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

South Dakota · constitutional amendment · on the November 3, 2026 ballot. The ballot wording and the arguments for and against from the state’s official voter guide, in the state’s own words, each read the same way for rhetorical techniques. We don’t recommend a vote.

On the ballot

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Medicaid is a program, funded by the State and the federal government, to provide medical coverage for low-income children, pregnant women, disabled individuals, and the elderly. In the 2022 General Election the voters approved Constitutional Amendment D, which expanded Medicaid eligibility in South Dakota.

Amendment D requires the State to also provide Medicaid benefits to anyone over the age of 18 and under 65 whose income is at or below 133% of the federal property level, plus 5% of the federal poverty level for the applicable family size. Currently, federal law requires the federal government to fund 90% of South Dakota’s Medicaid expansion.

This proposed Constitutional Amendment ends the expanded Medicaid coverage if the federal funding for expansion drops below 90%. If federal funding drops below that 90% threshold, Medicaid coverage will once again only apply to low-income children, pregnant women, disabled individuals, and the elderly.

From sdsos.gov. Checked 2026-10-20. Confirm with your official ballot (sample-ballot lookup).

Argument for

By Lt. Governor Tony Venhuizen; Sen. Casey Crabtree, Madison; and Rep. Will Mortenson, Ft. Pierre

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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. In 2022, voters approved Medicaid expansion. The state has honored that vote, and today about 30,000 South Dakotans receive coverage through the program.

A major reason voters supported expansion was a promise from the federal government: Washington would pay 90% of the cost, while South Dakota would pay 10%. Amendment I says that as long as Washington keeps that promise, nothing changes. But what if Washington changes the deal? Think about any service you buy at a set price.

If the company raises the price, you get to decide whether the service is still worth the cost. South Dakota deserves the same choice. 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. Our state has many important needs.

We fund schools, law enforcement, nursing homes, and services for people with disabilities. Medicaid expansion for able-bodied, working-age adults should not have a guaranteed place at the front of the line if Washington stops paying its promised share. Amendment I does not prevent South Dakota from continuing Medicaid expansion.

It simply ends the constitutional requirement if federal funding falls below 90%. Legislators and voters could then decide whether expansion is still worth the new cost. Our state has participated in Medicaid programs for more than fifty years, without having it in the constitution. South Dakotans made the decision to expand Medicaid.

If Washington changes the deal, South Dakotans should make the next decision too. Vote YES on Amendment I.

From sdsos.gov, the official voter guide.

Argument against

By Deb Fischer-Clemens, RN, BSN, MHA

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A vote NO would keep the South Dakota Constitution unchanged and preserve Medicaid expansion as approved by South Dakota voters in 2022. Medicaid expansion provides health insurance to adults with incomes up to $1,835 per month (about $22,00 per year) for a single individual or $3,142 per month ($37,700 per year) for a family of three.

Before expansion, many low-income South Dakotans had no affordable way to see a doctor or fill prescriptions. 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.

A vote NO would ensure that changes in federal funding do not automatically take health coverage from South Dakotans.

From sdsos.gov, the official voter guide.

Who’s behind it

Party positions: South Dakota Democratic Party: VOTE NO · South Dakota Republican Party: VOTE YES

Committees registered to support or oppose Constitutional Amendment I, and what they reported to South Dakota Secretary of State Campaign Finance Reporting System (sdcfr.sdsos.gov). Checked 2026-10-21.

Before comparing the sides: each committee’s figures come from its own latest report, so they can cover different dates. Some committees work on more than one measure or other campaigns, and their totals include all of it. A side with no registered committee can still have supporters. How much a side raised says nothing about whether the measure is a good idea.

Supporting

No registered committee supporting Constitutional Amendment I found as of 2026-10-21.

Opposing

No on I

Ballot measure committee

Registered; no financial report filed yet.

A rhetorical technique is about wording, not about whether a measure is a good idea or an argument is true. Ballot wording is written under each state’s own rules, and official arguments by the people the state names. All South Dakota measures →