Medicaid Expansion for SD

update 6/17/24

     Please Vote NO on Amendment F on the November ballot.

There is nothing helpful in Amendment F,
No help for anyone. It is only punitive.  

   We, the people of South Dakota, passed Medicaid expansion, specifying no added conditions, for our lowest-income uninsured neighbors. Now let's Vote NO on the added conditions allowed in Amendment F.

• A work requirement would be a blow to public health. It does not promote the objectives of Medicaid, which is health coverage for low-income people who lack it. 

• 61% are already working. Another 30% would be ineligible for work.[estimates*]

• Threatening to take away healthcare is cruel and inhumane.

• Evidence shows it does not expand employment.

• It creates bureaucratic cracks for people to fall through.

• In Arkansas, 18,000 lost healthcare, almost one-fourth of all those in the program. 95% of them shouldn’t have, because they were already working or should have been exempt.

• Medicaid is a stepping stone to work.

Vote NO on potential work reporting for Medicaid to help to secure the blessing of South Dakota’s voter-approved Medicaid for the lowest-income South Dakotans and for the public health of the state.


Simply remember:  F - NO!

Amendment F would leave no one any better off.

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More info if you want to keep reading: 


Work Rule - Too Extreme and Inhumane for Medicaid Expansion


       In 2022, the voters of South Dakota passed Medicaid expansion specifying no added conditions

   Now a majority of the State Legislature decided SD voters must re-vote on Medicaid expansion. (They can do that without gathering signatures.) They want to let SD, if the feds ever to allow it again, to take away Medicaid from those not reporting enough hours of work or work-like activity or verifiable disability.

---     The punishment (losing healthcare) is too extreme. Some legislators think a work requirement is ok for Medicaid, because SNAP has one. With the SNAP requirement, those who get too few hours of work, or don’t get their report turned in, must find food somewhere, like a food pantry. But if the work rule goes on Medicaid too, they’d lose not only food but also their healthcare, and possibly their health. It’s an extreme and inhumane punishment.


Medicaid saves lives and health.

Save Medicaid for all who need it.

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Lessons from SD’s failed Food Tax Refund Program (2004-2012)

  Low-income people are least able to keep up with the bureaucracy for programs designed to benefit them. Here’s an example:

  In 2012, after 8 years of SD’s Food Tax Refund Program, despite the publicity and simple application, 98% of those who were eligible were missed, because reporting to the state was involved. Most were working low-wage jobs.

  The low-income people, working or not, are more likely to have poor health, fluctuating incomes, low functioning ability, and the overwhelming realities of life at low income. They struggle daily for life’s basics, many preferring to manage without government help.

   We can take these LESSONS:

1. Medicaid expansion has 61% people working already and 30% more who should be exempt from required work. Many of them would miss work reporting and lose their Medicaid. Vote No on Amdt.F to protect the lowest-income SD’ans from losing their healthcare.

2. Vote Yes on I.M.28 to take the state’s portion of tax off food.

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The state legislature, not the people, put this potential change to Medicaid expansion on the ballot. They should not have. Here's why:

    In general, it is not wise to make policy based on the exception but which will then apply to the whole group. That is why work reporting for Medicaid expansion has so many problems, if the goal is to incentivize work.


It is based on myths and stereotypes. It assumes that people covered by Medicaid expansion are not working. It assumes compelling people with the threat of taking away health coverage will get more people into the workforce. These are wrong. There is evidence to the contrary. Studies show most are working or doing some other activity that society needs (like family caregivers sparing the public a big nursing home expense) and that the requirement does not increase employment. Policies should be based on evidence.


It should not be on the ballot, because here’s a chance it could pass. If it did, it would apply unnecessarily in two ways. (a) All the Medicaid expansion group would have the reporting burden. It would apply to the vast majority who are already working or in a situation that would likely be exempted. Low-income lives are generally complicated already. This added burden would not help them at all.

(b) Additional burdens would be on state workers to keep track of the majority who are working along with those who are not. Even more of a challenge would be determining the exemptions that would be needed and then tracking those who would be exempted or not. That would be a lot of additional tracking of our citizens’ activities by state employees.


It should not be on the ballot, because if passed, some people would lose healthcare. A work requirement is against the purpose of Medicaid expansion, which was to get health coverage to low-income people who lacked it. Yet healthcare loss is what happens.  This is an extreme and inhumane punishment for failure to report enough work or verify qualifications for an exemption. The punishment should fit the crime.

For example, the experience in Arkansas, before it was ruled as being against the purpose of Medicaid, was well studied. About ¼ of the people involved lost coverage, of whom 95% should not have been dropped. South Dakotans should not have to go through this nightmare. I hope the purpose of the initiative is not to cut the caseload.                                   

It cost the state an enormous amount of money. A bunch of people lost their healthcare,
and we have nothing to show for it.-Arkansas Advocates for Children and Families 


It should not be on the ballot, because (4) if passed, it would not incentivize work. If work is the purpose, this goal has been studied, and the results are in: There is no overall benefit to the workforce. Example: Like many reports on Arkansas’ experience, the journal Health Affairs Sept.2020, reported “work requirements did not increase employment over eighteen months of follow-up.”


It should not be on the ballot, because (5) it creates more shame and humiliation for low-income South Dakotans who need government programs. During most of this year, they would hear the false assumptions and stereotypes that they endure so often already. It may be hard for the rest of us to imagine how that feels.

   People do not generally aspire to being on government help. I believe this is why Medicaid expansion enrollment has been so slow.

Also, they would have to live with this threat to their healthcare, because the initiative does not have specifics, so they would not know if they would still qualify for Medicaid. Before the election, they would not know what would happen to them in these situations, for which the state would need to develop policies:

Caretakers of all sorts

Part-time and seasonal workers

Post-secondary students

Workers between jobs

Domestic violence situations

Grandparents raising grandchildren

Gig workers and other Self-employed

Other jobs with unpredictable work hours

Various unstable health or housing situations

Conditions requiring ongoing medical care but able to work at times

Areas short of employment opportunities

and more.

     The initiative does not recognize, but we must, that life and work for low-income people are precarious. As good neighbors, we surely want to be understanding and supportive, like the help we are offering with Medicaid expansion.


It should not be on the ballot, because (6) the Legislature had many years to accept Medicaid expansion and do so on its own terms. But not having done so, the Legislature should now respect the will of the voters.

   Voters approved Medicaid expansion explicitly banning additional requirements. Did voters know that meant work requirements? Yes. Medicaid work requirement proposals and reports had been in the news throughout several years before November 2022. News media covered states submitting requests for “waivers” to allow them. News media reported on court cases. News media covered the experience in Arkansas.
    For example, a Feb.18, 2020, KFF article notes that Medicaid work requirements were being covered in widely accessed media: The New York Times, the Associated Press, The Hill, NBC news, the Washington Post, Wall Street Journal, NPR, Bloomberg News, and CNN.

*an estimate from KFF report: 

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Download the items below using the little button that will appear in the upper right corner.

  -- Income limits for Medicaid expansion (and children's Medicaid and

  -- Background info on Amendment F

  -- the SD Synod ELCA Resolution on Protecting Health Coverage for the Vulnerable People in South Dakota 

signup handout M'caid, ACA, CHIP v4.pdf
Background Amdt F, 6'24.pdf
SD Synod Resolution passed.pdf