it’s hard to find them to let them know they are eligible.”

Some lawmakers would like more clarity on what’s causing the disparity between enrollments and eligibility.

“How do you fall 40,000 short of your estimate?” said Rep. Linda Duba, D-Sioux Falls. “People are going to want to know. I want to know.”

Deputy Secretary Brenda Tidball-Zeltinger said during the Tuesday meeting that part of the reason has to do with people waiting to enroll until they have a health care appointment.

Department of Social Services spokesperson Emily Richardt told South Dakota Searchlight in an email, “There won’t be any further comment than what was presented in the meeting.”

Matt Althoff, Secretary of the South Dakota Department of Social Services. (John Hult/South Dakota Searchlight)
Matt Althoff, Secretary of the South Dakota Department of Social Services. (John Hult/South Dakota Searchlight)

Secretary Althoff also introduced a new digital dashboard during the meeting offering an up-to-date look at Medicaid enrollment in the state. It shows about 121,000 South Dakotans are currently enrolled.

Through a combination of disenrollments since the end of federal protections and re-enrollments or new enrollments through expansion, there was a net decline of 32,106 Medicaid enrollees from March through September, according to the new dashboard. Enrollees dropped from 152,987 to 120,881 during that period.

The expansion now allows people earning up to 138% of the federal poverty level to enroll in Medicaid. That includes individuals with incomes up to about $20,000 per year and families of four with an income up to about $40,000 per year.

The Community HealthCare Association of the Dakotas has initiated an effort to help guide residents in accessing Medicaid coverage. The services are free. Personnel can meet by phone, Zoom or in-person to help sign people up.



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Joshua Haiar
Joshua Haiar

Joshua Haiar is a reporter based in Sioux Falls. Born and raised in Mitchell, he joined the Navy as a public affairs specialist after high school and then earned a degree from the University of South Dakota. Prior to joining South Dakota Searchlight, Joshua worked for five years as a multimedia specialist and journalist with South Dakota Public Broadcasting.