South Dakota voters to decide on Medicaid work requirement amendment in Nov. 2024

South Dakota voters will decide on a constitutional amendment that will allow for the state legislature to establish work requirements for certain individuals to receive Medicaid. The amendment will appear on the November 2024 ballot.

The amendment, which was introduced to the state legislature as Senate Joint Resolution 501 (SJR 501), passed the Senate by 28-4 on Jan. 25, with all Republicans voting for the amendment and all Democrats voting against it. On Feb. 27, the State House of Representatives voted 63-7 to pass the amendment, with all 63 Republicans voting for the amendment and all seven Democrats voting against it.

This amendment would allow for the state legislature to establish work requirements for individuals who are eligible for Medicaid under the expansion of the program that voters approved in 2022. These work requirements would apply to individuals who are not diagnosed as being mentally or physically disabled.

In 2022, South Dakota voters approved Constitutional Amendment D, which expanded Medicaid to adults between 18 and 65 with incomes below 138% of the federal poverty level starting on July 1, 2023. According to the South Dakota Department of Social Services, this is up to $41,400 for a family of four. According to Secretary of Social Services Matt Althoff, an estimated 18,000 South Dakotans are enrolled under the Medicaid expansion.

State Rep. Tony Venhuizen (R-13), who sponsored the measure, said, “What we’re voting on today doesn’t say we’re going to do a work requirement. It doesn’t say we have to do one. It doesn’t even necessarily say we want to do one. What it says is, it shouldn’t be in our constitution that we can’t ever do one.”

State Sen. Reynold Nesiba (D-15), who opposed the measure, said, “This is about government bureaucracy. This is about denying health care to people who otherwise qualify for it.”

The Social Security Act of 1935 allows states to apply to the Centers for Medicare and Medicaid Services (CMS) for approval to develop state-level Medicaid work requirement programs. CMS approved Medicaid work requirement waivers in 13 states during the Trump administration. During the Biden administration, CMS later withdrew all approved waivers for Medicaid work requirements.

Currently, Georgia is the only state that has implemented Medicaid work requirements, which were established with the Georgia Pathways program on July 1, 2023.

Additional Reading: