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South Dakota Constitutional Amendment I, Medicaid Expansion Conditioned on 90% Federal Funding Amendment (2026)
| South Dakota Constitutional Amendment I | |
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| Election date |
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| Topic Public assistance programs and Public health insurance |
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| Status On the ballot |
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| Type Legislatively referred constitutional amendment |
Origin |
South Dakota Constitutional Amendment I, the Medicaid Expansion Conditioned on 90% Federal Funding Amendment, is on the ballot in South Dakota as a legislatively referred constitutional amendment on November 3, 2026.
A "yes" vote supports amending the South Dakota Constitution to make Medicaid expansion contingent on the federal government covering at least 90% of the program's cost. Under Amendment D (2022), Medicaid was expanded to persons with incomes below 138% of the poverty level, with 90% of the program’s cost covered by federal funding under the Affordable Care Act. If federal funding drops below 90%, the proposed amendment would remove the state’s constitutional obligation to provide the coverage. |
A "no" vote opposes amending the South Dakota Constitution to make Medicaid expansion contingent on the federal government covering at least 90% of the program's cost. |
Overview
What would this amendment do?
This amendment would condition state Medicaid expansion on federal funding remaining at or above 90%. Voters in South Dakota voted to expand Medicaid in 2022 when they approved Amendment D, which required the state to provide Medicaid benefits to adults between 18 and 65 with incomes below 133% of the federal poverty level.[1]
Under this amendment, if federal funding for Medicaid falls below 90%, the constitutional requirement for Medicaid expansion would no longer apply.[1]
What is the status of Medicaid in South Dakota?
The Medicaid program provides medical insurance to groups of low-income people and individuals with disabilities and is jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. Because South Dakota voters approved Amendment D in 2022, Medicaid was expanded in the state to include all individuals earning incomes up to 138% of the federal poverty level.[2]
In 2024, South Dakota voters also approved Amendment F, which allowed for the state legislature to establish work requirements for individuals eligible for Medicaid under the program expansion that voters approved in 2022. Under that amendment, work requirements apply to individuals who are not diagnosed as mentally or physically disabled.
Have other states expanded Medicaid?
The Affordable Care Act (ACA) was signed into law on March 23, 2010. The ACA provided for the expansion of Medicaid to cover all individuals earning incomes up to 138% of the federal poverty level, which amounted to $17,774 for an individual and $36,570 for a family of four in 2021. The law was designed to provide 100% of funding to cover the new recipients for the first three years and to cut off federal Medicaid funding to states that chose not to expand coverage. However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius (2012) that the federal government could not withhold Medicaid funds from states that chose not to expand eligibility. According to the Kaiser Family Foundation, this ruling had the practical effect of making Medicaid expansion optional for states.[3]
As of 2025, 41 states and Washington, D.C., had expanded or voted to expand Medicaid, while 10 states did not.[4]
Text of measure
Constitutional changes
- See also: Article XXI, South Dakota Constitution
The ballot measure would amend Section 10 of Article XXI of the South Dakota Constitution. The following underlined text would be added and struck-through text would be deleted:[1]
Note: Hover over the text and scroll to see the full text.
Beginning For the period beginning July 1, 2023, and ending on the day that the federal medical assistance percentage, described in 42 U.S.C. § 1396d(y) (January 1, 2025), is reduced below ninety percent, the State of South Dakota shall provide Medicaid benefits to any person over eighteen and under sixty-five whose income is at or below one hundred thirty-three percent of the federal poverty level plus five percent of the federal poverty level for the applicable family size, as authorized by federal law as of January 1, 2021. Such person shall receive coverage that meets or exceeds the benchmark or benchmark-equivalent coverage requirements, as such terms are defined by federal law as of January 1, 2021.
The State of South Dakota may not impose greater or additional burdens or restrictions on eligibility or enrollment standards, methodologies, or practices on any person eligible under this section than on any person otherwise eligible for Medicaid under South Dakota law, except that the State of South Dakota may, to the extent permitted by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, impose a work requirement on any person, eligible under this section, who has not been diagnosed as being physically or mentally disabled.
No later than March 1, 2023, the Department of Social Services shall submit all state plan amendments necessary to implement this section to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services.
The State of South Dakota shall take all actions necessary to maximize the federal financial medical assistance percentage in funding medical assistance pursuant to this section.
This section shall be broadly construed to accomplish its purposes and intents. If any provision in this section or the application thereof to any person or circumstance is held invalid or unconstitutional, such invalidity or unconstitutionality shall not affect other provisions or applications of the section that can be given effect without the invalid or unconstitutional provision or application, and to this end the provisions of this section are severable.[5]
Support
Supporters
Officials
- State Sen. Casey Crabtree (R)
- State Sen. Randy Deibert (R)
- State Sen. Helene Duhamel (R)
- State Sen. Taffy Howard (R)
- State Sen. Mark Lapka (R)
- State Sen. Ernie Otten Jr. (R)
- State Sen. Carl Perry (R)
- State Sen. Glen Vilhauer (R)
- State Sen. MyKala Voita (R)
- State Sen. David Wheeler (R)
- State Sen. Larry P. Zikmund (R)
- State Rep. Aaron Aylward (R)
- State Rep. Jeff Bathke (R)
- State Rep. Heather Baxter (R)
- State Rep. Steve Duffy (R)
- State Rep. Timothy Goodwin (For the People Party)
- State Rep. Spencer Gosch (R)
- State Rep. Jon Hansen (R)
- State Rep. Terri Jorgenson (R)
- State Rep. Curt Massie (R)
- State Rep. Elizabeth May (R)
- State Rep. Scott Moore (R)
- State Rep. Will Mortenson (R)
- State Rep. Tina Mulally (R)
- State Rep. Al Novstrup (R)
- State Rep. Drew Peterson (R)
- State Rep. Tony Randolph (R)
- State Rep. Rebecca Reimer (R)
- State Rep. Kent Roe (R)
- State Rep. Kevin Van Diepen (R)
- State Rep. Tony Venhuizen (R)
- State Rep. Mike Weisgram (R)
Arguments
Opposition
Opponents
Officials
- State Sen. Liz Larson (D)
- State Sen. Tom Pischke (R)
Arguments
Campaign finance
Ballotpedia did not identify ballot measure committees registered to support or oppose the ballot measure.[6]
| Cash Contributions | In-Kind Contributions | Total Contributions | Cash Expenditures | Total Expenditures | |
|---|---|---|---|---|---|
| Support | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Oppose | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Background
Medicaid expansion under the ACA
- See also: Medicaid
The Affordable Care Act (ACA) was signed into law on March 23, 2010.[7] The ACA provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $17,236 for individuals in 2019.[8][9][10] The law was designed to provide 100 percent of funding to cover the new recipients for the first three years and to cut off federal Medicaid funding to states that chose not to expand coverage. However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius (2012) that the federal government could not withhold Medicaid funds from states that chose not to expand eligibility. According to the Kaiser Family Foundation, this ruling had the practical effect of making Medicaid expansion optional for states.[3]
From 2014 to 2016, the federal government covered 100 percent of the costs of state expansion of Medicaid. In 2017, the total cost of expanded coverage that the federal government financed decreased to 95 percent. The ACA was designed to decrease the amount the federal government covers to 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020 and subsequent years.[11]
The Affordable Care Act had not provided tax credits to adults with household incomes less than the federal poverty line because the law had aimed to cover these people under Medicaid. In states that did not expand Medicaid, many of these adults fell into a coverage gap in which they neither qualified for Medicaid nor for federal tax credits to purchase health insurance. As of 2018, around 2.5 million people fell into this coverage gap across the states that did not expand Medicaid.[8]
Medicaid in South Dakota
The South Dakota Department of Social Services (DSS) is the agency responsible for administering Medicaid.[12] In 2024, the DSS reported that 140,074 individuals participated in the Medicaid program in 2024.[2]
There are multiple Medicaid programs in South Dakota, each with their own eligibility and rules. As of 2025, state medical programs in South Dakota included:[12]
- Medicaid Expansion - Adult Group (approved by voters in 2022);
- Children’s Health Insurance Program (CHIP);
- Low-Income Families;
- Pregnant Women;
- Newborns;
- Medicare Savings Program;
- Individuals in Assisted Living Facilities, Nursing Facilities or Homes;
- Breast and Cervical Cancer Program;
- HOPE Waiver for Individuals in Assisted Living or Community Home Facilities;
- HOPE Waiver for Individuals Living in their Homes;
- CHOICES Waiver for Children and Adults with Disabilities;
- Family Support 360 Waiver for Children and Adults with Disabilities;
- Disabled Children's Program;
- Assisted Daily Living Services Waiver for Individuals with Quadriplegia;
- South Dakota Medicaid for Workers with Disabilities (MAWD);
- Individuals with Chronic Renal Disease;
- South Dakota Medicaid for Youth Formerly in Foster Care;
- South Dakota Medicaid for Individuals in Adult Foster Care Facilities;
- Adults Currently and Formerly Receiving Supplemental Security Income; and
- Refugee Medical Assistance.
Medicaid eligibility
As of 2025, adults under the Medicaid expansion were eligible for Medicaid based on the following income ranges:
| South Dakota Medicaid Expansion Adult Group | |||
|---|---|---|---|
| Household size | Maximum gross monthly income | ||
| 1 | $1,800 | ||
| 2 | $2,433 | ||
| 3 | $3,065 | ||
| 4 | $3,698 | ||
| 5 | $4,331 | ||
| 6 | $4,963 | ||
| 7 | $5,595 | ||
| 8 | $6,228 | ||
Constitutional Amendment D (2022)
On November 8, 2022, South Dakota voters approved Constitutional Amendment D by 56.21% voting to approve the amendment and 43.79% voting to reject the amendment. The amendment required the state to provide Medicaid benefits to adults between 18 and 65 with incomes below 133% of the federal poverty level beginning July 1, 2023. Because the Affordable Care Act includes a 5% income disregard, this measure effectively expanded Medicaid to those with incomes at or below 138% of the federal poverty level.[13][14]
The amendment was placed on the ballot through a citizen initiative campaign. South Dakotans Decide Healthcare led the campaign in support of the initiative, and reported $4.52 million in contributions. No on Amendment D opposed the measure, and reported $3,646 in contributions.
Constitutional Amendment F (2024)
On November 5, 2024, South Dakota voters approved Constitutional Amendment F by 56.12% voting to approve the amendment and 43.88% voting to reject the amendment. The amendment allowed the state legislature to establish work requirements for individuals eligible for Medicaid under the program expansion that voters approved in 2022. The expansion mandated the state to extend Medicaid to adults between 18 and 65 with incomes below 138% of the federal poverty level. Under this amendment, work requirements apply to individuals who are not diagnosed as mentally or physically disabled.[15]
Medicaid expansion
As of March 2025, 41 states and Washington, D.C., had expanded or voted to expand Medicaid, while 10 states had not. The map below provides information on Medicaid expansions by state.
Path to the ballot
Amending the South Dakota Constitution
- See also: Amending the South Dakota Constitution
A simple majority vote is required during one legislative session for the South Dakota State Legislature to place a constitutional amendment on the ballot. That amounts to a minimum of 36 votes in the South Dakota House of Representatives and 18 votes in the South Dakota State Senate, assuming no vacancies. Amendments do not require the governor's signature to be referred to the ballot.
House Joint Resolution 501 (HJR 5001)
The following is the timeline of the constitutional amendment in the state legislature:
- January 14, 2025: House Joint Resolution 501 (HJR 5001) was introduced to the South Dakota State House.[16]
- January 21, 2025: the House voted 59-7 to pass the amendment.[16]
- March 3, 2025: the Senate voted 31-3 to pass the amendment.[16]
Learn more about the ballot measures PDI →
| Votes Required to Pass: 36 | |||
| Yes | No | NV | |
|---|---|---|---|
| Total | 59 | 7 | 3 |
| Total % | 86 | 10 | 4.3 |
| Democratic (D) | 0 | 6 | 0 |
| Republican (R) | 59 | 1 | 3 |
| Votes Required to Pass: 18 | |||
| Yes | No | NV | |
|---|---|---|---|
| Total | 31 | 3 | 1 |
| Total % | 89 | 9 | 2.8 |
| Democratic (D) | 0 | 3 | 0 |
| Republican (R) | 31 | 0 | 1 |
How to cast a vote
- See also: Voting in South Dakota
See below to learn more about current voter registration rules, identification requirements, and poll times in South Dakota.
See also
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External links
Footnotes
- ↑ 1.0 1.1 1.2 South Dakota State Legislature, "House Joint Resolution 5001," accessed March 5, 2025
- ↑ 2.0 2.1 South Dakota Department of Social Services, "South Dakota Medicaid Report SFY24," accessed March 14, 2025
- ↑ 3.0 3.1 Kaiser Family Foundation, "A Guide to the Supreme Court’s Affordable Care Act Decision," July 2012
- ↑ Kaiser Family Foundation, "Status of State Medicaid Expansion Decisions," accessed March 15, 2025
- ↑ Note: This text is quoted verbatim from the original source.
- ↑ South Dakota Campaign Finance Reporting, "Search Committees," accessed March 15, 2025
- ↑ New York Times, "Obama Signs Health Care Overhaul Bill, With a Flourish," accessed March 23, 2010
- ↑ 8.0 8.1 Kaiser Family Foundation, "The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid Coverage," accessed October 23, 2019
- ↑ Kaiser Health News, "Consumer’s Guide to Health Reform," April 13, 2010
- ↑ Office of The Assistant Secretary for Planning and Evaluation, "Poverty Guidelines," January 25, 2016
- ↑ Kaiser Family Foundation, "Understanding How States Access the ACA Enhanced Medicaid Match Rates," September 29, 2014
- ↑ 12.0 12.1 South Dakota Department of Social Services, "Medical Programs Available in South Dakota," accessed March 14, 2025
- ↑ South Dakota Secretary of State, "Potential 2022 Ballot Questions," accessed July 16, 2021
- ↑ South Dakota Secretary of State, "Medicaid expansion initiative (South Dakotans Decide Healthcare," accessed July 16, 2021
- ↑ South Dakota Legislature, "Senate Joint Resolution 501," accessed February 27, 2024
- ↑ 16.0 16.1 16.2 South Dakota Legislature, "House Joint Resolution 5001," accessed January 24, 2025
- ↑ South Dakota Secretary of State, “General Voting Information,” accessed July 23, 2024
- ↑ 18.0 18.1 18.2 South Dakota Secretary of State, “Register to Vote, Update Voter Registration or Cancel Voter Registration,” accessed July 23, 2024
- ↑ 19.0 19.1 NCSL, "State Profiles: Elections," accessed July 23, 2024
- ↑ 2025 South Dakota Legislature, "HB 1066," accessed April 2, 2025
- ↑ Under federal law, the national mail voter registration application (a version of which is in use in all states with voter registration systems) requires applicants to indicate that they are U.S. citizens in order to complete an application to vote in state or federal elections, but does not require voters to provide documentary proof of citizenship. According to the U.S. Department of Justice, the application "may require only the minimum amount of information necessary to prevent duplicate voter registrations and permit State officials both to determine the eligibility of the applicant to vote and to administer the voting process."
- ↑ 22.0 22.1 South Dakota Secretary of State, "General Voting Information," accessed October 8, 2025
