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Health Care Reform:

Health Insurance & Affordable Care Act

By Randy Dotinga

Reviewed by Lisa Zamosky

WebMD Health News

Medicaid Expansion in South Dakota Uncertain

July 31, 2013 -- For the time being, South Dakota has rejected expansion of Medicaid as allowed under the Affordable Care Act.

While the issue remains under consideration, don't expect anything to happen soon.

"The state is wrestling with many issues, particularly the impact to the state budget on a long-term basis, whether there will be access for individuals to primary care in the rural areas of South Dakota, the federal deficit, and the moral issue that individuals with the lowest incomes will not have access to subsidies through the federal Exchange," says Deb Bowman, a senior adviser to Gov. Dennis Daugaard. "If Medicaid is expanded, the [start] date would be up to the governor and Legislature but likely would be no earlier than July 1, 2014."

In 2012, the Supreme Court ruled that expansion of Medicaid was up to the states.

If South Dakota does expand Medicaid, coverage will become available to adults under age 65 who aren’t pregnant, aren’t already eligible, and have incomes less than 138% of the federal poverty level. That’s $32,499 for a family of four in South Dakota and almost all other states.

A task force created to study the issue is expected to submit its report by Sept. 15. The group started meeting in May and has one more meeting in August.

"It is a difficult issue with strong sentiments on both sides of the issue," Bowman says. "The task force report will clearly outline the pros and cons for decision-makers in the state."

Almost all Americans will need to either have insurance by Jan. 1, 2014, or pay tax penalties. However, in states that rejected Medicaid expansion, people who would have qualified under it will be exempt from the mandate to have insurance.

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