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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House lawmakers have approved a bill to make it harder for low income Iowans to qualify for public assistance, and critics said the measure would hurt families who are already struggling to make ends meet.

Known around the Iowa Statehouse as the SNAP bill, Senate file 494 would have the state look into how many assets someone has before allowing them to qualify for public assistance, and would also require recipients to make more money than they currently do to be able to get those benefits, including Medicaid.

Rep. Heather Matson, D-Ankeny, said while designed to increase accountability, the bill is actually creating more barriers for Iowans who are already struggling, and would have an especially damaging effect on youth.

"Especially in really tough economic times when people are already struggling," Matson pointed out. "When we look at the rising costs that people are facing and the fact that food pantry use is at record highs, we know a lot of Iowans are struggling, kids should not get kicked off of getting access to food."

Advocates for low income Iowans are holding a public hearing on the measure today to take input from people who need those benefits, and put faces on the people who are using them.

Matson noted Iowa will invest about $8 million to implement the asset investigation program, which is the same amount the state stands to save if the bill becomes law. Because there is no economic benefit to the state, she calls the bill politically motivated and designed to create the impression lawmakers are fighting fraud and increasing accountability on behalf of taxpayers.

She added the bill would have unintended consequences if it becomes law.

"If you kick somebody off of Medicaid, that is their health insurance," Matson explained. "If things get really bad, they are going to go to the emergency room where we know emergency care is way more expensive than preventive care. If kids are hungry, and they are not able to get food, then do you think that they're going to be able to focus in school? No, they won't."

The bill would also create a new verification system for benefit recipients and require them to appeal to the state within 10 days if they are removed from the public assistance rolls.