South Dakota
Pace of Medicaid enrollment remains slower than expected – South Dakota Searchlight
Fewer people than expected are signing up for Medicaid through an expansion backed by voters in 2022, and the state Department of Social Services is adjusting its budget to reflect the slower pace.
That’s at least partially because the state hasn’t publicized the expansion. Most enrollees sign up when they have a medical issue and need coverage to help pay for it, DSS Deputy Secretary and Director of Operations Brenda Tidball-Zeltinger told the budget-setting Joint Appropriations Committee this week.
Medicaid expansion opened the subsidized health care program to people whose incomes sit at 138% of the federal poverty level or less, which is up to $41,400 for a family of four or $15,060 a year for a single person.
Enrollment for Medicaid expansion opened on July 1, 2023, after South Dakota voters approved the expansion in 2022.
The appropriations committee typically has one budget hearing for each state department during the regular legislative session. For DSS, the committee set aside a second meeting date explicitly to dive into Medicaid and Medicaid expansion.
Initially, state officials projected that about 57,530 people would be eligible for expanded services, Tidball-Zeltinger told the committee. But those figures were pulled from 2015 data, and assumed that all eligible residents would sign up.
“Now, as we examine and have a few months of data in terms of how many people have enrolled in the program, we’re really revising that,” Tidball-Zeltinger said.
At the end of December, she said, the state had 17,520 people on the expansion enrollment list.
Based on that slower uptake – enrollments have grown a little more than 26% each month for the last three months – Tidball-Zeltinger told lawmakers that about 40,000 people will have expanded coverage in 2025.
Those people are mostly adults without children, she told the committee. That group makes up 67% of the expansion population, the rest being parents. Sixty-five percent of enrollees also qualify for the Supplemental Nutrition Assistance Program, commonly referred to as food stamps.
Minimal outreach
Another figure offered during Monday’s meeting in Pierre caught the attention of lawmakers: 80%. That’s the number of newly enrolled Medicaid participants to have signed up with a medical claim.
“Oftentimes people come to us when they’ve got a health care issue, or they come to us through a provider as they’re seeing them,” Tidball-Zeltinger said.
Rep. Linda Duba, D-Sioux Falls, pressed the deputy secretary on why the agency hasn’t been more proactive in seeking out eligible adults.
“I can see billboards about vaccinations, and I can see billboards about STDs, but I have never seen any advertisements or any proactive community health workers that are out in communities as a result of DSS encouraging enrollment in those populations,” Duba said.
The department doesn’t intend to advertise, Tidball-Zeltinger said, but there are community organizations encouraging sign-up. The Community HealthCare Association of the Dakotas has worked to guide potential enrollees through the process.
The department sees providers as partners in sign-ups, as they are often the ones who suggest that coverage might be available when someone shows up seeking care.
“We have done a lot of stakeholder webinars and communication work with our partners,” Tidball-Zeltinger said.
Duba pointed to North Carolina to suggest that South Dakota could do more. She said she’d recently visited and saw ads encouraging sign-up.
Tidball-Zeltinger said that “some states took an approach very much like South Dakota,” which involved outreach to providers, while others used ad campaigns.
“It’s really a mix,” she said.
She also pointed to a chart in the DSS presentation that compared rates of Medicaid expansion take-up in states surrounding South Dakota. Some states, like Iowa, had faster uptake for Medicaid initially. Others saw rates similar to South Dakota. But all of them saw steadily increasing numbers during the first two years of expansion.
Adding around 2,000 people a month, Tidball-Zeltinger said, is “in the ballpark with what we’ve seen in other states that surround us.”
Duba suggested, however, that the DSS work to track how much the state pays per enrollee and separately report the cost for those who sign up when seeking care versus those who sign up beforehand.
Duba argued that the second group of enrollees is likely to be less expensive to cover in the long run.
“If we were more proactive, people would be using preventative services, instead of coming in when they’re sicker, or they’re in greater need, which drives our utilization costs up,” Duba said.
Budget adjustments
Lower enrollments have also had an impact on the DSS budget, at least for 2024 and 2025. The federal government covers 90% of the cost for Medicaid expansion, and South Dakota also gets 5% more per year in federal dollars until 2026 to help the state ease into the expansion.
Lawmakers set aside about $54 million in state money for the first year of expansion. The department needed $37.5 million less than that.
The department also revised its ask for 2025 downward by $16.4 million based on the lower enrollments.
South Dakota voters approved Medicaid expansion, but implementation may not be easy
Those budget revisions don’t signal savings, though. The department also set aside $11.4 million in “buy-down” dollars in 2024, and will ask to set aside another $18.3 million for 2025, in hopes of softening the budgetary blow when the 5% federal boost dries up in 2026.
Jason Simmons, the budget director for the DSS, told appropriators that the $29.7 million set aside over those two years still won’t be enough come 2026.
“That’s still going to leave $34.5 million that the state is going to have to come up with (for 2026) just to maintain that baseline level of services,” Simmons said. “Any additional enrollment, any provider inflation, anything we see added to Medicaid is going to make that number go up.”
The DSS, Bureau of Finance and Management and the Legislative Research Council worked to adjust projections after enrollments began. The revised projections are a sign that a work group that met last year to discuss Medicaid expansion did its job, according to Rep. Tony Venhuizen, R-Sioux Falls.
“This is a big area in our state budget with a lot of unknowns right now and a lot of future growth, and it’s going to take up a lot of ongoing revenue into the future,” Venhuizen said. “And I think we’ve done a very good job of working together to project this to the extent that we can and to plan for building it into our budget.”
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South Dakota
SDAHO Highlights Internal Expertise at the 2026 Rural Health Leaders Conference – Midwest Medical Edition
Get ready to be inspired! The South Dakota Association of Healthcare Organizations (SDAHO) is bringing the energy, insight, and expertise of our own team to the 2026 Rural Health Leaders Conference. Join us June 24–25, 2026, at our new location—the Ramkota Hotel and Conference Center in Pierre, South Dakota—for a dynamic event centered around this year’s theme: A Century Strong: Charting the Next Frontier of Rural Health.
This year’s conference delivers a powerful lineup of speakers and sessions designed to spark ideas, strengthen leadership, and shape the future of rural health care. Among the highlights are sessions led by SDAHO experts who are working every day to advance health care across our state.
State Advocacy UpdateTim Rave and Jacob ParsonsSDAHO’s advocacy team will provide a timely recap of the 2026 legislative session, along with updates on current advocacy efforts and emerging state policy priorities. Attendees will gain valuable insight into evolving reimbursement, funding, and policy developments—and what they mean for health care organizations across the continuum of care. (CE: NHA)
Partnering for Impact: How SDAHO’s Rural Health Initiatives Team Helps Healthcare Facilities SucceedBecky Heisinger, Michelle Jury, Loretta Bryan, Lindsay StromanThis session highlights how SDAHO’s Rural Health Initiatives (RHI) team partners with health care facilities statewide to support quality improvement, workforce development, opioid stigma reduction, and grant management success. Presenters will share how organizations can leverage available programs and funding while strengthening collaboration with SDAHO’s RHI team. (CE: NHA)
Important Deadline Reminder
A room block is available for conference attendees at the Ramkota Hotel, offering the convenience of staying just steps away from the event. Be sure to reserve your room soon—the room block closes May 24.
Ready to celebrate a century of strength and help chart the next frontier of rural health? Join us in Pierre and be part of the momentum. Click here to learn more and register today!
South Dakota
‘Nine Little Indians’ tells story from South Dakota’s ‘painful’ Native boarding schools
MARTY, S.D. — A documentary about nine sisters who attended a boarding school for Native American children in South Dakota and later underwent a lengthy legal battle with the Catholic Diocese of Sioux Falls will see a global premiere this month.
“
Nine Little Indians
” follows the Charbonneau sisters, who are members of the Turtle Mountain Band of Chippewa Indians. They attended St. Paul’s Indian Mission School, also known as Marty Indian School, in Marty, South Dakota. All nine sisters said they experienced abuse at the hands of priests and nuns at the school.
Native American children were sent to boarding schools as early as the mid-19th century. Many boarding schools were affiliated with religious groups, and many were directly funded or supported by the federal government through the Indian Civilization Fund Act. That legislation allowed for funding to religious groups that wanted to open schools for Native Americans in an effort to introduce tribes to the “arts of civilization.”
At least 3,000 children died
in Native American boarding schools in the United States between 1828 and 1970, according to an investigation by the Washington Post.
Shannon Kring, the film’s director, has worked with Indigenous communities across the world and directed the 2021 documentary “End of the Line: The Women of Standing Rock.” That film chronicles the yearslong fight of the Standing Rock Sioux and other Native American people against the Dakota Access Pipeline.
For “Nine Little Indians,” Kring worked with executive producers actor Leonardo DiCaprio and motivational speaker and author Tony Robbins.
Photo courtesy of South Dakota News Watch
Kring told News Watch that she wants the film to be a “healing tool” for all of those who were involved in the boarding school system, as well as their descendants, and acknowledged that it will likely bring up difficult feelings for many who have experiences at boarding schools, even outside of South Dakota.
Kring said that conversations throughout the film’s production and release rollout indicate a general unawareness of the country’s boarding school system. An important part of ensuring the film’s salience is hitting on the scale and scope of the system, she said.
Just
10 states in the country
did not have any Native American boarding schools, and a study from the National Native American Boarding School Healing Coalition said that the United States had a total of 526 schools.
The film will premiere at Lincoln Center
in New York City in a sold-out showing on May 27.
Darrell Red Cloud, a Lakota historian and the great-great grandson of Chief Red Cloud, will open the premiere with a prayer song. Kring told News Watch that the premiere will also include a recitation of the Lord’s Prayer.
Kring also plans showings in South Dakota this summer. She said that she hopes the documentary will resonate even with those who don’t have connections to the boarding school system.
All of the nine tribes in South Dakota had boarding schools operating on their reservations at one point in time, and several existed outside of tribal lands.
Photo courtesy of South Dakota News Watch
The National Native American Boarding School Healing Coalition (NABS) is also doing its part to preserve the stories of those who attended Indian boarding schools throughout the United States. The organization, which was founded in 2012, is near the end of its
two-year oral history project funded by the Department of the Interior
.
That initiative has involved nearly 400 survivors of boarding schools across the United States sitting down with historians to share their experiences at the schools in video interviews, which will be stored in a permanent, public archive of survivor stories.
Charlee Brissette (Sault St. Marie Ojibwe), co-director of the oral history project, told News Watch that hearing real stories, like those told in “Nine Little Indians” and in the oral history project, can allow for a much more potent understanding of the system – especially considering survivors are still alive today.
“To be able to witness firsthand stories from survivors … we’re able to see a face of somebody who’s been directly impacted. We’re able to hear exactly what they’ve gone through, and how that experience has impacted their life and shaped them as a person,” Brisette said.
The South Dakota Lottery offers multiple draw games for those aiming to win big.
Here’s a look at May 23, 2026, results for each game:
Winning Powerball numbers from May 23 drawing
04-16-41-48-66, Powerball: 26, Power Play: 2
Check Powerball payouts and previous drawings here.
Winning Lotto America numbers from May 23 drawing
05-16-24-32-41, Star Ball: 04, ASB: 03
Check Lotto America payouts and previous drawings here.
Winning Dakota Cash numbers from May 23 drawing
02-05-07-10-16
Check Dakota Cash payouts and previous drawings here.
Winning Millionaire for Life numbers from May 23 drawing
15-20-30-45-49, Bonus: 03
Check Millionaire for Life payouts and previous drawings here.
Feeling lucky? Explore the latest lottery news & results
Are you a winner? Here’s how to claim your prize
- Prizes of $100 or less: Can be claimed at any South Dakota Lottery retailer.
- Prizes of $101 or more: Must be claimed from the Lottery. By mail, send a claim form and a signed winning ticket to the Lottery at 711 E. Wells Avenue, Pierre, SD 57501.
- Any jackpot-winning ticket for Dakota Cash or Lotto America, top prize-winning ticket for Lucky for Life, or for the second prizes for Powerball and Mega Millions must be presented in person at a Lottery office. A jackpot-winning Powerball or Mega Millions ticket must be presented in person at the Lottery office in Pierre.
When are the South Dakota Lottery drawings held?
- Powerball: 9:59 p.m. CT on Monday, Wednesday, and Saturday.
- Mega Millions: 10 p.m. CT on Tuesday and Friday.
- Lucky for Life: 9:38 p.m. CT daily.
- Lotto America: 9:15 p.m. CT on Monday, Wednesday and Saturday.
- Dakota Cash: 9 p.m. CT on Wednesday and Saturday.
- Millionaire for Life: 10:15 p.m. CT daily.
This results page was generated automatically using information from TinBu and a template written and reviewed by a South Dakota editor. You can send feedback using this form.
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