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State Will Pilot Medicaid Work Requirement in Minnehaha and Pennington, Taking Public Comment Now

South Dakota is applying to the federal government for a waiver that will allow the state to implement a work requirement for Medicaid recipients. Governor Dennis Daugaard announced this plan in his budget address on January 9. The draft “1115 waiver” application was reviewed by the Medicaid Work Requirement & Employment and Training Stakeholder Workgroup at its April 4 meeting in Pierre. South Dakota will start with a pilot program run by the Department of Social Services and the Department of Labor and Regulation called “Career Connector” in Minnehaha and Pennington counties. “Career Connector” sounds much better than “Forced Labor,” don’t you think?

The workgroup estimates that 1,300 Medicaid recipients in those two counties will be subject to the work requirements. Medicaid recipients must work at least 80 hours per month or submit within three months to an individualized employment and training plan. According to the Career Connector 1115 waiver application, the individualized plan may include but is not limited to the following:

  • English as a second language;
  • Health insurance literacy courses;
  • Financial literacy courses;
  • Disease management courses;
  • Other healthy living courses;
  • Treatment for chronic or behavioral health conditions;
  • High school equivalency education;
  • Post-secondary education and training;
  • Volunteer work;
  • Resume writing and soft skills training;
  • Job search.

(Note to DSS and DLR: it’s not “volunteer work” if the state makes you do it.)

Beyond the 80-hours/month work threshold, the Career Connector 1115 waiver application lists several exemptions:

  • Individuals age 18 or younger;
  • Individuals age 60 or older;
  • Full-time students;
  • Pregnant women;
  • Individuals whose eligibility has been determined on the basis of disability or who have been determined disabled by the Social Security Administration;
  • Medically frail individuals (e.g. individuals unable to work due to cancer or other serious or terminal illness);
  • Individuals already participating in a workforce participation program that the State has determined meets the objectives of the Career Connector program (e.g. SNAP, TANF or unemployment insurance);
  • Parents of dependent children under one year old living in the parent’s residence;
  • Primary caregivers of elderly or disabled individuals living in the caretaker’s residence.

Workgroup member Jerilyn Church, CEO of the Great Plains Tribal Chairmen’s Health Board, said at the April 4 workgroup meeting that barriers to employment, including racism, justify exempting American Indians from the Medicaid work requirements. The state takes the position that the pilot program will take place in urban centers with lots of employment opportunities. The Department of Social Services and Department of Labor and Regulation will work hard to make sure everyone subject to the work requirement can find work. Besides, the state has concluded that it cannot legally exempt American Indians.

The pilot programs will give Medicaid recipients three months to meet the 80-hour requirement or start the individualized plan that the Department of Labor and Revenue comes up with for them. Non-compliant individuals will get nasty notes the first month and the second month. Folks who sit out for three months will get “10 day timely notice of closure of [their] Medicaid eligibility.” If an individual ignores that last notice, the individual loses Medicaid for 90 days; however, that ineligibility will not affect a spouse, child, or other household member.

Folks put on notice will be able to request “good cause” exemptions, including but not limited to the following:

  • The participant has a family member in the home with a disability under federal disability rights laws and was unable to meet the requirement for reasons related to acting as the short-term caretaker of that family member;
  • The participant experiences a hospitalization or serious illness or has an immediate family member who lives in the home with the participant that experiences a hospitalization or serious illness;
  • The participant experiences the death of a family member living with the participant;
  • The participant experiences severe inclement weather (including a natural disaster) that renders him or her unable to meet the requirements;
  • The participant has a family emergency or other life-changing event. Examples include a divorce or domestic violence.

Medicaid recipients can volunteer to take part in the Career Connector program starting July 1. The state will start requiring participation within 90 days of the 1115 waiver okey-dokey from the feds.

The state opened a 30-day public comment period yesterday. We get two public hearings, one in each of the pilot program counties:

  • May 24, 2018, in Sioux Falls: 11:00 AM CT, Department of Social Services, 811 East 10th Street
  • May 31, 2018, in Rapid City: 1:00 PM MT, Department of Labor and Regulation, 2330 North Maple Ave, Suite 1
  • Individuals requiring assistive technology or other services in order to participate in a meeting should submit a request to Marilyn Kinsman via telephone at 605.773.3165 or via email at at least 48 hours prior to the meeting in order to make accommodations available. Commenters are allowed to appear telephonically at these hearings. To appear telephonically please dial 866.410.8397 and enter conference code 8176972761.


  1. Donald Pay 2018-05-22 08:53

    Politicians want to focus on the wrong side of the question because it’s far easier to kick the poor when they are down than to approach the issue where it would do the most good. Want to get people off Medicaid? Approach it by putting employers on notice that paying people under a living wage is not going to be allowed. That means lifting the minimum wage to $15 per hour, making sure people can collectively bargain for wages, requiring health care coverage for all workers. Medicaid, for the most part, is a subsidy for modern slave-based businesses. And that’s where this should be fixed. Put modern slavery out of business and you fix Medicaid.

    When I see programs like this I see lots of good. Jobs are good for people, and helping people get a job ought to be something that government does. However, when government serves as a procurer of slaves for businesses that abuse workers, underpay them, and fail to provide adequate benefits, then there is something very wrong about the approach.

    Where is the attempt to find out why people with a job have to have Medicaid and other services? Why are the businesses these people work at refusing to pay people an adequate wage or provide adequate benefits? Why not list those businesses, because they are the real problem?

    Before I retired finding jobs for people was my life, so I know a little bit about this. The program listed in your post is partly good, and partly bad. The exemptions, at least, provide some understanding of the life difficulties faced by many poor families. But the three-month time frame is not realistic for many. My experience is that is a minimum. Many people need considerable assistance. A lot of applications are on-line. No computer, or limited computer skills, no job. A lot of those applications have stupid personality tests. Outlaw them.

    This program’s goal is not to get people employed in jobs that don’t require Medicaid. The goal seems to be this: let’s trap people in a job where they can stay on Medicaid forever. It’s a stupid way to approach things.

  2. TB 2018-05-22 09:35

    Then they need to up the income guidelines. Before I remarried, I was a single mother of four children, working for not much more than minimum wage, and I couldn’t qualify for Medicaid for myself. While I’m grateful for coverage for my children, a single parent being sick and missing work is no joke. My husband and I don’t qualify for Medicaid now, either, with only one income currently, while I’m caring for our children.

  3. Loren 2018-05-22 10:01

    Lots of moving parts. Sounds like a long walk up hill for a short ride down. Won’t it take another whole layer of bureaucracy to administer, this from the “less gov’t” folks? If we are busy with this, who will monitor public restrooms for gender appropriateness? Who will monitor who is sleeping with who? Shouldn’t we be more concerned that the next move will be gov’t confiscation of our bump stock? Is all this really our best use of time and resources? Sadly, in SD, it probably is.

  4. Donald Pay 2018-05-22 10:54


    If you are really going to serve those 1,300 folks to help them meet the employment goals, it will take 35-40 FTE, assuming you don’t phase in the requirements. That is for the job search, soft skills training, etc. That is assuming just 1.0 hour coverage per week with each person, which, in my experience, is a vanishingly small commitment to each person. That would give each Job Councilor a case load of 35 folks. That’s a bare bones, almost token, commitment, not really serving people in need. Some will be much more independent, and won’t need much support. Others will need considerably more support, including rides to interviews, coordination for child care, some good clothes to go to interviews, etc. The smart way would be to phase folks in, taking volunteers for the first round. The volunteers would be the most motivated, but give you a sense as to what is actually required. Phasing it in would allow you to cut the FTEs.

    After the person gets the job, there should be some follow on to make sure any difficulties are addressed. The mistake here is that there really isn’t a commitment to the people. There are a lot of seasonal jobs, but those don’t meet the program’s requirements. A person who scrambles to get a seasonal job that ends in a couple months is going to be punished under this program. That needs to be addressed.

    Here’s how the state could be doing RIGHT NOW, but they are too intent on kicking the poor, rather than serving them: get commitments RIGHT NOW from Rapid City and Sioux Falls businesses to hire these folks into good jobs. Get state and local government in Sioux Falls and Rapid City to open up jobs at skill levels that these folks could hold. Stop using high priced consultants, and use that money to serve the people by creating good jobs for these folks. Get businesses to stop certain practices, like combining stocking with cashiering. A lot of folks can do stocking, but not cashiering, so when businesses combine those duties they disemploy thousands of folks.

  5. mike fom iowa 2018-05-22 12:13

    Will it exempt wasicus, as some states have tried?

    Another thing, if South Dakota claimed the state couldn’t trust the Fed under Obama to fund the program, there is no way in the world anyone with a brain would trust Drumpf’s cabal to fund it.

  6. Alice Edwards 2018-05-22 13:56

    Cruel, pointless, bureaucratic. Focusing on urban centers will unevenly impact African American poor.

  7. Peter Froelich 2018-05-23 09:31

    I plan on giving comments tomorrow in Sioux Falls. I have a message out to DSS about hearing format and will post here once I receive an answer.

  8. Cory Allen Heidelberger Post author | 2018-05-23 10:24

    Thanks, Peter! Let us know what you say and what you hear from other citizens and from DSS/DLR at the meeting.

  9. Pat Baker 2018-05-23 15:34

    What about those folks who have a mental illness or substance addiction and are unable to work? Do they have an exemption? Are we such an uncaring country that our poor people must suffer?

  10. Cory Allen Heidelberger Post author | 2018-05-23 21:48

    Substance addiction is a problem, but would the disability exemption take care of some of the folks with mental illnesses?

  11. Peter Froelich 2018-05-24 08:32

    From Samuel Matson, Medical Eligibility Program Administrator Division of Economic Assistance:

    The hearing will be held in the Rushmore Room. The building has a secure entrance so when you enter, you will be guided to the correct room.

    As far as time allotment goes, we don’t have a set time limit nor do we know what attendance will be. That said, if we have to restrict the time for each question to get to everyone, we may do so.

    You may submit written request to the Department of Social Services at the address listed on the notice.

    The Director of the Division of Medical Services and I will be present at a minimum. Other program staff will likely be in attendance as well.

  12. jerry 2018-05-26 04:18

    The immortal words of William Sherman have never left the landscape. “These men flocked to the plains, and were rather stimulated than retarded by the danger of an Indian war. This was another potent agency in producing the result we enjoy to-day, in having in so short a time replaced the wild buffaloes by more numerous herds of tame cattle, and by substituting for the useless Indians the intelligent owners of productive farms and cattle-ranches.”
    ~~Gen. William Tecumseh Sherman, Memoirs of W.T. Sherman (1889)

    Boy, it seems like we are still partying like it was 1889. Republicans can never change their spots.

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