Senate passes constitutional amendment for 2026 ballot that could end expanded Medicaid

The South Dakota Senate approved a measure this week (March 3, 2025) asking voters to amend the state constitution to end Medicaid expansion if federal funding drops below 90%.

House Joint Resolution 5001 passed 31-3, after senators rejected putting the question on the June 2026 primary ballot.

The proposed amendment follows South Dakota’s 2022 voter-approved Medicaid expansion. It increased coverage to adults with incomes up to 138% of the federal poverty level.

If approved in November 2026, the amendment would end expanded coverage for approximately 28,000 South Dakotans, again, if federal funding declines. The state’s cost for Medicaid is about $36 million, annually.

PIERRE, S.D. (SDBA) — The South Dakota House voted Tuesday (Jan. 21, 2025) to let voters decide whether to modify the state’s Medicaid expansion requirements if federal funding drops below current levels.

Representatives voted 59-7 to put the constitutional amendment on the 2026 ballot. House Joint Resolution 5001 would remove the constitutional requirement for Medicaid expansion if federal matching funds fall below the current 90% rate.

“We need to be prepared for changing circumstances,” said Rep. Tony Venhuizen, R-Sioux Falls, the bill’s sponsor. He noted that every 10% reduction in federal funding would cost South Dakota $36 million annually.

Venhuizen added that it would not repeal expanded Medicaid but allow the legislature to deal with its financial ramifications.

Opponents argued the measure undermines voter intent after South Dakotans approved Medicaid expansion in 2022.

“This threatens our rural hospitals, which rely on Medicaid reimbursements to stay open,” said Rep. Kadyn Wittman. “We’re talking about real lives that will be impacted.”

Rep. Eric Emery, D-Rosebud, said if the legislature discontinued expanded Medicaid, it would disproportionately impact Native American South Dakotans.

If the Senate and voters approve, the change would take effect in July 2027. The measure wouldn’t automatically end expansion if federal funding decreases but would give legislators flexibility to debate continuing the program.

According to Rep. Erik Muckey, D-Sioux Falls, about 29,000 South Dakotans are currently enrolled in expanded Medicaid coverage.