South Dakota Constitutional Amendment I — Medicaid Expansion Conditioned on Federal Funding (Nov 2026)

Statewide — All South Dakota Voters

What The Amendment Does

Lets the state discontinue the expanded Medicaid coverage that voters added to the constitution in 2022 if the federal medical-assistance match drops below 90 percent (the current rate).
Does not by itself end coverage — it creates the constitutional authority to do so if Washington stops paying its share.

How It Got On The Ballot

Legislatively referred constitutional amendment carried in House Joint Resolution 5001 (2025 session).
Reported votes: House 59-7 (Jan 21, 2025); Senate 31-3 (Mar 3, 2025).
Placed on the November 3, 2026 general-election ballot as Amendment I.

Who Supports This

Legislative majorities that referred it (House 59-7, Senate 31-3)

Who Opposes This

Medicaid-expansion advocates who warn it threatens coverage for current enrollees

RESOLUTE Citizen Analysis

This is a budget guardrail, not a values fight. The 2022 expansion is written into the constitution, so the state is on the hook even if federal support shrinks; this gives lawmakers a release valve if Washington stops paying its 90 percent. Supporters call that simple prudence — don't promise coverage the state can't fund alone. Critics hear a trapdoor under tens of thousands of enrollees. The honest question for a voter is who should carry the risk if federal money dries up: the state treasury or the people on the rolls. Count the cost either way.

"For which of you, intending to build a tower, sitteth not down first, and counteth the cost, whether he have sufficient to finish it?"

— Luke 14:28 (KJV)

Sources & Resources

Ballotpedia — South Dakota Constitutional Amendment I, Medicaid Expansion Conditioned on 90% Federal Funding Amendment (2026)South Dakota Secretary of State — 2026 Ballot Questions DRGNews — Senate passes HJR 5001 expanded-Medicaid resolution (Mar 4, 2025)