Medicaid expansion enrollment ‘slow & steady’ as state launches application portal

Over 21,500 South Dakotans have enrolled in Medicaid expansion since it became available in July 2023, representing about 16% of total Medicaid enrollment in the state.

Medicaid is a joint federal-state health insurance program for low-income adults, children, pregnant women, elderly adults and people with disabilities.

South Dakota voters approved a citizen-proposed constitutional amendment in 2022 that expanded Medicaid to people whose incomes are 138% of the federal poverty level or less, which is up to $43,056 for a family of four or $20,783 a year for a single person in 2024.

Expansion enrollment is lower than what the state Department of Social Services originally projected. The department planned for 57,000 expansion enrollees. But the department now expects to see 40,000 South Dakotans enrolled by 2025 — 17,000 less than anticipated.

Members of the state Board of Social Services on Tuesday in Pierre discussed efforts to reach eligible Medicaid expansion patients. That includes a new online enrollment system meant to improve the application process and “engaging with people where they’re at,” said Medicaid Director Heather Petermann.

“We’ve seen a slow and steady increase in the numbers,” Petermann said. “It’s a little bit of a crystal ball, we can’t completely know for sure. We expect this will continue.”

Some legislators and health care organizations have criticized the department for a lack of outreach and advertisement contributing to lower enrollment numbers. Secretary Matt Althoff said the department doesn’t have a backlog of applicants, calling it a “steady stream.”

Many expansion enrollments are a result of a patient visiting a medical provider and being referred to Medicaid expansion, said Deputy Secretary and Director of Operations Brenda Tidball-Zeltinger. The department also hopes to more proactively connect eligible patients when they seek other help from the department outside of Medicaid enrollment. For example, over two-thirds of South Dakotans eligible for expanded Medicaid are also eligible for the Supplemental Nutrition Assistance Program, known as SNAP.

“I think it’s when they come to us for other safety net programs. That’s what I think is the most effective: I’m coming to you about a food need, well, let’s talk about your health care. I’m coming to you because I have a behavioral health need, well, let’s talk about your primary care provider and talk about your health care needs as well,” Tidball-Zeltinger said during the meeting.

Tidball-Zeltinger said she hopes “another feeder” for expanded Medicaid will be a growth in preventative health care and screenings.

The department launched its Benefits Eligibility Enrollment System on March 4, meant to streamline processes for benefit programs. The online portal is limited to Medicaid currently, but will eventually include other programs such as child care assistance, SNAP, Temporary Assistance for Needy Families and energy assistance.

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When Medicaid expansion was passed by voters, South Dakota was one of three states without an online account system, according to KFF Health News. Tricia Brooks, a Georgetown professor and expert on Medicaid administration, worried at the time that South Dakota’s lack of technology would be a problem for enrollment.

“South Dakota is not advanced in their use of technology,” Brooks told KFF in November 2022. “I worry if it’s too manually driven that the state will be overwhelmed. And that will slow down the processing.”

Online enrollees can now check on their application status, report changes, complete renewals and request appeals. The system also pre-screens qualification for enrollees.

The modernized system replaces South Dakota’s roughly 40-year-old data entry system, said Carrie Johnson, division director for economic assistance.

“Maybe that doesn’t sound flashy, but it sounds like Mars to me compared to what we worked with,” Johnson said.

The department has seen an increase in the number of online applications since its launch.

“It has an electronic interface, so we can verify customer information easier,” Johnson said. “We’ve got more scrutiny. In those eligibility determinations, it’s certainly more efficient.”

About a quarter of expanded Medicaid patients are between the ages of 19 and 26, or considered “young adults” by the department. Petermann suggested the department reach out to the age group to help “prepare them for a successful start” regarding health care coverage.

“That is something we can take a look at for a disconnect from our typical programs and outreach methods,” Petermann said.

A majority of expanded Medicaid patients are between 27 and 54 years old. About 70% of expanded Medicaid patients are single adults without children.

Total Medicaid enrollment in the state stood at 131,464 as of February, with 56% of enrollees being children. For fiscal year 2023, South Dakota covered about 32% of the $1.23 billion cost of Medicaid in the state, and the federal government covered the rest.