SIOUX FALLS, S.D. (KELO) — If you are between 19 and 64 and make about $18,700 a year in South Dakota, you could likely qualify for expanded Medicaid if the measure is approved by voters on Election Day on November 8.

The measure would require the state to provide Medicaid benefits to any person over 18 and under 65 if their income is at or below 133% of the federal poverty level, plus 5% of the federal poverty level for the classified family size.

The 138% and 5% is 138% of the federal poverty level guideline for the 48 contiguous U.S. states. The income level at 138% for one person is $18,754. For a household of four, it’s $38,295. The income level for a household of three would be $31,781. The income level for a household of two is $25,268.

Expanded Medicaid is an initiative under the Affordable Care Act (ACA).

According to the U.S. Census Bureau, an estimated 83,000 South Dakotans did not have health insurance in 2021. The Census Bureau said 11.4% of persons under 65 did not have health insurance.

Research indicates that those without insurance included people in low-paying jobs or jobs with fluctuating hours. But, also, among those 83,000 are children without coverage.

If Medicaid is expanded, 27,800 more children would be covered by Medicaid, according to the Kaiser Family Foundation (KFF).

More than 40,000 state residents would be eligible with expanded Medicaid.

Healthinsurance.org says that 16,000 residents have no realistic access to health insurance without Medicaid expansion.

South Dakota does have a Medicaid program, which is funded through state and federal money.

In South Dakota, childless non‐disabled adults are not currently eligible for Medicaid regardless of their income. That individual could apply under expanded Medicaid. KFF said 72% of those who would become eligible under Medicaid expansion are childless adults.

In order to receive federal money, the state is required to provide Medicaid to these groups: pregnant women with income below 138% of the Federal Poverty Level (FPL); children
under age 6 with family income below 182% of the FPL; children age 6 to 18 below 116% of
the FPL; parents below cash‐assistance eligibility levels; and elderly and persons with disabilities who receive Supplemental Security Income (SSI).

Under the current Medicaid structure in South Dakota, the income qualification for a family of three is $23,030, according to KFF.

South Dakota is one of 12 states that has not expanded Medicaid.

The South Dakota Department of Social Services said in its 2022 fiscal year report in September, “It is also worth noting that South Dakota has a very conservative Medicaid reimbursement policy and focuses on managing program costs. As a result, the state spends less for each Medicaid enrollee (per capita) than most surrounding states.”

Expanded Medicaid would require state money but the share of federal money is larger for expanded care than with traditional Medicaid.

The federal government pays about 90 cents for each dollar spent on expanded Medicaid. The state pays the remaining 10 cents.

The government’s contribution is less with traditional Medicaid coverage. The federal government paid for 58.69% of Medicaid expenses in South Dakota in FY2022. According to SDDSS, the federal share will decrease to 56.74% in FY 2023.