Constitutional Amendment I: Condition Medicaid Expansion on 90% Federal Funding
Statewide — all of South Dakota
General election · Tuesday, November 3, 2026
- The South Dakota Legislature referred this amendment as House Joint Resolution 5001 (2025 session); it passed the House 59-7 on Jan. 21, 2025 and the Senate 31-3 on March 3, 2025, according to the Legislature's bill record. It amends the Medicaid expansion that voters adopted in 2022 as Amendment D (approved 56%-44%, according to Ballotpedia News).[4][2]
- Lawmakers who referred the amendment have said it would not automatically end expanded Medicaid eligibility, while Attorney General Marty Jackley, who writes the ballot language, has said it would automatically repeal expansion if federal funding falls below 90%, according to South Dakota Searchlight.[3]
The question on the ballot
An Amendment to the South Dakota Constitution that Repeals Expanded Medicaid Coverage if Federal Funding for the Program Drops below 90%.[1]
Attorney General explanation: Amendment D (2022) requires the State to provide Medicaid benefits to adults over 18 and under 65 with income at or below 133% of the federal poverty level plus 5%. Federal law currently funds 90% of the expansion. This proposed amendment ends the expanded Medicaid coverage if federal funding for expansion drops below 90%; if that occurs, Medicaid coverage will once again only apply to low-income children, pregnant women, disabled individuals, and the elderly. The text is two pages long with two sections.[1]
A YES vote means
Vote “Yes” to adopt the amendment.
A NO vote means
Vote “No” to leave the Constitution as it is.
The law today
Per the Attorney General's explanation, Amendment D, approved by voters in 2022, requires the State to provide Medicaid benefits to adults over 18 and under 65 with income at or below 133% of the federal poverty level plus 5% of the federal poverty level. Federal law currently requires the federal government to fund 90% of South Dakota's Medicaid expansion.[1]
Arguments made for
- Statement by Lt. Governor Tony Venhuizen, Sen. Casey Crabtree and Rep. Will Mortenson: “Amendment I is about making sure that South Dakotans get to make their own decisions about how to spend state money. It would NOT automatically end Medicaid expansion. It would let South Dakotans make that decision.”[1]
- Statement by Venhuizen, Crabtree and Mortenson: “For every 10% of Medicaid expansion costs shifted from Washington to South Dakota, our state would have to find about $36 million more each year. That could mean higher taxes or cuts elsewhere.”[1]
Arguments made against
- Statement from Deb Fischer-Clemens, RN, BSN, MHA: “A vote NO would allow approximately 30,000 South Dakotans who receive insurance through Medicaid expansion to keep their insurance and access the care needed to stay healthy, support their families, work, and contribute to their communities.”[1]
- Statement from Deb Fischer-Clemens, RN, BSN, MHA: “A vote NO would ensure that changes in federal funding do not automatically take health coverage from South Dakotans.”[1]
On record in support
Research notes & limits
Title, explanation and effect of a vote are the Attorney General's text as printed in the Secretary of State's 2026 Ballot Question Pamphlet; the pro and con statements are the authors' own statements printed there (the pamphlet says the Secretary of State is not responsible for their accuracy). The pamphlet prints no fiscal note for this amendment. The Attorney General's reading (automatic end of expansion) and the sponsors' reading (authority to reconsider) conflict; both are reported above, and the summary follows the Attorney General's official text. The Con statement's author is listed only by name and credentials in the pamphlet. No fiscal note or committee finance totals were found for Amendment I; the pro statement's $36 million figure is the sponsors' own estimate, not an official fiscal estimate.
Sources · 5
Researched 2026-10-19. Green citations are official government records.
- 1.2026 Ballot Question Pamphlet · South Dakota Secretary of State Official record
- 2.South Dakota voters to decide on constitutional amendment to condition Medicaid expansion on continued federal funding in Nov. 2026 · Ballotpedia News Reference
- 3.South Dakota ballot measure could auto-repeal Medicaid expansion, attorney general says in contrast to lawmakers · South Dakota Searchlight (via KFGO) · 2026-09-19 News report
- 4.HJR 5001 (2025): bill actions and votes · South Dakota Legislature · 2026-10-19 Official record
- 5.What's on your ballot: Amendment I · Dakota News Now · 2026-09-29 News report