PIERRE — South Dakota legislators took the first step Wednesday toward asking voters for the authority to impose work requirements on some Medicaid recipients.

The Senate State Affairs Committee voted 7-1 to send the resolution to the full Senate. If passed by that body and the House of Representatives, the measure will be placed on ballots statewide in the Nov. 5 general election. 

Voters would be asked to put authority into the state constitution for the state to impose work requirements on Medicaid recipients who have not been diagnosed as physically or mentally disabled. Medicaid is a federal-state health insurance program for eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.

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South Dakota voters approved a constitutional amendment in the 2022 general election to expand Medicaid income eligibility, making South Dakota the 39th state to expand the program. Current data from the state Department of Social Services says nearly 126,000 South Dakotans are enrolled in Medicaid.

The proposed resolution, if approved by voters, would add an exception to the voter-approved amendment, which currently prohibits the state from imposing “greater or additional burdens or restrictions” on eligibility.

Rep. Tony Venhuizen, R-Sioux Falls, is sponsoring the resolution in the House. He testified that the amendment does not mandate a work requirement but opens the possibility for it. 

“We’re honoring the will of the voters because we’re going back to the voters,” Venhuizen said. “We’re asking a clarifying question.”

Venhuizen said getting capable people to work is something that the state should incentivize with its social programs. He said exemptions from work requirements for people on cancer treatment or for a new mother are examples of things “we all agree about.” He said those exemptions are details that can be ironed out later.

However, opponents, including several health organizations, argued that Venhuizen could not guarantee those exemptions would be put in place. They said the amendment would threaten access to health care for some Medicaid recipients.

Governor Kristi Noem’s former Department of Health secretary, Kim Malsam-Rysdon, lobbied on behalf of Avera Health against the bill.

Malsam-Rysdon said most people on Medicaid are already working. She said “work requirements just don’t work” if the goal is to increase the labor pool.

Malsam-Rysdon said there is evidence, however, that work requirements may cause some people to lose their health care coverage.

Deb Fischer-Clemens, lobbying on behalf of the Catholic Presentation Sisters, who sponsor Avera, said the organization sees the potential effects of the proposed amendment “as a problem with ensuring people can get preventative care.”