State Policy · SD
South Dakota Voters Reject Measure to Repeal Medicaid Expansion
South Dakota voters rejected Amendment I on Tuesday, with 56% opposed and 44% in favor as of early Wednesday with over 80% of votes counted. The measure, referred by Republican state lawmakers, would have repealed the state's constitutional Medicaid expansion mandate if the federal funding match for expansion dropped below 90%. Voters originally approved expansion through a 2022 citizen initiative, covering adults up to 138% of the poverty level; about 31,000 of South Dakota's roughly 143,000 Medicaid enrollees are covered through expansion. Rejection preserves the constitutional expansion requirement, though sponsors say they will continue monitoring the state's fiscal exposure if the federal match share declines.
Why it mattersThe outcome locks in South Dakota's constitutional Medicaid expansion mandate, removing a mechanism that would have automatically triggered repeal and coverage loss for roughly 31,000 expansion enrollees if federal funding shares fell.