South DakotaConstitutional Amendment I

Constitutional Amendment I

South Dakota · November 3, 2026

Condition Medicaid expansion on federal funding remaining at least 90%

A yes vote means Medicaid expansion will only continue in the state if the federal government pays at least 90% of its costs.
A no vote means Medicaid expansion can continue even if federal funding drops below 90% of the costs.
Simple explanation
Right now, if the federal government pays for most of a Medicaid expansion program, the state can keep it even if federal funding drops. This amendment says the state can only keep the expansion if the federal government keeps paying at least 90% of the costs — kind of like only agreeing to a gym membership if someone else keeps covering 90% of the bill.

Source: Ballotpedia

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