Medicaid is a federal program granting healthcare to people and families with low-income. The federal and state governments fund it, with the states managing the program. The Affordable Care Act had provisions to expand coverage, but it was left up to each state to choose whether to expand coverage. South Dakota is one of several states to decline the expansion.

Who is covered?

Eligibility in South Dakota varies by category, but is based around the Federal Poverty Line (FPL). Currently, pregnant women and children up to age 5 can be covered by Medicaid if their family income is up to 133% of the FPL; children age 6 to 18 are covered at family income of up to 100% FPL, but the parents could only be covered at income up to 52% FPL. The Medicaid expansion would cover low-income individuals and families at up to 138% FPL (what this means for a family).

Who does this help?

The Affordable Care Act requires all Americans to have health insurance. At present, there are Americans who cannot afford insurance even with subsidies, but make too much money to qualify for Medicaid. The expansion would extend Medicaid coverage to approximately 49,000 adults in South Dakota (although about 9,000 of these are eligible, but not enrolled). Currently, about 116,000 people are covered by Medicaid in South Dakota.

What is the cost?

Governor Dennis Daugaard has cited the increased cost of the program as the reason not to expand. Initially, the federal government would cover the entire cost increase. After three years, the state governments will start covering some of the increase, going up to 10% of the increase at the end of four more years; Governor Daugaard has also been concerned about if the federal government would uphold their end.

In actual terms, South Dakota would pay $157 million more over the seven year period (even without the expansion, South Dakota would pay $35 million when currently eligible people sign up). This would be 3.6% more of the budget than Medicaid currently costs.

This amount would be balanced in part by people now being covered for services the government or other entities would have paid for. For example, currently uninsured people will get medical service in emergency rooms; when they are unable to pay for the procedures, hospitals absorb the costs and pass them on to the insured.

Current Legislative Action

Democrats in the South Dakota Legislature are in favor of the expansion. Republicans would prefer a limited expansion to help those most in need; they would like to see coverage extended to those making up to 100% of the FPL. So far, the federal government has offered the expansion as an all or nothing deal.

Past Legislative Action

In 2013, House Bill 1205 was introduced to expand Medicaid. This bill was tabled by the House State Affairs Committee.


The Math of the Medicaid Expansion  Looks at how the expansion affects North Dakota (which is expanding) and South Dakota

Reduction in Uninsured through Medicaid Expansion  Map with how much the Medicaid expansion would reduce the number of uninsured people in each state

Additional Resources

Medicaid stories and reports in our archive

How would the Medicaid expansion affect South Dakota?

Medicaid Expansion Fact Sheet

South Dakota Medicaid Eligibility

South Dakota Medicaid Report, December 2012