South Dakota Constitutional Amendment I
Tie the constitutional Medicaid expansion requirement to a 90% federal share · November 3, 2026 · Tax year 2028 · Scenario
What Constitutional Amendment I would do
South Dakota Amendment I concerns Medicaid expansion if the federal government's share of its cost falls below 90%. The Attorney General's explanation and the sponsors' statement disagree on whether expansion would then end automatically; PolicyEngine models a scenario in which the share falls and expansion ends on July 1, 2027.
A conditional scenario, not a forecast
Under current federal law, the federal government pays 90% of the cost of the expansion group, so Amendment I would have no immediate effect. These figures show a scenario in which the federal share falls below 90% and expansion ends on July 1, 2027. The Attorney General's explanation and the sponsors' statement read the amendment differently; these figures follow the Attorney General's reading, and Methodology sets out both.
What changes if it passes
- Limits the constitutional requirement to provide expanded Medicaid to the period before the federal share of its cost falls below 90%.
- Has no effect while the federal share remains 90%.
Estimates at a glance
People losing Medicaid in the scenario, 2028
Loading…
PolicyEngine estimate
Enrolled through expansion
29,055
Department of Social Services, South Dakota Medicaid Report SFY25 (January 2026), Average monthly enrollment, July 2024 - June 2025
In the coverage gap
Loading…
People losing Medicaid with income below the poverty line, with no subsidized marketplace option
Current law and the scenario
| Group | Current law | Scenario: expansion ends |
|---|---|---|
| Income up to 100% of poverty | Medicaid | No Medicaid; not eligible for marketplace premium tax credits |
| 100% to 138% of poverty | Medicaid | No Medicaid; may qualify for marketplace premium tax credits |
Who is affected
In the scenario, adults covered through expansion lose Medicaid; those with income at or above the poverty line may qualify for premium tax credits to buy marketplace coverage.
Key facts
- Vote needed
- A majority of the votes cast.
- Takes effect
- If approved, July 1, 2027, with an effect only if the federal share falls below 90%.
- Years modeled
- Tax year 2028