BISMARCK, N.D. – This weekend marks the 52nd anniversary of the Medicaid program, signed into law by President Lyndon Johnson on July 30, 1965.

Medicaid provides insurance for children, pregnant women, people with disabilities, seniors and low-income adults, and 114,000 North Dakotans currently are enrolled in the program.

Amy Thom is a social worker whose daughter Emory suffers from epilepsy due to a rare disorder called Sturge-Weber Syndrome. Emory has undergone numerous therapies and receives therapy in school thanks to Medicaid. Thom says she and her husband also get in-home services for her daughter.

"We aren't able to just leave her with a typical babysitter and maybe go out to supper one night, or even to just run out and do a couple errands,” she points out. “And so, Medicaid has helped that piece. We have the in-home supports that we can hire respite to come in an hour or two here or there."

Thom notes that both she and her husband are insured and use Medicaid as supplemental coverage for Emory. She says her family would pay about $11,000 out-of-pocket each year without it.

Friday at noon, speakers will be on the Burleigh County Courthouse lawn in Bismarck, celebrating the anniversary of Medicaid's signing.

The Trump administration and the U.S. House have proposed massive cuts to the program to bring down the federal deficit. Along with changes to the Affordable Care Act in the American Health Care Act, the House budget would slash $1.5 trillion from Medicaid over the next decade.

Mike Chaussee, associate state director for advocacy at AARP North Dakota, says an unlikely alliance has formed to oppose cuts.

"It's not always that the health care industry and the consumer advocates are fighting for something together,” he states. “And in this fight, we all agree on how important it is to save Medicaid."

Chaussee says the program has been especially helpful for seniors who aren't able to fully cover nursing or in-home costs through Medicare. He calls the program a "lifeline" for many seniors.

Thom says she wants to advocate for the people who can't advocate for themselves.

"I think it's incredibly important because it's people's lives, and it affects the quality that they're able to have, and there's amazing services out there," she stresses.





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Last year's Medicaid expansion in South Dakota increased eligibility to another 51,000 adults but a new report showed among people across the state who qualify, only 39% are enrolled.

Groups likely to be uninsured include young adults and American Indian young adults. About half of those who are uninsured now qualify for Medicaid benefits.

Xanna Burg, director of South Dakota Kids Count, said low enrollment rates are, in part, due to timing. She explained the expansion was rolling out just as states were ending the federal requirement which kept everyone on Medicaid covered during the pandemic.

"I think having those happen in tandem hurt the ability to really do this significant outreach to eligible populations," Burg observed. "Because you're trying to deliver one message saying, 'We've expanded eligibility,' and then there's this other message that's saying, 'You need to, like, re-enroll.'"

Matt Althoff, secretary of social services, has said some people who were disenrolled are making more income and no longer qualify and this should be celebrated. The expansion actually increased the income level for households to qualify, from just over $14,000 a year for a family of four, to about $43,000.

Burg noted one challenge for enrollment is, the information helping to determine eligibility is housed under different programs in the state. She argued more communication could boost the numbers.

"Thinking about where programs can talk to each other, whether it's through SNAP or WIC or the Free and Reduced Price Lunch Program," Burg suggested. "Working across agencies to really identify these populations that might be eligible."

State officials said it could take up to two years to reach full enrollment.

Members of the U.S. House Work and Welfare Subcommittee came to Illinois this month to drum up support for work requirements for anyone seeking public assistance.

U.S. Rep. Darin LaHood, R-Peoria, and U.S. Rep. Danny Davis, D-Chicago, held a field hearing on what they called the "Dignity of Work," stressing the importance of employment as a solution to lift people out of poverty.

Nearly 12% of Illinois residents live below the federal poverty line - LaHood said at the hearing that teamwork is needed to help more of them find jobs.

"Whether it's through churches, nonprofits, private foundations or government programs," said LaHood, "when providing relief and assistance to those in need, we should be exploring every possibility to promote work as the surest pathway out of poverty."

But the Center on Budget and Policy Priorities points out that most working-age adults who receive assistance like Medicaid or SNAP are already working - their jobs don't pay enough to meet basic household expenses.

Others are dealing with child care or elder care, have health issues, or are between jobs and need assistance only temporarily.

Testimony at the hearing included multiple examples of people who were able to become self-sustaining with help from the federal programs.

Kristy Schofield, now the director of Homeless and Housing at Dream Center Peoria, said she was a single mother of two and living in her car before reaching out for help.

She said these programs are a godsend for someone who has lost hope.

"These programs give our guests an opportunity to work - and with that, accomplish and achieve," said Schofield, "thereby gaining that self-esteem and belief in themselves, and lowering the chance that they will live in poverty."

Congressman LaHood said, "Tying federal benefits to the expectation of work is not a punishment."

He cited an Axios-Ipsos poll out last year that found growing support for making people look for work if they want public assistance - including 80% of Republicans, 66% of Independents, and 49% of Democrats.

Missouri's Department of Social Services anticipates as many as 200,000 Missourians will lose their Medicaid benefits over the course of the next year, because their income has increased and they no longer qualify.

While the public health emergency was in effect, states could not remove anyone from their Medicaid rolls, but as the Medicaid "unwinding" has begun, the department is resuming annual renewals.

Kim Evans, director of the family support division for the Department of Social Services, encouraged everyone to be sure the state has their current contact information so they don't miss important forms and requests for information. They can do it in a number of ways.

"Individuals can go online and report that, at mydss.mo.gov, they can fax that to us, they can scan it to us," Evans outlined. "On our website we have a live chat, and somebody can report it to us that way also."

Evans pointed out there is also a resource center in every county for those who would like help in person. She explained the renewals will be processed the month the person originally qualified, beginning with June. The first round of annual renewal forms will be sent out the first week of May and must be returned by June 30.

Evans noted two circumstances will cause a person to receive a form.

"If we cannot verify the person's information, or the information we receive makes them totally ineligible for Medicaid, we will send an annual renewal form," Evans pointed out.

She stressed if people do not return their form on time, they risk a break in coverage. After the due date, they have 90 days to submit their information to have their case reopened.

Evans added the state is opening a new customer portal in early May, where all future forms and notices will be placed. She encouraged everyone to sign up once it is available.

"So they will be able to access this form that they'll be able to review, make changes," Evans explained. "Then they can submit that directly to the agency. That is really how we want everybody to complete their forms, because that populates the system."

Those who no longer qualify for Medicaid will be referred to the Marketplace to look for an insurance plan that works for them.


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