State Policy · SD
South Dakota Officials Disagree on Medicaid Ballot Amendment's Effect
South Dakota's Nov. 3 ballot includes Constitutional Amendment I, which addresses what happens to Medicaid expansion if the federal match drops below 90%. Republican legislative backers say the amendment would merely give lawmakers flexibility to decide whether to continue expansion, not end it automatically. But Republican Attorney General Marty Jackley's official ballot explanation states the amendment "ends the expanded Medicaid coverage" if federal funding falls below 90%, directly contradicting the lawmakers' framing. The conflicting interpretations leave roughly 31,000 South Dakotans covered under expansion uncertain about their coverage's fate, with voters deciding the measure without a clear understanding of its legal effect.
Why it mattersState Medicaid officials, providers, and the 31,000 expansion enrollees face uncertainty over whether a federal match reduction would automatically terminate coverage or merely trigger a legislative review, with direct implications for rural hospital finances and the state's $870 million in federal funding since 2022.