The South Dakota Department of Social Services assumes it will have lower Medicaid utilization in the coming year.
That's led state lawmakers reduced the state Medicaid match by $4.5 million for the coming fiscal year.
"There was a lot of reason to believe there were more numbers, more South Dakotans than what we've realized," Althoff said.
Althoff said the program is averaging about 30,000 South Dakotans — that’s ten thousand less than anticipated last year.
He attributes that in part to skewed Medicaid numbers during the COVID-19 public health emergency, which prohibited states from removing ineligible recipients during that time.
The state pays for 10 percent of medical expenses for the Medicaid expansion population.
In November 2026, South Dakota voters will decide whether expanded Medicaid benefits can continue if the federal match dips below 90 percent. Officials expect any cut to cost the state millions.
Althoff said a cut in the federal match would have a dramatic effect on the department's budget.
"That ripples out into all of state government. Ninety percent of the bill is a big amount of the bill. To reduce from that — when we've just been through a legislative session right now where we all realize revenues to state government are lower and a challenge... It would be a dramatic shift, or pressure, put onto the state's government budget."
When asked if the state would be obligated to pay for Medicaid coverage if the federal match dipped below 90 percent, Althoff said that's a constitutional question for Attorney General Marty Jackley to interpret.
