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Medicaid Expansion Is on the Ballot in South Dakota

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If South Dakota voters approve a ballot initiative on Nov. 8, that will leave 11 states that have not expanded their Medicaid programs under the ACA.

Twelve states have not expanded their Medicaid programs under the Affordable Care Act (ACA), but only 11 will remain if more than 50% of South Dakota voters vote in favor of Amendment D November 8.

Amendment D would expand the state’s Medicare program. Gov. Kristi Noem, a Republican, who is expected to win her re-election bid, said she would implement the amendment if it passes, although she does not support Medicaid expansion.

Other states that have not expanded Medicaid include Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

Proponents of Medicaid expansion see it as a practical step toward covering more Americans with health insurance. Critics say it will strain state budgets, and some want conditions, such as work requirements, attached to coverage. Several states have tied coverage to work requirements, though the Biden administration is removing waivers that allowed those states to impose work requirements.

South Dakota’s ballot initiative would amend the state’s constitution to expand Medicaid. An amendment that would have raised the threshold from 50% of the vote to 60% was defeated earlier this year.

About 42,500 South Dakotans will become eligible for Medicaid coverage if voters approve the amendment, according to the Chief of Argusthe daily newspaper of Sioux Falls, South Dakota,

For states that have accepted Medicaid, the ACA extends program coverage to nearly all adults whose income can reach 138% of the federal poverty level (which equates to about $18,750 this year). The ACA increases the federal match rate for the extended population to 90%.

Proponents of Medicaid expansion see it as a practical step toward covering more Americans with health insurance. Critics say it will strain state budgets, and some want conditions, such as work requirements, attached to coverage. Several states have tied coverage to work requirements, though the Biden administration is removing waivers that allowed those states to impose work requirements.

The American Rescue Plan Act of 2021 also had provisions that funneled more federal dollars into state Medicaid programs.

According to the Commonwealth Fund, if the ballot measure passes in South Dakota, it would be the seventh state to expand Medicaid after voters approved a ballot initiative. The other six are Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah.

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