South Dakota voters reject Medicaid repeal trigger
With Amendment I failing at the ballot box, health leaders urge lawmakers to end repeated attempts to alter the state's expanded Medicaid program.
By Amit Chukwu ·
South Dakota voters turned down Amendment I on Tuesday, keeping a potential repeal mechanism for the state's Medicaid expansion out of the constitution. The measure failed with 56 percent of votes against it and 44 percent in favor. The ballot question was designed to allow lawmakers to repeal the expansion if the federal government lowered its funding share. With the defeat, the program remains secure from that specific legislative trigger.
The expansion was approved by voters in 2022. It extended health coverage to low-income adults who were previously ineligible. Under the current structure, the federal government covers 90 percent of the costs, while the state pays the remaining 10 percent. Amendment I would have changed this arrangement by giving the legislature the power to cut the program if Washington cut its financial support. The state's Republican-dominated legislature sent the amendment to voters after failing to pass the expansion through normal legislative channels in prior years.
Tim Rave, president and CEO of the South Dakota Association of Healthcare Organizations, said the result reflects a clear voter preference. He is a Republican and former state legislator. Rave stated that a majority of South Dakotans support the expansion and do not want it disturbed. He noted that his organization will now focus on state revenues and their impact on healthcare funding. He is unsure if lawmakers will return to the issue.
Deb Fischer-Clemens, a Democrat and former legislator who led the opposition group No on I, expressed hope that the legislature will accept the result. She served as president of the South Dakota Nurses Association. Fischer-Clemens said she hopes lawmakers will move on from the issue. She added that her group will continue to watch and listen to legislative activity. She noted that attention is now turning to federal work requirements included in the One Big Beautiful Bill Act.
Those work requirements could impact state enrollment numbers. The state Department of Social Services estimates that 1,213 people on expanded Medicaid could be disenrolled next year. That number represents about 4 percent of the expanded group. Fischer-Clemens identified these federal changes as the next major challenge for the state program.
Rep. Will Mortenson, R-Fort Pierre, sponsored the resolution that placed Amendment I on the ballot. He did not seek reelection this year. Mortenson said he hopes the legislature keeps an eye on the issue. He warned that state schools, nursing homes, and the balanced budget could face pressure if the state must pay a larger share of Medicaid costs in the future. He cited concerns about federal funding levels.
Sen. Taffy Howard, R-Rapid City, won reelection on Tuesday. She sits on the state budget committee. Lawmakers estimated last year that if federal support drops to 70 percent, the state would need to cover about $72 million to maintain the expansion. Howard said something has to be done about potential budget constraints, though she is not certain if lawmakers will address the program again in the near future. Voters also rejected Amendment L, which sought to raise the threshold for approving constitutional amendments to 60 percent.
