What Would South Dakota Amendment I Change for Medicaid Expansion Coverage?
What is on South Dakota's Nov 3, 2026 ballot for Medicaid expansion?
Amendment I asks South Dakota voters whether to change the state constitution so expanded Medicaid for adults is tied to the federal government keeping at least a 90% funding match. The measure is on South Dakota's Nov 3, 2026 ballot. Statewide results post after polls close. Coverage does not change on election night alone. Official results and the ballot measure page are at the South Dakota Secretary of State election results site and on Ballotpedia. EllenRx® does not tell you how to vote. Below is what the official ballot language says, what sponsors say the measure does, and what to watch if you are on expansion coverage.
What does the Attorney General's official explanation say Amendment I does?
The Attorney General's final ballot title and explanation, filed May 18, 2026, call the measure "An Amendment to the South Dakota Constitution that Repeals Expanded Medicaid Coverage if Federal Funding for the Program Drops below 90%." The explanation states that the amendment "ends the expanded Medicaid coverage if the federal funding for expansion drops below 90%," after which coverage would return to the pre-expansion groups: low-income children, pregnant women, disabled individuals, and the elderly (South Dakota Attorney General statement, May 18, 2026; reprinted in the Secretary of State 2026 Ballot Question Pamphlet). Vote "Yes" adopts the amendment. Vote "No" leaves the Constitution as it is (SOS pamphlet). Voters first wrote adult expansion into the constitution in 2022 (Amendment D). Amendment I reached the ballot as a 2025 legislative referral (HJR 5001) (SOS ballot questions page; Ballotpedia).
Do sponsors say Amendment I automatically ends Medicaid expansion?
In the pamphlet's "Pro" statement, sponsors write that Amendment I "would NOT automatically end Medicaid expansion." They say that as long as the federal government keeps the 90% match, nothing changes, and that the amendment "simply ends the constitutional requirement if federal funding falls below 90%," after which legislators and voters could decide whether to continue expansion. The Pro statement also says about 30,000 South Dakotans receive coverage through the program, and that for every 10% of Medicaid expansion costs shifted from the federal government to South Dakota, the state would have to find about $36 million more each year (SOS pamphlet Pro statement). The pamphlet's "Con" statement, from Deb Fischer-Clemens, says a "No" vote keeps the South Dakota Constitution unchanged and preserves the 2022 expansion. It says a "No" vote would allow approximately 30,000 South Dakotans who receive insurance through Medicaid expansion to keep their insurance, and would ensure that changes in federal funding "do not automatically take health coverage from South Dakotans" (SOS pamphlet Con statement). Independent reporting has covered the gap between those readings. In September 2026, Meghan O'Brien of South Dakota Searchlight reported that Attorney General Marty Jackley stands by ballot language describing an end to expansion below the 90% threshold, while sponsoring lawmakers dispute that the change would be automatic. Searchlight also reported lawmakers' estimate that if the federal share fell to 70%, the state would be on the hook for about $72 million, and quoted Tim Rave of the South Dakota Association of Healthcare Organizations saying about $400 million a year from the expansion goes to hospitals, clinics, and other providers. Searchlight's November 2 preview again described that dispute over whether a drop below 90% would end expansion right away or only open the door for lawmakers to act (Searchlight, Nov 2, 2026).
Will my South Dakota Medicaid expansion coverage change on election night? Your day-to-day coverage does not change on election night alone. Under South Dakota law, a constitutional amendment approved by voters takes effect on the first day of July after the official canvass by the State Canvassing Board (SDCL 2-1-12; also stated in the SOS pamphlet). If Amendment I passes, that effective date is July 1, 2027. Even then, the amendment only matters for expansion coverage if the federal match drops below 90%. Watch for official notices about eligibility, renewals, or medication coverage. Keep any letter that mentions a change in eligibility, a new prior authorization, or a denial. Read the reason codes and the deadlines on the letter itself. For help reading denial paperwork on medications or treatment, see how to read a denied EOB and how to read a denial letter. Track timing with the insurance appeal deadline clock. If the letter involves a specialty medication denial, see what happens when insurance denies a specialty medication.
How can Ellen® help if a coverage letter arrives later?
If a letter later denies a medication or changes a prior authorization for treatment you already use, upload it to Ellen's Denial Decoder. If you are mid-appeal on a medication or treatment coverage denial, use the Appeal wizard. You can also start from I Was Denied or Medicaid denial help. If a notice says your Medicaid eligibility itself is ending or changing, that goes through a state fair hearing with the South Dakota Department of Social Services, not an insurance appeal. DSS explains how to request a fair hearing on its fair hearings page. Read the deadline on your notice. Your next step: if a medication or treatment coverage denial letter shows up after the results, open the Denial Decoder and upload it before the deadline on the letter passes. If the letter is about eligibility ending, follow the DSS fair hearing instructions on the notice.