South Dakota expanding Medicaid to 52,000 residents

Photo: Tempura/Getty Images

South Dakota has decided to expand Medicaid under the Affordable Care Act, and according to the Department of Health and Human Services, this will result in new eligibility for health coverage for about 52,000 residents of the state, including many members of South Dakota tribes.

Those South Dakotans were slated to receive full Medicaid benefits effective July 1. According to the Centers for Medicare and Medicaid Services, the new beneficiaries now have access to primary, preventive and emergency care, as well as substance abuse treatment and prescription drug benefits.

In implementing the expansion, South Dakota will be able to offer all adults ages 19 to 64 with incomes under 138% of the federal poverty level ($20,120) comprehensive health coverage through Medicaid.

WHAT'S THE IMPACT?

South Dakota now becomes the 39th state, along with Washington. D.C., to adopt the ACA's Medicaid expansion.

Due to the American Rescue Plan, the state will now receive additional federal funding. The ARP incentivized states that have not yet expanded Medicaid coverage by offering a five percentage point increase in the regular federal matching rate for most Medicaid services for two years.

States that expand Medicaid also qualify for the 90% federal matching funds currently available through the ACA for services provided to certain Medicaid expansion enrollees, which means that the federal government pays 90% of the costs and the state pays 10%.

Medicaid, together with the Children's Health Insurance Program (CHIP), remains the largest source of health care coverage in the U.S. The two programs connect nearly 94 million individuals to a range of critical health services, according to CMS.

If all remaining states were to expand their Medicaid programs under the ACA, as many as four million more uninsured or underinsured individuals could enroll in healthcare coverage through Medicaid, the agency said.

Specifically, the number of Black adults eligible for Medicaid would be almost five times greater, and six times greater for Hispanic adults.

THE LARGER TREND

A pair of studies published in 2018 showed some of the apparent benefits of Medicaid expansion. One found that the initial two years of Medicaid expansion under the ACA, 2014 and 2015, bolstered the quality and receipt of care for millions of low-income rural patients.

Another found that expansion of Medicaid under the ACA was related to increased insurance coverage among all potentially eligible individuals, regardless of race, age, marital status or income. It also said that health insurance gains were largest for adults without a college degree; short-term and long-term uninsurance rates declined; use of primary care, mental health services and preventive care among Medicaid enrollees went up; more low- and moderate-income adults had a regular source of care; and reliance on emergency departments decreased.

Medicaid has also been a boon to the Biden administration's push to improve maternal health, with a 17% decline in postpartum hospitalizations in states that elected to expand the federal program, according to a Health Affairs study released in January.

The results showed this reduction in hospitalizations held for the first 60 days postpartum, and there was some evidence of a smaller decrease in hospitalizations between 61 days and six months postpartum.

ON THE RECORD

"Medicaid is a lifeline for millions of people, and a cornerstone for achieving health equity – particularly for underserved communities," said CMS Administrator Chiquita Brooks-LaSure. "Today, South Dakota becomes the 39th state along with D.C. in adopting the ACA's Medicaid expansion. We urge the more than 52,000 newly eligible South Dakotans to apply for coverage, and we look forward to working with more states to expand Medicaid and continue the historic improvements in getting people insured under the Biden-Harris Administration."
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com