Amendment I: Medicaid expansion amendmentEnd the required Medicaid expansion if the federal share drops below 90%
Read the full text of the measure: Secretary of State ballot question pamphlet (PDF)
In plain words
In 2022 voters added a rule to the state constitution that South Dakota must cover adults under 65 with low incomes under Medicaid (the government health plan for people with low incomes). The federal government now pays 90% of the cost of this group; the state pays 10%. This amendment would end that required coverage if the federal share ever drops below 90%. Supporters and opponents disagree on what happens next (see the sides below). Nothing changes right away if the federal share stays at 90% or more. (news.ballotpedia.org )
Before and after
| Question | Today | If it passes |
|---|---|---|
| Does the constitution require Medicaid for adults under 65 with low incomes? | Yes (added by voters in 2022, Amendment D) | Yes, but only while the federal government pays at least 90% of the cost |
| Who pays now | Federal government 90%, state 10% | Same |
| If the federal share drops below 90% | State must still cover the group | The constitution no longer requires the state to cover the group |
| People covered | About 30,000 South Dakotans (figure used by both the pamphlet's opponents and AARP; supporters' sources cite about 28,000) | No change unless the federal share drops |
Numbers from the sources linked (not yet checked against the official ballot title) (ballot title ); also see (dakotanewsnow.com )
Biggest change
- Limits the 2022 Medicaid expansion requirement to the time the federal government pays at least 90% of the cost. source: news.ballotpedia.org
- The state keeps its power to require work rules for non-disabled enrollees, which voters approved in 2024 (Amendment F). source: news.ballotpedia.org
Who it affects most: Adults under 65 who earn up to about 138% of the federal poverty level and are covered through expanded Medicaid (about 30,000 people), the hospitals and clinics that treat them, and state taxpayers if the federal share changes.
Cost to the state: The Secretary of State's pamphlet and handout list no fiscal note. Sen. Casey Crabtree (R-Madison), the Senate sponsor, projects the state's 10% share costs about $36 million a year (the sponsor's own estimate, not an official one). No official estimate of what the state would pay if the federal share dropped.
Our plain-words summary. Every line points to its source.
What your vote means
Medicaid for adults under 65 with low incomes stays a constitutional requirement only while the federal government pays at least 90% of the cost.
The constitution keeps requiring the state to cover these adults, whatever share the federal government pays.
Our one-line summary. The Attorney General's official Yes and No effects are quoted above.
Why people want it, and why others object
Why this is on the ballot
The Legislature put this on the ballot. It changes the state constitution, so only another statewide vote can change it back. It passes with a simple majority of the votes cast on it.
- Voters approved Medicaid expansion in 2022 (Amendment D), 56% to 44%. It covers adults 18 to 65 with incomes below 138% of the federal poverty level. In 2024, voters approved Amendment F, 56% to 44%, letting the Legislature set work requirements for expansion enrollees who are not disabled. source: news.ballotpedia.org
- The Legislature put this on the ballot: the House passed it 59-7 on Jan. 21, 2025, and the Senate 31-3 on March 3, 2025. source: news.ballotpedia.org
Why supporters want it
- Lt. Gov. Tony Venhuizen, Sen. Casey Crabtree and Rep. Will Mortenson, in the official pamphlet: "It would NOT automatically end Medicaid expansion." They say voters get to decide again if the federal share drops. source: sdsos.gov (Secretary of State)
- Sen. Casey Crabtree (R-Madison) says it protects taxpayers if Washington changes the funding deal, and that backers of expansion promised the federal government would pay 90% so "South Dakota taxpayers would only have to pay 10 percent." source: news.ballotpedia.org
Why opponents object
- Deb Fischer-Clemens, RN, the opponent author in the official pamphlet, says a No vote protects about 30,000 enrollees from losing coverage if federal funding changes. Fischer-Clemens also says lawmakers are trying to get out of an obligation voters created in 2022 and warns hospitals could close. source: dakotanewsnow.com
- Jean Hunhoff, a former lawmaker and nurse, says it is too soon to drop the match before the state knows what it would owe, and that if it passes the state is "done with Medicaid expansion." source: dakotanewsnow.com
- AARP South Dakota urges a No vote. It says the amendment "could automatically end Medicaid expansion in South Dakota if the federal matching rate falls below 90%" and puts more than 30,000 people at risk. source: aarp.org
- Sen. Liz Larson (D): "People shouldn't die because they can't afford to live." source: news.ballotpedia.org
Who backs each side
- For: the Republican legislators who placed it on the ballot (90 of 91 Republicans voting said yes). Against: Fischer-Clemens (chair of the opposing side per Dakota News Now), AARP South Dakota, and the Democratic legislators (all voted no). No campaign committee or money totals found yet; check the Secretary of State's campaign finance site. source: dakotanewsnow.com
In each side's own words where we could find them, quoted or summarized with a link to the source. We don't endorse either side.
What you will see on your ballot
Official ballot wording, word for word (tap to open)
The official ballot title, word for word from the Secretary of State's official ballot question pamphlet .
Constitutional Amendment I. Title: An Amendment to the South Dakota Constitution that Repeals Expanded Medicaid Coverage if Federal Funding for the Program Drops below 90%.
Attorney General explanation: Medicaid is a program, funded by the State and the federal government, to provide medical coverage for low-income children, pregnant women, disabled individuals, and the elderly. In the 2022 General Election the voters approved Constitutional Amendment D, which expanded Medicaid eligibility in South Dakota. Amendment D requires the State to also provide Medicaid benefits to anyone over the age of 18 and under 65 whose income is at or below 133% of the federal property level, plus 5% of the federal poverty level for the applicable family size. Currently, federal law requires the federal government to fund 90% of South Dakota’s Medicaid expansion.
This proposed Constitutional Amendment ends the expanded Medicaid coverage if the federal funding for expansion drops below 90%. If federal funding drops below that 90% threshold, Medicaid coverage will once again only apply to low-income children, pregnant women, disabled individuals, and the elderly.
Vote “Yes” to adopt the amendment.
Vote “No” to leave the Constitution as it is.
The text of this constitutional amendment is two pages long with two sections.
Copied from the Attorney General's title, explanation and vote effects in the pamphlet (printed pages 2 to 5). The Legislature's file holds the resolution's own title and the amendment text, which are different from the Attorney General's ballot title.
Latest news
Recent reporting from a range of outlets, newest first. We link to it; we don't endorse it.
No articles collected yet for this measure.
Full text of the measure
The exact words of the amendment are in the Attorney General's final-form PDF on the Secretary of State's site, which is scanned and not yet checked by us. The Legislature's file for HJR 5001 shows the words struck and added to Article XXI, section 10. Read it in the Secretary of State ballot question pamphlet (PDF) , or on the Legislature's page for House Joint Resolution 5001 (2025) , which also shows the votes in each chamber.
Read more
- Secretary of State: 2026 ballot question pamphlet (PDF)
- Dakota News Now: What's on your ballot, Amendment I
- Ballotpedia News: the Medicaid amendment
- Secretary of State: 2026 ballot question pamphlet (PDF)
We link to analysis from several sources; we don't endorse it.