In 2022, South Dakota voters made the smart fiscal choice to expand Medicaid under President Barack Obama’s wildly successful Affordable Care Act. Dictator Trump’s July budget law didn’t repeal that Medicaid expansion, but it did impose work requirements that overrode the Republican-backed amendment that voters approved in 2024 to allow South Dakota to apply for its own work-requirement waiver.
The federal mandate, brought to you by limited-government Republicans, actually creates more paperwork and bureaucracy for South Dakota:
The state’s proposal would have implemented fewer paperwork and tracking requirements than at the federal level, officials said during a public hearing process. Althoff called the waiver application a potential “exercise in futility” shortly after it became clear that federal requirements could be adopted.
…The federal work requirements will mandate that those between the ages of 19 and 65 who rely on the program work, volunteer or go to school 80 hours a month. Participants will have to meet those requirements a month before they enroll, and Medicaid renewal will be moved from an annual basis to every six months.
The federal government allows exceptions for people who are disabled, pregnant, eligible for the Indian Health Service, in foster care, were formerly in foster care and are younger than 26, or were released from incarceration in the last 90 days, among others.
South Dakota’s plan would not have set a number of hours to be eligible, but would have required Medicaid recipients to work, train, attend school, or serve as a caretaker for a child or elderly or disabled person in their home, unless they qualified for an exemption. Compliance with the state-level work rules would have been reviewed on an annual basis, at the time of Medicaid renewal, rather than at the time of application.
South Dakota Medicaid Director Heather Petermann said during the public hearing process that the state-proposed requirements were intended to “encourage” work without “trying to track arbitrary work hours.”
The federal work requirements must be implemented by the end of 2026 [Makenzie Huber, “Passage of Federal Medicaid Work Requirements Leads SD to Withdraw Its Own Proposal,” South Dakota Searchlight, 2025.07.23].
The federal work requirement will likely compensate for the heightened administrative burden it places on the states by booting people with substance abuse problems off the expanded Medicaid rolls:
Angela Kennecke, CEO of the addiction-focused nonprofit Emily’s Hope, said people with a history of addiction often have criminal records. She said that means they face steep obstacles in the job market.
“If you can’t get a job, you lose coverage,” she said. “But without coverage, you can’t get treatment. That’s the cycle we’re concerned about.”
…Taylor Clark, the operations supervisor at Choices Recovery Services in Sioux Falls, told South Dakota Searchlight that 95% of the people who seek care there are Medicaid recipients, and few of those people are employed. Clark said that without Medicaid for those seeking care, services may be in jeopardy [Joshua Haiar, “Advocates Worry Medicaid Work Requirements Will Block Care for People with Substance Use Disorders,” South Dakota Searchlight, 2025.07.29].
Medicaid expansion has become the primary pathway for people struggling with substance abuse or behavioral disorders to get affordable health care. Complicating their access to care with a federal work requirement puts those people at risk:
Being in poor health is associated with an increased risk of job loss, while access to affordable health supports obtaining and maintaining employment. Regular access to care, including mental health and substance use disorder treatment, can help stabilize behavioral health symptoms. However, disruptions or losses in coverage can interrupt treatment, exacerbating these conditions. For instance, stopping medication for opioid use disorder significantly increases mortality risk, with individuals facing a six-fold greater risk of death in the four weeks immediately following treatment discontinuation [Heather Saunders, Amaya Diana, Elizabeth Hinton, and Robin Rudowitz, “Implications of Medicaid Work and Reporting Requirements for Adults with Mental Health or Substance Abuse Disorders,” Kaiser Family Foundation, 2025.06.23].
Work requirements don’t increase employment; the surer path to promoting work is making health care affordable so people on the margins can get healthy enough to get and keep jobs.
But the whole point of Trumpism is punishment, so rather than implementing socially beneficial policy, let’s punish druggies trying to get clean and all those darned liberal legislatures and voters who chose to help more people get health care.
Related Reading: South Dakota Republican legislators can’t bring themselves to repeal Medicaid expansion, but they are hoping Trump will do it for them: in the 2025 Session, the Legislature placed on the 2026 ballot HJR 5001, an amendment that would end South Dakota’s participation in Medicaid expansion “on the day that the federal medical assistance percentage… is reduced below ninety percent“.
South Dakota is 51st in elder protections.
In my home state of South Dakota the Republican former governor chose to infect thousands (some reports say millions) with the Trump Virus putting its entire population at risk. Kristi Noem’s biological war on her own constituents created dire circumstances sending nurses out of state, forcing people over 65 into the workplace and driving the closures of nursing homes and a private college. Influenza preys on the elderly and the poor: two demographics South Dakota has in abundance so it comes as little surprise that South Dakota is failing its oldest residents.
There is a growing movement among Democrats and others to fund Medicare for all but I like the idea of rolling the funding for Obamacare, TriCare, Medicare, the Indian Health Service and the Veterans Health Administration together then offering Medicaid for all by increasing the estate tax, raising taxes on tobacco and adopting a carbon tax.
Yes, socialized agriculture, socialized dairies, socialized cheese, socialized livestock production, a socialized timber industry, socialized air service, socialized freight rail, a socialized nursing home industry, socialized water systems and now a socialized internet are all fine with Republicans in South Dakota but then they insist single-payer medical insurance is socialized medicine.
Hi Cory!
That’s an interesting article on punishment mentality!
“When you express outrage on [Dakota Free Press], not only do you get the immediate satisfaction of posting that but you also get repeated and amplified reinforcement of that behavior because people like what you say, they share it, they re-post it—and it creates a highly self-reinforcing cycle.”
Let’s nip that in the bud!
“Do not speak to harm, tear down, or create discord, but to edify and encourage each other.”
Kind regards,
David