South Dakota voters will decide whether to allow state lawmakers to require Medicaid recipients work in order to receive healthcare benefits.
Last election, voters approved expanding Medicaid benefits for individuals by 56 percent.
As of October 4, 27,300 South Dakotans are enrolled in Medicaid because they qualify under expanded benefits. Officials expect a total of 60-thousand people will be enrolled in the program in the next few years.
Medicaid expansion covers healthcare costs whose income is at or below 133 percent of the federal poverty line—or about $3,500 for a household of four.
The 2022 constitutional amendment passed with 56 percent of the vote.
In addition to expanding Medicaid, the measure prohibits the state from imposing requirements or restrictions on eligibility or enrollment. Now, state lawmakers want voters to approve whether the state can impose work requirements should the federal government allow it.
“What we’re doing is going back to the voters and offering them a clarifying question. ‘Okay, we passed Medicaid expansion. What about a work requirement? Is that a good idea or a bad idea?’" said Representative Tony Venhuizen, R-Sioux Falls, during a recent forum about the ballot questions up for consideration this November.
Venhuizen said the prohibition on requirements for Medicaid eligibility was not a part of the 2022 debate.
“What Amendment F would do is remove that prohibition so that a future governor, a future legislature, could consider enacting a work requirement," Venhuizen added. "That also requires approval from the federal government and presumably would mean we would need a different administration in the White House that’s willing to entertain a work requirement.”
But, a proposed work requirement amendment to the state’s Medicaid expansion clause in the state constitution leaves some with too many questions.
“We have no information available about how those restrictions would be put in place," said Shelly Ten Napel, with Community Health Care Association of the Dakotas. “There are people who get a cancer diagnosis and find that they can’t work. What about stay-at-home moms? Are they going to be forced into the workplace in the middle of a childcare affordability crisis? The answer, again, is we don’t know.”
Ten Napel points to Arkansas example as a reason why voters should reject the idea.
“This has been implemented in one state. It was an abject failure," Ten Napel added. “It was stopped by a judge who said people who were eligible for coverage were losing it because the paperwork, the red tape, was keeping people from benefits they were eligible for.”
In Arkansas, enrollees were required to work 80 hours a month and report their work using an online portal.
According to the Kaiser Family Foundation, that state saw a drop of over 18,000 enrollees in 2018 for failure to comply with requirements.
The primary backer of the work requirement proposal, Venhuizen, said there’s not enough data to suggest work requirements fail.
“I would say there really hasn’t been a state that’s had the time to get a Medicaid work requirement off the ground in an expansion program and have time to make it work,” Venhuizen said. “What I do know is in South Dakota we administer work requirements successfully in all of our other social programs. So, I’m confident we’d be able to do it in a efficient way.”
According to a 2022 analysis by the Congressional Budget Office, a national Medicaid work requirement would result in 2.2 million adults losing Medicaid coverage per year and lead only a small increase in employment. It would reduce federal spending by $15 billion annually due to the reduction in enrollment.
Ten Napel points to a recent study by the state of Montana about its Medicaid expansion population. It finds that a vast majority of Medicaid enrollees are already working, are students or are disabled. The study finds four percent of enrollees reported not working or having no impediments to work.
"For whom we’re setting up a huge government bureaucratic program that we know will keep people who are eligible and working and disabled from the coverage that they need," Ten Napel said.
According to the Bureau of Labor Statistics, South Dakota has a two percent unemployment rate.
Recent campaign filings show the ballot question committee “Vote ‘No’ on Amendment F” has raised well over half a million dollars to campaign against the work requirement. There is no ballot question committee in favor of passing the amendment, though the republican controlled state legislature endorses the idea.
Earlier this year, Department of Social Services Secretary Matt Althoff spoke in favor of the work requirement amendment. That department administers Medicaid.
