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President-elect Donald Trump approved work requirements in 13 states during his last term, all of which were rescinded or withdrawn under President Joe Biden.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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Last week, Senate Republicans unveiled reduced cuts to food assistance programs in their version of the budget bill.

The proposal from Senate Republicans cuts $211 billion from the Supplemental Nutrition Assistance Program.

The reduction is $80 billion less than what was passed by House Republicans, but the program's supporters say even reduced cuts would still impact access to SNAP - formerly Food Stamps - around the nation.

Cassie Edner, public benefits attorney at the Virginia Poverty Law Center, said a focus on error rates in SNAP -- the rate of people being overpaid or underpaid for benefits -- is encouraging lawmakers to make it harder to get benefits or deny them altogether.

"There's an incentive to improperly deny and improperly terminate," said Edner. "There's an incentive to request more verifications, which is going to increase that cost of the administration share. And it's just going to make benefits harder to access in Virginia for people that are eligible, and it's going to increase denials for things like verification, not eligibility reasons."

While Republicans in the Senate have taken a smaller axe to the budget than their counterparts in the House, a majority still support efforts to cut government spending and provide tax cuts to wealthy Americans.

If the bill is passed and states must contribute more to SNAP, Edner said, that could mean higher taxes or cuts to benefits throughout Virginia.

"So this creates uncertainty with the program," said Edner. "We don't know what cuts are going to be made. We don't know if there's going to be an increase in taxes to cover these expenses. But something's gonna happen to have to cover these costs or either cut benefits. There's just uncertainty as to what that is."

More than 800,000 Virginians received SNAP benefits between October 2023 and September 2024, according to the Center on Budget and Policy Priorities.

A new bill in the U.S. House of Representatives could make it easier for people to get job training while they're receiving federal food assistance.

It's hopeful news for the more than 800,000 Virginians receiving Supplemental Nutrition Assistance Program benefits.

The last Farm Bill made a change that allowed people getting SNAP benefits to pursue paid job training - but their wages for that training were counted against their monthly benefit amount, reducing or even ending their food assistance.

Leah Bacon, director of investment advocacy at the Center for Employment Opportunities, said this "unintended consequence" meant people had to choose between SNAP benefits and job training opportunities.

"For far too long, people have really had to make an impossible decision - to either put food on the table for themselves and their families, or invest in their future through workforce development," said Bacon. "That really can't be the status quo."

Supporters say the legislation would ensure people in temporary, paid job-training programs won't lose access to SNAP benefits. It has bipartisan support in Congress.

Bacon said the legislation could also affect people who've recently reentered society from prison.

An estimated 60% of people are unemployed for a year or more after their release - and they experience food insecurity at twice the rate of the general public.

"People need immediate stability, and by offering access to a paying job and food security - through the Supplemental Nutrition Assistance Program," said Bacon, "these are really key ways in ensuring that people have the right tools as they transition back into society."

The bill was introduced in late April and is in the House Committee on Agriculture.




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Today is National Caregivers Day, recognizing those who help friends or family members who are living with an illness, injury or disability.

A 2024 report painted a picture of Montanans who rely on public assistance, a picture largely populated by caregivers.

The report, commissioned by the Headwaters Foundation, found about one in four Montana families, or 120,000, received income-based public assistance in a given year after Medicaid expansion. It noted most are working families with children, or family members who are older or disabled.

Bryce Ward, founder of ABMJ Consulting, compiled the report.

"It's not hard to imagine how they got into this situation," Ward pointed out. "They're just low-income workers or the people for whom it's hard to work. They're old or disabled, or they have kids or other caregiving responsibilities."

Medicaid expansion is getting a lot of attention in the current Montana Legislature. House Bill 245, which would continue the program beyond its original June sunset date, was referred to the Senate Committee on Finance and Claims yesterday after passing the House earlier this month.

A big takeaway from the report is there is no "typical" participant in public assistance and many who need it use it for brief time periods. Ward cautioned conversations in the policy and media spaces can have what he called a "dehumanizing element." He hopes the report will change it.

"These populations include all the different types of people in Montana," Ward stressed. "You probably know lots of people who have, or are on, income-based public assistance."

The median family of three with income around the poverty line receives about $400 a month in benefits, according to the report.


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