Mission:

To promote responsible and equitable fiscal policies through research and education

Joy Smolnisky, Director 808 N. West Ave., Sioux Falls, SD 605-367-9667 joys@sdbudgetandpolicyproject.orghttp://sdbpp.org

Funded through a grant from theNorthwest Area Foundation

Medicaid Expansion – a South Dakota Decision

Federal Affordable Care Act includes:

regardless of SD decision on Medicaid expansion

1. Coverage guarantees

2. Insurance exchanges

3. Federal tax credits to

pay for insurance

4. Individual mandate

5. Funding provisions

2012 Federal Poverty Level (FPL) by household size

Household Size Annual Income100% FPL

Expanded Medicaid138% FPL*

1 $11,170 $15,415

2 $15,130 $20,879

3 $19,090 $26,344

4 $23,050 $31,809

For each additionalperson, add $3,960 $5,464

*138% minus 5% income disregard = 133% FPL

2014 FEDERAL TAX CREDITS TO MAKE PREMIUM COSTS AFFORDABLE

92,800 South Dakotans eligible

Premiums: The table below compares premiums* for subsidized families by income

Family Income PremiumsIncome Annual Salary Premiums Annual premiums

(as % FPL) (for family of 3) (as % of income) (for a family of 3)100% $19,090 2% $381.80133% $25,390 3% $761.69150% $28,635 4% $1,145.40200% $38,180 6.30% $2,405.34250% $47,725 8.05% $3,841.86300% $57,270 9.50% $5,440.65350% $66,815 9.50% $6,347.43400% $76,360 9.50% $7,254.20

* based on 2012 Federal Poverty Levels Data source: http://www.kff.org/healthreform/upload/7962-02.pdf

FEDERAL TAX CREDITS – Cost Sharing

1/3 of out-of-pocket cap

1/2 of out-of-pocket cap2/3 of out-of-pocket cap

Children Pregnant Women

Parents Childless Adults

200%

133%

52%

0%

Current Medicaid eligibility limits for non-elderlySouth Dakotans*

*Based on income as a percentage of the Federal Poverty Level by household size

100% FPL

400% FPL

Children Pregnant Women

Parents Childless Adults

200% 133% 52% 0%

2014 federal insurance exchange subsidies (sliding scale)

Children Pregnant Women

Parents Childless Adults

200% 133% 52%

2014 federal insurance exchange subsidies (sliding scale)

South Dakotanswithout accessto affordablehealth insurance

100% FPL

400% FPL

South Dakotan health insurance in 2014

30,000 uninsured

South Dakotans

92,800116,000

SCENARIO #2 (without Medicaid expansion)

Susan Frank Mary Willis

Susan and Mary are both single parents. Susan’s daughter Sarah and Mary’sson Zeke are first grade classmates. These moms both work full time.

Susan’s earnings Mary’s earnings$7.50/hour – 38 hrs/week $7.75/hour – 38 hrs/week98% FPL (Federal Poverty Level) 102% FPL (Federal Poverty Level)

Can these moms get affordable health insurance?

NO YESSusan’s income is TOO LOW to Mary’s HIGHER income isqualify for federal subsidies eligible for federal subsidies.(below 100% FPL) and too high Her insurance premium costto qualify for SD Medicaid will be less than $310 a year.

SCENARIO #3 (without Medicaid expansion)

Bob & Cathy Nick & Deb Olsen Hansen

The Olson Hansen families each have two children, ages 6 months and 3 years old. Each dad works full time while mom is home taking care of the children.

Olson family earnings Hansen family earnings$10.90/hour $11.15/hour(98% FPL) (101% FPL)

Can these parents get affordable health insurance?

NO YESBob’s income is TOO LOW to Nick’s HIGHER income makes bothqualify the parents for federal subsidies parents eligible for federal subsidies(below 100% FPL) and too high Their insurance premium costto qualify the parents for SD Medicaid. will be less than $500 a year.

exchange subsidies

Children Pregnant Women

Parents Childless Adults

200%

133%

52%

0%

Medicaid expansion would cover additional low-income non-el-

derly South Dakotans

138% FPL

100% FPL

Medicaid Expansion Costsas estimated by SD Dept of Social Services

Distribution of cost of Medicaid Expansion between federal and SD State government (in millions) Total thru SFY2020

Cost in Millions6 months of

SFY14 SFY15 SFY16 SFY17 SFY18 SFY19 SFY20Total thru SFY2020

Federal Share $58.3 $273.4 $321.9 $333.1 $342.4 $359.3 $373. $2,061.1

South Dakota State Share $1.50 $1.90 $2.1 $10.6 $22.1 $27.2 $36.9 $102.1

Cost of Medicaid Expansion per South Dakota resident or household based on 2012 census data

Cost of increased state spending spread across South Dakota population (in dollars per period) Total thru SFY2020

in dollars6 months of SFY14 SFY15 SFY16 SFY17 SFY18 SFY19 SFY20

Total thru SFY2020

SD per person increase (2012 SD census 833,354) $1.80 $2.28 $2.52 $12.72 $26.52 $32.64 $44.28 $122.52

SD per household increase (318,466 households) $4.71 $5.97 $6.59 $33.28 $69.40 $85.41 $115.87 $320.60

November 2012 Kaiser Commission Estimates (million)

1 yr cost 1 yr cost 10 yr cost 2016 2022 2013-2022

SD: $ $1 $ 36 $157 % 0.3% 5% 2.9%

Fed: $ $214 $307 $2,110 % 25.9% 25% 22.8%

*Table 6,7, & 8 Kaiser Commission on Medicaid and the uninsured. “Cost and Coverage implication of the ACA Medicaid Expansion National and State-by-state Analysis” November 2012

Which road does SD take?

Medicaid expansion