Simplified: In the next month, an estimated 52,000 more people in South Dakota will be eligible for Medicaid benefits. Here's what you need to know.
Why it matters
- Voters approved Medicaid expansion last November by passing Constitutional Amendment D with 56% of the vote. The amendment was largely endorsed by health systems in the state, though it did receive pushback from Republicans – including Gov. Kristi Noem – who expressed concerns about the cost. Noem did not support the amendment, but ultimately said she'd implement it if passed, per the Associated Press.
- Before the vote, South Dakota was one of only a dozen states that hadn't expanded Medicaid to include nearly all adults with incomes up to 138% of the poverty line.
- The expansion takes full effect July 1, but any Medicaid applications submitted starting June 1 will be evaluated using the expanded parameters.
"It’s worth it to go through the application process and see if you qualify," said Lindsey Karlson, director of programs for the Community Healthcare Association of the Dakotas (CHAD). "Even if you don't qualify for Medicaid, the health insurance marketplace has a lot of really affordable plans."
Tell me more about who's eligible for Medicaid
Adults age 19 to 64 make up the largest group of people who will now be eligible for coverage under the expansion.
- Prior to July 1, Medicaid largely only covered adults who had children.
- Income alone wasn't enough to qualify someone for Medicaid, but that changes July 1.
Now, anyone with an income up to 138% of the poverty level is eligible.
- To put it in real numbers, for one person that's an annual income of $20,120. And for a family of four, it's a household income of $41,400.
"There are folks who are working a couple of jobs, maybe don't have a full-time job with benefits – they'll be able to get insurance." Karlson said. "(That also includes) our rural entrepreneurs who are trying to get started, people who are self employed providing really important services for our community."
What is Medicaid, and what does it cover?
Medicaid is a federal- and state-funded program to provide health insurance for people who qualify.
It's a pretty comprehensive health plan, including coverage for:
- prescription drugs,
- preventative services,
- pediatric services,
- emergency services,
- outpatient care,
- pregnancy, maternity and newborn care,
- outpatient care,
- mental health and substance use services, including behavioral health treatment.
You can find a full list of benefits from the state Department of Social Services.
How do I get signed up?
Fill out an application at healthcare.gov, and it'll be submitted to the state to determine Medicaid eligibility.
What if I need help or have questions?
CHAD can help.
- The organization has received a grant to help people throughout the state navigate the process of finding healthcare – whether through Medicaid or the health insurance marketplace.
There are a number of trained professional "navigators" around the state and in partner organizations who can help you determine eligibility and answer any questions you have.
- Partner organizations include Horizon Health Care, Community Health Center of the Black Hills, Falls Community Health, South Dakota Urban Indian Health, the Helpline Center and Western South Dakota Community Action.
You can also find a navigator at GetCoveredSouthDakota.org or by dialing 2-1-1.