South Dakota Initiated Measure 28, Medicaid Expansion Initiative (2022)

South Dakota Initiated Measure 28
Election date November 8, 2022
Topic Healthcare
Status Not on the ballot
Type State statute	Origin Citizens

South Dakota Initiated Measure 28, the South Dakota Medicaid Expansion Initiative, was not on the ballot in South Dakota as an initiated state statute on November 8, 2022.

A "yes" vote would have supported expanding Medicaid to adults between 18 and 65 with incomes below 133% of the federal poverty level.

A "no" vote would have opposed expanding Medicaid to adults between 18 and 65 with incomes below 133% of the federal poverty level.

Withdrawn

See also: South Dakota Constitutional Amendment D, Medicaid Expansion Initiative (2022)

On July 11, 2022, Dakotans for Health, the campaign behind Initiated Measure 28, withdrew the initiative. Rick Weiland, co-founder of Dakotans for Health, said the campaign joined South Dakotans Decide Healthcare to support Amendment D, which, like Initiated Measure 28, was designed to expand Medicaid. Initiated Measure 28 was a statute, whereas Amendment D was a constitutional amendment. "After conversations with South Dakotans Decide Healthcare members, we have agreed that the best path forward to accomplishing this goal is to join efforts behind one campaign," said Weiland. Initiated Measure 28 was the first initiative to ever be withdrawn after qualifying for the ballot in South Dakota. In 2009, the legislature passed a bill establishing the withdrawal process.

Overview

What would Initiated Measure 28 have done?

See also: Text of Measure

Initiated Measure 28 would have added a new section to the South Dakota statute to require 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 would have effectively expanded Medicaid to those with incomes at or below 138% of the federal poverty level.

Have other states expanded Medicaid?

See also: Background

The Affordable Care Act (ACA), also known as Obamacare, 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.

As of 2022, 38 states and Washington, D.C., have expanded Medicaid (six through ballot measures) while 12 states had not expanded Medicaid. Of the seven Medicaid expansion measures that appeared on a state's statewide ballot, six were approved (Maine, Utah, Nebraska, Idaho, Oklahoma, and Missouri) and one (Montana) was defeated. The Montana measure combined Medicaid expansion with a tobacco tax increase.

Why were there two Medicaid expansion measures on the South Dakota ballot?

See also: South Dakota 2022 ballot measures

There were two measures on the South Dakota 2022 ballot that would Medicaid–one being Initiated Measure 28, which was withdrawn from the ballot, the other being Constitutional Amendment D, which is still on the ballot.

Both measures were designed to expand Medicaid to adults between 18 and 65 with incomes below 133% of the federal poverty level. The difference between both measures is that Constitutional Amendment D would amend the South Dakota Constitution while Initiated Measure 28 would have amended the state law.

Former Democratic U.S. Senate candidate Rick Weiland (D), who sponsored Initiated Measure 28 with Dakotans for Health, stated that he would like to see both measures pass, and that he views Initiated Measure 28 as an alternate way to expand Medicaid in the state in case Constitutional Amendment D fails. “My hope is that both of these will pass and it will send a very strong message to the people in power, to our legislature, to the governor,” Weiland said. “I think it’s really important that voters know that they’ve got two paths forward to pass Medicaid expansion this fall. A constitutional amendment, now an initiated law, and we’re encouraging them to vote for both.”

On July 11, Initiated Measure 28 was withdrawn from the ballot. Constitutional Amendment D was still on the ballot.

Measure design

Medicaid expansion

The measure would have expanded Medicaid in South Dakota using the income methodology of the Medicaid statute at 42 U.S.C. §1396a(a)(10)(A)(i)(VIII). The measure would have expanded to adults between 18 and 65 with incomes below 133% of the federal poverty level. Because the ACA includes a 5% income disregard, this measure effectively expanded Medicaid to those with incomes at or below 138% of the federal poverty level. Under the measure, the state could not have imposed other additional burdens or restrictions on Medicaid eligibility, enrollment, or benefits. It would have authorized the Department of Social Services to authorize low-income persons as an eligible population for Medicaid coverage.

The measure would have required the state, 90 days after voter approval, to submit a state plan amendment and take the necessary steps to seek required approvals from Centers for Medicare and Medicaid Services for those would qualify for Medicaid coverage under this initiative.

Text of measure

Ballot title

The ballot title is as follows:

“

Title: An initiated measure expanding Medicaid eligibility.

”

Attorney General explanation

The attorney general's explanation for the measure is as follows:

“

Medicaid is a program, funded by the State and the federal government, to provide medical coverage for low-income people who are in certain designated categories. This measure expands Medicaid eligibility in South Dakota. It requires the State to provide Medicaid benefits to any person over age 18 and under 65 whose income is at or below 133% of the federal poverty level and who meets other eligibility requirements in federal law. For people who qualify under this measure, the State may not impose burdens or restrictions that are greater than those imposed on any other group eligible for medical assistance. The State must obtain federal approval of the Medicaid expansion coverage set forth in this measure. Additionally, the South Dakota Department of Social Services must pass rules to implement this measure.

”

Full text

The full text of the ballot measure is below:

Sponsors

Dakotans for Health led the campaign in support of the initiative. Former Democratic U.S. Senate candidate Rick Weiland of Dakotans for Health sponsored the initiative.

Arguments

Dakotans for Health said, "Right now, too many South Dakotans work at jobs that don’t offer health insurance, forcing thousands of our neighbors and family members to choose between life-saving care and putting food on the table. Reforming Medicaid will change that for over 40,000 South Dakotans, making our families healthier and our economy stronger. It will deliver healthcare to those who need it but can’t afford it, including many parents, seniors, and hardworking folks who earn less than $17,000 a year. It will also bring more than $300 million of our tax dollars home from Washington, D.C. every year that will make it possible to provide health insurance to the uninsured, protect our rural hospitals, boost our economy, and create thousands of new jobs."

Background

Medicaid in South Dakota

The South Dakota Department of Social Services (DSS) is the agency responsible for administering Medicaid. As of 2022, Medicaid in South Dakota was available to children, low-income pregnant women and parents, seniors in nursing homes, and individuals with disabilities.

State medical programs in South Dakota include:

• Children's Health Insurance Program (CHIP);
• Pregnant Women;
• Disabled Children's Program;
• South Dakota Medicaid for Workers with Disabilities (MAWD);
• Home and Community Based Services for Developmentally Disabled;
• South Dakota Medicaid for Individuals in Assisted Living Facilities, Nursing Facilities or Homes;
• Quadriplegics who would Require Nursing Home Care if not for Special Services Performed in their Home;
• Refugee South Dakota Medicaid;
• Breast and Cervical Cancer Program;
• Family Support Services;
• South Dakota Medicaid for Certain Newborns;
• South Dakota Medicaid for Individuals with Chronic Renal Disease;
• South Dakota Medicaid for Individuals in Adult Foster Care Facilities;
• Elderly Individuals who would Require Nursing Home Care if not for Special Services Performed in their Home;
• South Dakota Medicaid for Youth Formerly in Foster Care; and
• Low-Income Families.

Eligibility

Low-income families (consisting of a parent or adult caretaker and a dependent child) are eligible for Medicaid based on the following income ranges and family size:

SD Low-income family Medicaid eligibility
Household size	Maximum gross monthly income
1	$617
2	$776
3	$888
4	$995
5	$1,106
6	$1,218
7	$1,327
8	$1,435

The state reported 141,620 individuals participating in the state's Medicaid program in fiscal year 2020.

Medicaid expansion under the ACA

See also: Medicaid and Obamacare

The Affordable Care Act (ACA), also known as Obamacare, 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 percent of the federal poverty level, which amounted to $17,236 for individuals in 2019. 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.

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.

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.

Adoption of Medicaid expansion under the ACA

As of January 2022, a total of 38 states and Washington, D.C., had expanded or voted to expand Medicaid, while 12 states had not. The map below provides information on Medicaid expansions by state; for states that expanded, hover over the state to view the political affiliation of the governor at the time of expansion.

Medicaid expansion ballot measures

In 2017, Maine was the first state to approve a ballot measure to expand Medicaid. In 2018, there were four ballot measures proposing to expand Medicaid or renew expansion. Three were approved, and one was defeated. In 2020, Oklahoma voters approved a Medicaid expansion initiative. Missouri voters approved a Medicaid expansion initiative on August 4.

Year	Measure	Yes votes %	No votes %	Outcome
2017	Maine Question 2	58.95%	41.05%	a
2018	Utah Proposition 3	53.32%	46.68%	a
2018	Nebraska Initiative 427	53.55%	46.45%	a
2018	Montana I-185	47.30%	52.70%	d
2018	Idaho Proposition 2	60.58%	39.42%	a
2020	Oklahoma State Question 802	50.49%	49.51%	a
2020	Missouri Amendment 2	53.27%	46.73%	a

Path to the ballot

See also: Laws governing the initiative process in South Dakota

The state process

In South Dakota, the number of signatures required to qualify an initiated state statute for the ballot is equal to 5 percent of the votes cast for governor in the previous gubernatorial election. Signatures must be submitted by the first Tuesday of May during a general election year.

The requirements to get an initiated state statute certified for the 2022 ballot:

• Signatures: 16,961 valid signatures were required.
• Deadline: The deadline to submit signatures was May 3, 2022.

Once the signatures have been gathered and filed, the secretary of state verifies the signatures using a random sample method.

Details about this initiative

• Former Democratic U.S. Senate candidate Rick Weiland of Dakotans for Health sponsored the initiative.
• The measure was approved for circulation on November 5, 2020.
• On May 3, 2022, Dakotans for Health said it had submitted over 23,000 signatures to get this measure on the ballot.
• On June 9, 2022, Secretary of State Steve Barnett announced that the initiative has been validated and will appear on the November 2022 ballot. 17,249 signatures were deemed valid, based on a random sample.
• On July 11, 2022 Rick Weiland, the sponsor of Initiated Measure 28, withdrew the measure from the ballot.

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.

How to vote in South Dakota

Poll times

In South Dakota, all polls are open from 7 a.m. to 7 p.m. If the polls close while you are still in line, you will be permitted to vote. South Dakota is divided between Central and Mountain time zones.

Registration

Check your voter registration status here.

To register to vote in South Dakota, an applicant must be a citizen of the United States, a resident of South Dakota, and at least 18 years old by the day of the next election.

The deadline to register to vote is 15 days before the next election. To register, an applicant may submit a voter registration form to the county auditor. Prospective voters can also register in person at the county auditor's office, driver's license stations, certain public assistance agencies, or military recruitment offices.

Automatic registration

South Dakota does not practice automatic voter registration.

Online registration

See also: Online voter registration

South Dakota does not permit online voter registration.

Same-day registration

South Dakota does not allow same-day voter registration.

Residency requirements

To register to vote in South Dakota, you must be a resident of the state for at least thirty consecutive days.

Verification of citizenship

See also: Laws permitting noncitizens to vote in the United States

South Dakota does not require proof of citizenship for voter registration. An individual applying to register to vote must attest that they are a U.S. citizen under penalty of perjury.

All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment. Seven states — Alabama, Arizona, Georgia, Kansas, Louisiana, New Hampshire, and Wyoming — have laws requiring verification of citizenship at the time of voter registration, whether in effect or not. In three states — California, Maryland, and Vermont — at least one local jurisdiction allows noncitizens to vote in some local elections. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters.

Verifying your registration

The South Dakota Secretary of State’s office allows residents to check their voter registration status online by visiting this website.

Voter ID requirements

South Dakota requires voters to present photo identification while voting.

Voters can present the following forms of identification:

• South Dakota driver's license or nondriver ID card
• U.S. government photo ID
• U.S. passport
• U.S. Armed Forces ID
• Current student photo identification card from a South Dakota high school or South Dakota accredited institution of higher education
• Tribal photo ID

If a voter does not have a photo ID, he or she can sign a personal identification affidavit. The voter will then be given a regular ballot.

See also

2022 measures

• 2022 ballot measures
• Healthcare on the ballot

South Dakota

• South Dakota ballot measures
• South Dakota ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• South Dakota Secretary of State: Potential 2022 ballot questions
• Full text