South Dakota asks Trump administration to approve Medicaid work requirements for parents, caretakers

South Dakota asks Trump administration to approve Medicaid work requirements for parents, caretakers
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South Dakota health officials are asking the Trump administration to approve a program that would impose work requirements on some Medicaid recipients who are parents or caretakers.

Under the proposal, parents aged 19 to 59 and other caretakers on Medicaid who live in South Dakota's two most populous counties would have to work at least 80 hours a month, take classes or complete other activities to keep their coverage. 

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Those who don't meet the requirements for three months in one year lose their coverage.

The purpose of the program, state officials wrote in the application, is to "improve the health and wellbeing of able-bodied adult Medicaid recipients while empowering them to obtain full-time meaningful work." 

"South Dakotans value hard work and believe that work can add meaning and purpose to an individual's life," the officials wrote. 

The Trump administration has already approved work requirements on certain Medicaid populations in Indiana, Arkansas, Kentucky and New Hampshire. 

Kentucky's program was blocked by a federal judge and opponents are suing the administration over Arkansas's program. 

But all of those states expanded Medicaid under ObamaCare to more low-income adults without children. 

If approved, South Dakota would become the first state to impose work requirements on the traditional Medicaid population — parents or caretakers who have small incomes. In South Dakota, a family of three must earn less than $27,159 a year to qualify for Medicaid. 

Maine and Mississippi, which have not expanded Medicaid, both have work requirement proposals for parents awaiting approval from the Trump administration.

Wisconsin, another state that has not expanded Medicaid, also has a work requirement proposal, but it would only apply to childless adults between 0 and 100 percent of the federal poverty level — up to $12,140 for one adult.

South Dakota's proposal would run as a five-year pilot in Minnehaha and Pennington counties, with an estimated 1,300 Medicaid recipients eligible for the program.

The state said it might seek to expand the program to other areas of the state based on the initial outcomes of the pilot. 

South Dakota proposed several exemptions for the program. Medicaid recipients already working 80 hours or more a month and those aged 18 and younger or 60 and older would be exempt.

Full-time students, pregnant women, the disabled, medically frail, caregivers who live with elderly or disabled individuals and parents of children under 1 year old would also be exempt. 

Under the proposal, participants in the program would be connected with a case manager to help them meet the requirements. 

"Maintaining health coverage is a key tenant of the program," the officials wrote in the application. 

"Participants will be offered a range of services individualized to support employment goals." 

The Trump administration opened the proposal up for public comment Monday, and it closes Sept. 26. 

South Dakota noted in its application that the majority of comments it received during the statewide comment period were expressing opposition. 

"The State understands and appreciates concerns expressed by individuals generally opposed to work requirements or who are concerned about individuals losing Medicaid coverage," the officials wrote, responding to the criticism.

"The State has designed the Career Connector program with the intent of preventing anyone making a good faith effort to comply with the program from losing Medicaid coverage due to noncompliance."

Opponents of work requirements think they will lead to people losing benefits. 

"Non-expansion states generally do not offer Medicaid coverage to low-income adults without dependent children, and most of them cover only very low-income parents," Judith Solomon and Aviva Aron-Dine wrote in a June brief for the left-leaning Center on Budget and Policy Priorities.

"Work requirements will almost certainly result in large coverage losses among these parents, with harmful consequences for their children’s health and well-being as well."