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South Dakota · November 3, 2026 general election · Statewide ballot measure

Constitutional Amendment I: what your vote means

Medicaid expansion tied to federal funding. On every South Dakota ballot. Official sources checked October 21, 2026.

Constitutional Amendment I · Legislatively referred constitutional amendment

Medicaid expansion tied to federal funding

Heads up: voting YES on this measure would end the expanded Medicaid coverage voters approved in 2022 if federal funding for it drops below 90%.

Official ballot title (quoted exactly)

An Amendment to the South Dakota Constitution that Repeals Expanded Medicaid Coverage if Federal Funding for the Program Drops below 90%.

Attorney General’s title as printed in the 2026 Ballot Question Pamphlet, South Dakota Secretary of State.

A YES vote means:

Expanded Medicaid coverage approved by voters in 2022 (Amendment D) would end if the federal share of its funding drops below 90%.

A NO vote means:

Expanded Medicaid coverage stays in the constitution regardless of the federal funding level.

What it would change

  • Who is affected: adults 18 to 64 with incomes at or below 133% of the federal poverty level (plus 5%) who qualify through expansion.
  • Current law: federal law requires the federal government to fund 90% of South Dakota’s Medicaid expansion.
  • If funding drops: Medicaid would again cover only low-income children, pregnant women, disabled individuals, and the elderly.
  • Fiscal impact: No official fiscal note is published in the 2026 Ballot Question Pamphlet for this legislative amendment.

Official arguments, summarized

Short neutral summaries of the arguments printed in the official voters’ pamphlet. The committees that wrote them are responsible for their content. Read the full text at the link below.

Argument for

Supporters say voters should decide again whether expansion is worth the cost if the federal share falls, and estimate each 10% shift would cost the state about $36 million a year.

Written by: Lt. Governor Tony Venhuizen; Sen. Casey Crabtree; Rep. Will Mortenson

Argument against

Opponents say a NO vote preserves the expansion voters approved in 2022 and keeps coverage for about 30,000 South Dakotans.

Written by: Deb Fischer-Clemens, RN, BSN, MHA

Pro and con statements on Amendment I, 2026 Ballot Question Pamphlet (PDF)

Who supports it and who opposes it

These lists come from official campaign filings (registered committees) and public endorsements, each linked to its source. They are not complete, and SaveYourState does not endorse anyone listed. Lists checked October 30, 2026.

Who supports it

Who opposes it

Not yet compiled

Official sources

SaveYourState is independent and nonpartisan, not a government site, and does not take positions on ballot measures. This explainer describes effects only, using the official ballot title, explanatory statement, full text, and fiscal impact statement. If anything here differs from those documents, the official documents control.