SIOUX FALLS, S.D. (KELO) – South Dakota voters passed Amendment D 56% to 43% in November to provide medical coverage for low-income people and the Department of Social Services is asking for 68 new full-time employees to help implement the program.  

DSS provided an update to lawmakers on the Joint Committee on Appropriations about Medicaid expansion on Tuesday, detailing the current Medicaid program and projecting the expanded program starting July 1.  

DSS Deputy Secretary Brenda Tidball-Zeltinger said Amendment D is the biggest change to the program in 25 years. She said the forecasts for cost estimation and enrollment are difficult to project and DSS officials have been working with other states on how Medicaid expansion has worked. 

DSS has to start submitting amendments to the Medicaid State Plan to the federal government in March 2023 and enrollment in the program starts July 1, 2023. 

The breakdown of 68 new full-time employees looks like 32 for economic assistance (process applications and technology costs), 28 for medical services, 5 for secretary and three for child support. There would be 32 new employees to help manage application, renewal and ongoing case management. 

A DSS slide breaking down the costs for 68 new DSS employees.

DSS Medicaid Director Sarah Aker said the 68 employees would be helping handle an increase of volume and not starting new tasks or jobs under the Medicaid program.

Rep. Linda Duba (D-Sioux Falls) asked what the technology costs would be. Tidball-Zeltinger said DSS is midway through implementing new technology but it doesn’t start until late 2023. She said the older technology needs to be used July 1 and until the newer system is implemented.

Sen. Jim Bolin (R-Canton) asked if DSS could be overwhelmed by 57,530 new enrollments if the 68 new employees aren’t hired. 

Tidball-Zeltinger said DSS is feeling fairly confident about filling open positions but there may be contingency programs and other approaches if DSS can’t fill all its open positions. 

Expecting 57,530 new enrollments, but higher application numbers 

Aker said Medicaid is mostly for children as it operates today. DSS used Market Decision Research to conduct independent surveys for the number of people estimated to use Medicaid. 

“We feel confident in these numbers because of their consistency,” Aker said. 

Aker said DSS is estimating for a possible 52,300 to 57,530 people who may enroll in Medicaid through 2024. 

Aker said one-third of the expansion population will be parents with children and 60% of the expansion population will be working. 

A DSS slide breaking down the estimates for new enrollments for Medicaid expansion.

Tidball-Zeltinger said DSS is budgeting for Fiscal Year 2024 all 52,300 people would enroll starting July 1. Tidball-Zeltinger said DSS is not sure what pre-enrollment would look like before July 1. 

Aker detailed how people could be covered with Medicaid and then be removed from Medicaid.  

South Dakota’s current Medicaid program 

Aker said South Dakota runs a pretty conservative Medicaid program in terms of the services provided. 

Aker said Medicaid is a partnership with providers, which the state screens to make sure there’s compliance with federal requirements and state licensure. 

There were 289,000 paper claims and more than 7 million Medicaid claims processed by DSS in 2022. 

Aker said she would love to switch to electronic claims only, but some providers have not invested into electronic software and paper is the only way some providers can participate. 

Rep. Duba asked how many DSS employees help with data entry and Aker said three full-time employees as well as some temporary staff. 

Aker said prior to March 2020 when the COVID-19 pandemic started, Medicaid enrollment was on a downward trajectory. She said the return to normal Medicaid will be gradual and the state can start making redeterminations for a loss of coverage starting April 1. 

“Predicting health care costs is extremely challenging this year due to these factors and there is potential for significant variability and impacts on the budget,” a slide from the DSS presentation stated. 

Aker said DSS looks at every Medicaid case every 12 months.