Voters in South Dakota Will Decide If Medicaid Recipients Should Be Required to Work

South Dakota voters will vote on an amendment in the November elections to decide whether the state should require physically and mentally able Medicaid recipients to work

On the ballot is the Medicaid Work Requirement Amendment, or Amendment F, which would change the state’s Constitution to impose a work requirement on able-bodied individuals on Medicaid.

The Medicaid Work Requirement would need to be approved by the Centers for Medicare and Medicaid Services (CMS).

In 2022, voters in the state approved an expansion of Medicaid to adults between 18 and 65 with incomes below 138 percent of the federal poverty level.

That expansion of those on the Medicaid rolls in the state includes many who can work, Rep. Tony Venhuizen (R-Sioux Falls) told The Epoch Times via email.

“Unlike traditional Medicaid, the expansion population is made up of working-age, able-bodied adults,” Mr. Venhuizen said. “This amendment would allow future South Dakota policymakers to consider a work requirement, if the federal government allows it.”

Mr. Venhuizen said that social programs such as Medicaid should not be “a way of life.”

“In South Dakota, we believe social programs should be a hand up during tough times, not a way of life,” said Mr. Venhuizen, the prime sponsor of the measure going on the ballot.

North Dakota lawmakers voted along party lines to send Amendment F to the ballot in November, with Republicans favoring it and Democrats opposing it.

Two lawmakers, both Democrats, said they are opposed to the amendment as it would harm low-income residents, could affect their health, and lead to higher taxes.

“I am opposed to this Amendment because Medicaid work requirements are ineffective and harmful,” Rep. Kadyn Wittman (D-District 15) told The Epoch Times via email. “They do not significantly increase employment and often lead to loss of coverage for many individuals who are already facing significant barriers to employment, such as chronic health conditions or caregiving responsibilities.”

When asked if she believed that those on Medicaid who can work should be employed, Ms. Wittman replied, “I believe that those on Medicaid who are able to work should be supported in finding and maintaining employment. However, the majority of Medicaid recipients who can work are already employed.”

Ms. Wittman said for those who are not employed, the work requirement does not “address the underlying issues that prevent them from working, such as health problems, caregiving duties, or lack of job opportunities.”

The amendment would increase administrative costs and could lead to a loss of health care coverage and poorer health outcomes, according to Ms. Wittman.

Another opponent of Amendment F is Sen Reynold Nesiba (D-15), Senate Minority Leader, who told The Epoch Times via email, “Amendment F will raise our property taxes.”

“We know that growing government bureaucracy and increasing red tape requirements will end up denying healthcare to people who otherwise would qualify,” Mr. Nesiba said.

According to Mr. Nesiba, that will result in more patients with claims they cannot pay and health care systems with unpaid bills. “Who pays those? We all do. How? With higher healthcare costs, higher insurance premiums, and in South Dakota hospital systems like Sanford ask the local county to pay those unpaid medical debts,” he said.

Mr. Nesiba said counties pay those debts for the hospital systems by using their main source of funding, which is property taxes.

“So if you like higher property taxes, more government bureaucracy, more paperwork for small business owners to fill out to maintain their workforce, and more state employees hired to simply deny people health insurance, then support Amendment F,” Mr. Nesiba said. “I’m glad it’s letter F. As an economics professor, that’s the grade I’d give it as a constitutional amendment.”

Georgia is currently the only state with Medicaid work requirements. Georgia was one of 13 states that were approved for Medicaid work requirements by the Centers for Medicare and Medicaid Services under the Trump Administration.

However, the Biden administration’s CMS withdrew all of those approved waivers.

After its Medicaid work requirement was withdrawn, Georgia filed a lawsuit against the CMS and the Department of Health and Human Services and won. The state’s requirement went into effect in July 2023, years after it was supposed to go into effect. It is now set to expire in 2025.

However, Georgia Gov. Brian Kemp filed a lawsuit against the CMS in February to extend the state’s Medicaid Work Requirement, called Georgia’s Pathways to Coverage, through 2028 due to delays by the Biden administration’s CMS.

“After the Biden administration’s lengthy, failed attempt to interfere with Georgia’s innovative plan to afford thousands of Georgians the opportunity to receive quality healthcare, they are back at it again,” said Mr. Kemp in a press release when announcing the new lawsuit.

“We beat them in court then, and now we are again asking for the federal government to adhere to the terms they agreed to rather than play politics by refusing to give us back the time they stole from delaying the Pathways rollout and implementation,” Mr. Kemp said.

Georgia’s Pathways to Coverage Program requires those who received Medicaid to complete “qualifying activities” which include employment, on-the-job training, volunteering for a non-profit, vocational educational training, or receiving job readiness assistance.