Voters in Maine, Idaho, Utah, Nebraska, Oklahoma, and Missouri adopted Medicaid expansions through ballot measures when state legislators pushed back on adopting them. Despite voters passing these initiatives, lawmakers in Missouri, for example dragged their feet on implementing Medicaid expansions.
passed its expansion in 2020, set to take effect summer 2021. As of February 2022, there were more people who had pending applications to the state Medicaid program, MO HealthNet
, than the number of people enrolled via the expansion at that point. 64.2k were approved in comparison to 73k still pending applications.
Federal law requires that applications take no more than 45 days to process while a report
found that typical applications took 70 days. In many other states, Medicaid applications take no more than a week to process.
The legislature initially refused
to fund the expansion, but in August, a judge ordered the state to accept applications for those eligible according to the ballot initiative. No applications were processed until October
of 2021 because of necessary computer updates.
However, South Dakota’s ballot measure which passed last week with a 56% “Yes” vote took the form of an amendment to the state constitution, and the text outlines specific deadlines
in 2023 to ensure the expansions happen in a timely manner.
Some concerns about implementing the Medicaid expansion are already being voiced. For one
, South Dakota’s tools for handling Medicaid applications and enrollments are very manual, and it’s one of three states without an online account that can be used to monitor applications and upload documents to renew coverage.
The Department of Social Services must work to build out not only the internal infrastructure to handle an influx of enrollees to the program, but a cellphone-friendly system to manage Medicaid accounts must be created in time for summer 2023.