Some people who currently have subsidized private coverage through the South Dakota Marketplace will be newly eligible for expanded Medicaid as of July 1.
In addition to the non-disabled adults without minor children described above, this includes adult parents and caretakers with household income between 100% and 138% of the poverty level. For a single person, that’s between $14,580 and $20,120 in annual income this year. The amount increases if there are more people in the household.
These individuals were eligible for Marketplace subsidies to purchase private plans prior to July 1, 2023. And they will not automatically be transitioned to Medicaid in July. They’ll have the option to keep their Marketplace coverage (and subsidy) through the end of the year.
Or they can choose to apply for Medicaid and then drop their Marketplace plan if and when they’re approved for Medicaid. It’s important to wait until the Medicaid application is approved before dropping a Marketplace plan to prevent a gap in coverage. There would not be an opportunity to re-enroll in the Marketplace plan prior to January 1 unless the person has another qualifying life event.
For people in this income range who have Marketplace coverage and choose to keep it for now, Medicaid eligibility will be redetermined during open enrollment this fall. At that point, if a person is eligible for Medicaid (i.e. income up to 138% of the poverty level), they will be notified that they are no longer eligible for a subsidy in the Marketplace after the end of 2023, and are instead eligible for Medicaid.
People whose projected 2024 income is above 138% of the poverty level will continue to be eligible for subsidies in the Marketplace, as long as they can provide any requested income verification documentation. (There is no set upper income limit for subsidy eligibility. Subsidies are available as long as the benchmark plan would cost more than 8.5% of your household income.)