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.
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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.
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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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