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Medicaid-expansion enrollments slowing

todayMay 21, 2024 3

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PIERRE, S.D. (KELO) — The number of South Dakotans who have enrolled for Medicaid still hasn’t come close to the level predicted two years ago when voters were preparing to say yes or no to expanding income eligibility for the government-subsidized healthcare services.

South Dakota Social Services Secretary Matt Althoff met Tuesday with the Legislature’s Appropriations Committee that sets the spending levels for state government, including the Medicaid program. He had no simple answer why only half of those expected have come forward so far to sign up.

“We’re below the budget, if you will, on the total enrollment, but we don’t know why,” Althoff said.

South Dakota voters expanded Medicaid eligibility in the 2022 election after the Legislature’s Republican members refused to do so. Medicaid eligibility had previously been limited to households with income up to 100% of the federal poverty level. Voters approved a constitutional amendment 192,057 to 149,616 that eligible household income should expand to 138%.

The change took effect on July 1, 2023. The forecast prior to the vote had been that additional enrollment from expanded eligibility would eventually peak at 52,000 to 57,000. The Legislative Research Council officially estimated 42,500 enrollment within five years. The South Dakota Department of Social Services geared up for a crush, adding dozens of staff, but it never came.

So a group of legislators and Social Services staff reduced the forecast last winter. The revised estimate was pegged to pass 35,000-plus by July 2024, the one-year anniversary, followed by a much slower rise toward 40,000.

But as of April, Medicaid-expansion enrollment had reached a monthly average of 22,607, according to the department. Enrollments in the expanded-eligibility part of the program grew just 1.4% in March and 2.2% in April.

“We just want to be transparent with all of you this departure has begun, and we are examining it intensely as data continues to come forward,” Althoff said.

During the 2024 legislative session, Republican lawmakers put another Medicaid-related constitutional amendment on the November ballot for South Dakota voters to decide.

The proposed amendment would allow the Legislature in the future to impose a work requirement for able-bodied adult recipients who receive Medicaid services resulting from the expanded eligibility. Republican Rep. Tony Venhuizen, a member of the Appropriations Committee, was the lead House sponsor.

During the meeting Tuesday, Venhuizen recalled how the legislative work group built an enrollment forecast for South Dakota that was based on experiences of other Medicaid-expansion states, including the periods of time their enrollments took to slow.

“It looks like in fact we are reaching that point sooner, which budget-wise is a good thing,” Venhuizen said.

He raised a question about what happens in the months and years ahead.

“What will be interesting to see now is whether we will ever reach the peak that we were expecting,” Venhuizen said. “Or do we top out at a lower number than we thought?”

Althoff said the expansion-enrollees’ demographics do match what had been forecast.

“That population may still be there and one day may be on the Medicaid-enrolled program. We just don’t know the when,” Althoff said. “It may be this current departure from trend is saying it’s going to be further out. Maybe it won’t. But be assured we spend a lot of time in the department looking at this data, trying to understand it.”

Medicaid enrollment can serve as an economic signal, according to Althoff. “Should there be an economic downturn, we would likely be some of the first canaries in the coal mine,” he said.

Democratic Rep. Linda Duba asked the secretary on Tuesday, just as she had on prior occasions, whether state government was publicly promoting Medicaid expansion.

Althoff answered, “We had this discussion all throughout the session and before. We feel we’re doing a lot to actively promote this because we work hard to make sure we have a very user-friendly website, we have all the information available, we work very vigorously with our partners that provide the care.”

Responded Duba, ” So that’s a ‘we’re not pro-actively advertising this. There are programs out there, for example the Department of Health, where they have billboards and they have Instagram. But we are not actively advertising this — that’s what I’m hearing you say, and correct me if I’m wrong.”

Althoff replied, “That’s what I’m saying. If you’re questioning, if a promotion involved purchasing advertising –“

“Or social media,” Duba interjected.

“We do use social media,” Althoff said. “We have a DSS account that has subscribers. The communication director is here today, she can happily talk about some of the ways we’ve highlighted.”

“Thank you,” Duba said.

Written by: The Dam Rock Station

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