More than 52,000 low-income adults in Sout­­h Dakota are now eligible for Medicaid, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) announced recently, after the state expanded access under the Affordable Care Act (ACA).

Adults aged 19 to 64 with incomes under 138% of the federal poverty level ($20,120) who apply for coverage starting this month will receive full Medicaid benefits. 

The state will receive federal American Rescue Plan funding, which increases the federal matching rate for services for two years by 5%. South Dakota will also qualify for 90% federal matching funds available through the ACA for enrollees, meaning the state is on the hook for just 10% of the costs.

“The comprehensive health insurance that Medicaid provides can be life-changing for American families,” said HHS Secretary Xavier Becerra in a news release. “I urge the remaining states yet to adopt expansion to do so.”

In November, voters in South Dakota approved a measure that would expand the Medicaid program starting this month with 56% approval, Politico reported.

South Dakota is the 39th state to adopt ACA Medicaid expansion. North Carolina may be the next state to follow suit, with experts believing Medicaid redeterminations could drive a 30% decrease in uninsurance in the state, contingent upon budgetary approval, reports KFF.

CMS Administrator Chiquita Brooks-LaSure urges eligible applicants to take advantage of the program, saying it is a “cornerstone” for achieving health equity in underserved communities.

The agency projects that up to 4 million individuals that are uninsured or underinsured would be eligible to enroll if all 50 states passed the ACA Medicaid expansion.

Republican lawmakers have opposed Medicaid expansion efforts, requiring its supporters to put the issue on the ballot for voters to decide, but that process is politically tricky to navigate in many remaining states.