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.

South Dakotans passed Amendment F on Election Day, opening the door to impose work requirements on people who qualify for expanded Medicaid benefits.

Opponents said it could interrupt health treatment for those fighting cancer and other diseases. Any bill outlining work requirements for Medicaid would still need state passage and federal approval.

A report from the Congressional Budget Office on the effects of a similar rule finds it would reduce federal spending, decrease the number of people with health insurance and would not increase employment.

Ben Hanson, South Dakota government relations director for the American Cancer Society Cancer Action Network, said it would also cost the state.

"For the most part, state health departments will tell you, you're not going to save money by doing this," Hanson asserted. "You're going to wind up spending more to create a bureaucracy to oversee this new set of forms and paperwork they have to fill out, for an already qualifying population."

President-elect Donald Trump approved work requirements in 13 states during his last term, all of which were rescinded or withdrawn under President Joe Biden. South Dakota is one of nine states with pending programs or legislation to allow them.

Most adults with Medicaid benefits who are able to work are doing so. According to the health research organization KFF, of those under age 65 who do not have other state-sponsored care, 91% are either working, or not working because they are students, caregivers or are ill themselves. Hanson said, for instance, many people who go through cancer treatment miss work for several months because of its physical toll.

"This could take away your coverage for getting that treatment while you're trying to get better so you can go be an employee again," Hanson noted. "And more importantly, so you can survive your cancer diagnosis."

Hanson added work requirements might also prevent early cancer detection, which leads to more expensive treatment and worse outcomes.


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A new report from the Headwaters Foundation in Montana showed at least half the people who receive public assistance are only enrolled for one year, dispelling a myth recipients are getting long-term government aid.

Nearly two-thirds of people only receive one form of assistance. More than 120,000 Montana families receive government aid every year, based on their income.

Erin Switalski, program director for the foundation, said they wanted to know who the recipients are, why they are enrolled in public assistance programs and for how long.

"People are really receiving public assistance for short periods of time," Switalski reported. "We found that folks primarily are caregivers in the family. So, they might be caring for children; they might be caring for parents or an older adult."

The report found Montana's public assistance programs lift 69% of older adults and 44% of children out of poverty, and the numbers could be higher. The report estimated 40% of Montana families who are eligible for help do not get it because a variety of barriers prevent them from enrolling.

Bryce Ward, founder of ABMJ Consulting, was commissioned by the foundation to do the study, called "Supporting Our Neighbors." Ward said the variety of people on public assistance was surprising and well over half don't receive these benefits for more than a year.

"Those that are in for the longer periods of time are probably those you might imagine, right?" Ward observed. "They's the people who report more disabilities, families with young kids, and single parents."

The report also found 97% of families with children who receive public assistance but have no aging or disabled members in the household have at least one person who works full-time.

A new report showed more than 100,000 eligible Virginians 65 and older are not enrolled in the Supplemental Nutrition Assistance Program.

With senior participation rates at just 37.4%, advocates are calling for urgent action, particularly during Hunger Action Month.

Cassie Edner, public benefits attorney and director of Virginia Hunger Solutions at the Virginia Poverty Law Center, explained several factors contribute to the low enrollment, according to the report by the National Council on Aging and the Urban Institute. She noted a general lack of awareness and the complexity of applying for benefits in the Commonwealth may be key barriers for many, regardless of eligibility.

"It just could be too low," Edner acknowledged. "We often hear of people that say, hey, this isn't worth going through the hoops that we have to go through in order to receive just $23 per month."

Despite progress made with programs such as the Elderly Simplified Application Project, which streamlines the process for seniors without earned income, Edner emphasized more must be done to reach the most vulnerable populations. The Virginia Food Access Coalition and the Federation of Virginia Food Banks are partnering with the coalition to urge legislators to reduce administrative barriers to SNAP participation.

Edner and other advocates are urging policymakers to raise the minimum SNAP benefit for seniors to $50 per month and simplify the application process. In the meantime, the center operates a hotline to assist seniors in navigating the benefits process. She said many seniors are unaware of deductions to help increase their minimum benefit.

"You just need more than $35 in medical expenses for seniors and individuals with disability to get a $200 deduction for medical expenses, and we often see this not used often," Edner observed. "In some of the state, it may be difficult to receive information about SNAP."

Edner suggested mailing issues could be a factor, as the report shows the lowest SNAP enrollment rates are in Southeast and Northern Virginia, with fewer than one in four eligible seniors receiving benefits in York County and Poquoson City.

The U.S. Department of Agriculture's 2023 Household Food Security Report revealed 13.5% of U.S. households, 18 million in total, experienced food insecurity last year. In Virginia, 10% of the population faced food insecurity between 2021 and 2023.