South Dakota is the 39th state to increase Medicaid eligibility to cover low-income adults, with insurance coverage that can take effect as early as July 1. Applications were approved beginning June 1, and enrollment proceeds year-round.
What are the new Medicaid eligibility standards after expansion?
South Dakota’s Medicaid expansion makes coverage available to many low-income adults who weren’t previously eligible and now meet eligibility criteria. This includes adults who:
- Are under age 65.
- Have a household income up to 138% of the poverty line. (For a single person, that’s $20,120 in 2024; for a household of four, it’s $41,400.)
- Are not eligible for or enrolled in Medicare.
- Are legally present in South Dakota and have or have applied for a Social Security number.
- Have been legally present in the U.S. for at least five years. (Low-income lawfully present immigrants who have been in the U.S. for any amount of time are eligible for premium subsidies in the Marketplace instead.)
Previously, non-disabled adults under age 65 were only eligible for South Dakota Medicaid if they had small children and a household income that did not exceed 46% of the poverty line. (For a household of two, that was just over $9,000 in total annual income.)
Who became newly eligible for Medicaid in South Dakota as a result of expansion?
As a result of Medicaid expansion, an estimated 52,000 low-income adults in South Dakota are newly eligible for Medicaid as of July 2024.
This includes parents/caretakers with income over 46% and not more than 138% of the poverty line, along with childless adults with income up to 138% of the poverty line.
Can I get expanded Medicaid if I recently lost Medicaid in South Dakota?
Yes, some individuals who have recently lost Medicaid in South Dakota will find that they’re once again eligible for coverage under the new guidelines.
During the COVID pandemic, states could not disenroll anyone from Medicaid unless they moved out of state, passed away, or requested disenrollment. But that rule ended April 1, 2024, and South Dakota was among the first states to start disenrolling people. South Dakota Medicaid enrollment dropped by more than 21,000 individuals by May, after just two months of disenrollments (enrollment in March was nearly 153,000, and by May it had dropped to under 132,000).
If you’ve recently been disenrolled from South Dakota Medicaid, you may have already received a notification from the state about your potential eligibility for Medicaid expansion and a reminder to submit an application.
Will Medicaid expansion affect South Dakotans who currently have Marketplace plans?
Some people who currently have subsidized private coverage through the South Dakota Marketplace will be newly eligible for expanded Medicaid as of July 1.
Along with the non-disabled adults without small children described above, this includes adult parents and caretakers with household income between 100% and 138% of the poverty level. For a single person, that’s between $14,580 and $20,120 in annual income this year. The amount increases if there are more people in the household.
These people were eligible for Marketplace subsidies to buy private plans before July 1, 2024. They will not automatically be transitioned to Medicaid in July. They will have the option to keep their Marketplace coverage (and subsidy) through the end of the year.
Or they can choose to apply for Medicaid and then drop their Marketplace plan if and when they are approved for Medicaid. It is important to wait until the Medicaid application is approved before dropping a Marketplace plan to prevent a gap in coverage. There would not be an opportunity to re-enroll in the Marketplace plan before January 1 unless the person has another qualifying life event.
For individuals in this income range who have Marketplace coverage and choose to keep it for now, Medicaid eligibility will be redetermined during open enrollment this fall. Then, if a person is eligible for Medicaid (i.e., income up to 138% of the poverty level), they will be notified that they are no longer eligible for a subsidy in the Marketplace after the end of 2024 and are instead eligible for Medicaid.
Individuals whose projected 2025 income is above 138% of the poverty level will continue to be eligible for subsidies in the Marketplace, as long as they can provide any requested income verification documents. (There is no set upper income limit for subsidy eligibility. Subsidies are available as long as the benchmark plan would cost more than 8.5% of your household income.)
Which states might implement Medicaid expansion next?
South Dakota was the 39th state to expand Medicaid, leaving 11 others that have not yet done so. North Carolina appears likely to be the next state to expand Medicaid, with coverage expected to become available in late 2024 or early 2025.
Most of the states that have expanded Medicaid in the last few years have done so as a result of voter-approved ballot measures. However, those are not an option in most of the 11 remaining states and are unlikely to be an effective strategy in the states where they are possible.
North Carolina was the first state in several years to approve Medicaid expansion legislatively, and some of the remaining states may follow suit in the coming years. Other states—including Wyoming and Kansas—have seen multiple failed attempts in the past five years to advance expansion legislation.