Guest Column: Making Medicaid Expansion a pathway forward By Rep. Tony Venhuizen and Sen. Casey Crabtree

Making Medicaid Expansion a pathway forward
By Rep. Tony Venhuizen and Sen. Casey Crabtree

During the 2023 legislative session, we introduced House Joint Resolution 5004, a proposed constitutional amendment that would allow the State of South Dakota to consider a work requirement for those who enroll in Medicaid expansion. This proposal passed the State House overwhelmingly, but fell a little short in the Senate due to good-faith committee questions about it.

We have accepted input from some of the opponents and believe those concerns have now been addressed, and will be re-introducing this proposal in 2024.

This proposal asks a basic philosophical question: Is Medicaid expansion meant to be a hand up for people facing tough times, or should it be a way of life? We believe that Medicaid, like all social programs, should be a hand up for people who need it. But it should also be a pathway forward to something better.

South Dakota voters passed Medicaid expansion in 2022, and the governor and state legislators honored that decision. Medicaid expansion was implemented and went into effect on July 1, 2023, and it is available for eligible recipients today. 

One provision of the Medicaid expansion ballot measure, though, causes a problem. The amendment contained language that said that the state cannot impose any requirements on those who receive Medicaid expansion that are not also imposed on other Medicaid recipients.

Why is that a problem?

Because the traditional Medicaid program applies to children, the elderly, the disabled, and in some cases, pregnant women. We don’t apply a work requirement to these recipients, because it wouldn’t make any sense.

Medicaid expansion, though, applies to able-bodied, working-age adults – adults who are aged 18 to 65 and who are not disabled. It makes perfect sense to consider a work requirement for this population.

We want to be clear about what our proposal does, and what it does not do.

Our proposed amendment says that the State may consider a work requirement for these Medicaid expansion recipients, if it is allowed by the federal government.

It does not establish a work requirement for Medicaid expansion. It does not require South Dakota to adopt one in the future. It simply says that we can consider it. And it doesn’t address the program’s specific parameters, such as exemptions for parents of young children or those pursuing further education. Those would be decisions to be made at the time that a requirement is actually considered.

Currently, the Biden administration does not allow states to impose a work requirement in Medicaid expansion. The Trump administration did allow it, and during that time 13 states adopted a work requirement and 9 others were working toward it. When President Biden came into office, those requirements were abolished and no new ones are allowed.

We know, though, that President Biden will not be in office forever, and that at some point a future administration will allow a work requirement again. In addition to prior Republican administrations, even the administration of President Bill Clinton was open to work requirements in federal social programs. 

When a work requirement is once again allowed, South Dakota should not put ourselves in a position where we cannot even consider it, when every other state has that option. That just doesn’t make sense.

Finally, we want to emphasize that this proposed amendment honors the will of the voters. The voters in 2022 passed Medicaid expansion, and we have implemented it. Our proposal would also go before the voters. We are giving the voters the opportunity to refine their earlier decision with a more specific question. We know they want Medicaid expansion, but would they like to consider a work requirement, or not? If they say “yes,” that will be the will of the voters as well.

South Dakotans are hard-working people, and we believe in the value of work. Medicaid expansion, like all social programs, should be a pathway forward for those who receive it. This proposal is an important step in that direction, and we look forward to the discussion in Pierre in January.