SD Medicaid expansion would cover working poor
By Chet Brokaw
PIERRE (AP) — People who work in low-income jobs would make up a lot of the population that would be covered by an expansion of South Dakota's Medicaid program, state officials told a legislative committee Monday.
"Many of them are the working poor," Deb Bowman, a senior aide to Gov. Dennis Daugaard, said.
Bowman, who led a state task force that studied the advantages and disadvantages of expanding Medicaid, and state Social Services Secretary Kim Malsam-Rysdon met Monday with the Legislature's Planning Committee, a panel that conducts long-term studies of issues. The task force did not recommend whether South Dakota should expand Medicaid.
Under President Barack Obama's health care law, states have the option of expanding Medicaid, which uses state and federal money to pay health care costs for low-income people. Daugaard has said he likely will recommend that the South Dakota Legislature delay a decision on expanding Medicaid until more information is gathered on who would be covered and whether federal officials would give the state some leeway in deciding which income levels are covered.
South Dakota's Medicaid program covers about 116,000 children, adults and disabled people. An expansion would cover an estimated 48,500 additional people, mostly adults without children.
People earning up to 138 percent of the federal poverty level — $15,451 for a single person or $31,809 for a family of four — would be covered by an expansion. The federal government would fully cover those added to Medicaid's rolls through 2016, and the state's contribution would rise in stages to 10 percent of the medical costs by 2020.
The legislative committee had asked Bowman and Malsam-Rysdon to provide information on who would be covered by an expansion.
The two state officials did not provide information on exactly how many are now working in low-income jobs, but they said a state study has found that 41 percent of South Dakota's uninsured adults live in families with incomes below the poverty level while 25 percent live in families earning from 100 percent to 199 percent of the poverty level.
About 63 percent of uninsured adults are employed, and two-thirds of those work full time, Malsam-Rysdon said. That means many do not get insurance through their jobs.
The federal health care law seeks to provide more people with insurance through subsidized private insurance offered through online marketplaces called exchanges. States have the option of expanding Medicaid to cover people considered too poor to get the subsidized insurance.
Daugaard has said he is renewing a request that South Dakota be allowed to expand Medicaid only up to 100 percent of the poverty level because those over that mark can qualify for the subsidized private insurance. Federal officials rejected that request earlier.
Sen. Billie Sutton, D-Burke, said the health care law will provide subsidies so those earning above the poverty level get government subsidies to buy private insurance, but no help will be provided to really poor people without a Medicaid expansion.
"It just doesn't make sense," Sutton said.