5 days ago
Social Services explains Medicaid work proposal
PIERRE, S.D. (KELO) — South Dakota's proposal to place work, training and education requirements on some of the adults who receive Medicaid benefits might not be submitted for federal approval, according to several of the state government officials who have overseen its design.
South Dakota Social Services Secretary Matt Althoff and state Medicaid director Heather Petermann outlined the proposal called SD Career Link on Friday, first to an advisory board, and later at a general public meeting.
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They said Congress is considering a variety of stricter Medicaid work requirements that recently received approval from the U.S. House of Representatives as part of the 'One Big Beautiful Bill Act' and now await formal action in the U.S. Senate.
South Dakota's possible changes would affect only those men and women who became eligible for Medicaid benefits after South Dakota voters in 2022 approved expanding the maximum household income to qualify. What had been 100% of the federal poverty level was raised to 138%.
In April, South Dakota provided Medicaid benefits to 147,234 women, men and children. Those include 30,542 men and women who became eligible as a result of the expanded income threshold. The proposed work, training and education requirements would apply only to those in the expansion group.
Althoff said South Dakota already has work, training and education requirements for adults whose households receive SNAP, TANF and child-assistance benefits. He said work is a component for many of the department's programs.
'Some of what we're doing today has become an exercise in futility,' Althoff acknowledged to the state Board of Social Services on Friday morning. He said South Dakota's proposal would continue to go forward on a contingent basis because of uncertainty about the federal legislation at the congressional level and the Trump White House.
South Dakota's proposal would need approval from the federal Centers for Medicare and Medicaid Services. Board member Howard Grinager of Sioux Falls asked whether South Dakota could still submit its plan as a variation that works best for South Dakota, even if Congress passes its legislation.
Althoff replied that he doesn't know what will happen in Congress or whether President Donald Trump would sign Medicaid-related legislation into federal law. 'So everything is entirely speculative,' Althoff said. 'It's premature for me to answer that question.'
South Dakota's proposal wouldn't require applicants to provide any proof of work, training or education up front. Their compliance would be checked when they apply for renewals each year.
The federal legislation as passed by the U.S. House, on the other hand, would require applicants to show right away that they are working at least 80 hours per month, or spending at least 80 hours per month in community service, or attending work training at least 80 hours per month, or taking education courses on at least a half-time basis, or some combination totaling at least 80 hours per month.
The federal legislation also more aggressively calls for renewals twice a year, while South Dakota currently requires annual renewals. The federal legislation exempts all people who are Indian Health Service beneficiaries, as well as people who have recently been released from incarceration in prisons and jails, while South Dakota's proposal doesn't at this point.
Medicaid director Petermann said approximately 80% of the roughly 30,000 adults currently enrolled under the expanded income threshold would already meet South Dakota's proposed work, training and education requirement or would be specifically exempt.
She said South Dakota's proposed exemptions would include adults with mental and physical disabilities, pregnant and postpartum women, and people living in a geographic area with high unemployment rates. There also would be what Petermann described as 'good cause exemptions' that would be reviewed internally for acceptance.
As to the proposal's potential impact, Petermann said that is difficult to estimate. She said the expectation is a 5 to 10% reduction after the first year, and the numbers would stabilize in subsequent years.
Added Althoff, 'There are a lot of assumptions the department has no control over.'
South Dakota currently is in the middle of a public-comment period on the proposal. A second public session is scheduled for June 12 in Sioux Falls. Written public comments will be accepted through June 18.
Althoff said South Dakota's three members of Congress have been in 'active dialogue' with Gov. Larry Rhoden's administration.
Board member Colleen Winter of Pierre, a former state Department of Health employee, asked about administrative costs for monitoring. Petermann said there would be some costs for system upgrades. 'We don't know for sure how much those things would cost at this point, especially because you have to have approval first,' Petermann said.
Althoff added, 'The voters voted on something that didn't have a cost component to it.' He said the Medicaid expansion benefits have been running less than two calendar years and state government is still watching and learning about how much the expansion beneficiaries are costing and how frequently they're using the services.
The department would need to administer the work, training and education portion within the existing budget, according to Althoff. 'Not having new funds and new money for that is an important wrinkle to our process,' he said.
Board member Grinager said the message behind the proposal is that work has a beneficial part in people's lives. 'It's not just a requirement for requirement's sake. We're going to start gently and let people work into it,' he said. 'So I really appreciate the approach that you, our department, has taken in putting this together.'
Said Winter, 'It's very respectful of the individuals that we serve and are in need of services.'
The public information session that followed was offered primarily by teleconference. It drew only a handful of people to the call and the only ones in the meeting room were DSS officials and a news reporter.
One person spoke during the public comment period.
Nathaniel Amdur-Clark, a lawyer representing the Great Plains Tribal Chairmen's Association, said the department wasn't following the federal pattern of government to government consultations with each tribe.
Amdur-Clark said the proposal as currently written would have 'serious and deleterious effects' on tribal populations. He called for a specific exemption for Indian Health Service beneficiaries and pointed out a variety of other issues with the proposal, including a lack of follow-up with people who lost Medicaid coverage as a result of work, training and education requirements.
Althoff said there was a tribal consultation meeting last week. He said there is a convention in South Dakota that there are quarterly meetings that rotate locations. 'There's also ways to arrive at a convention colloquially,' Althoff said. He said there was 'some very robust exchange and outstanding feedback received from that group last week.'
When no one else responded to several prompts for comments, Althoff gave a closing summary. He stated, 'There's been no final determinations made.' He added that the department was responding to the wishes of South Dakota voters who last year approved allowing state government to pursue additional requirements.
Althoff described the proposal as 'a very light touch approach to the requirement aspect' and 'a hope-filled approach,' noting that people would be allowed to seek medical care and have a year to find work or training or education. That, he said, is intended to offer 'a lift up' rather than be 'a hammer or lever.'
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