South Dakota Voters Will Decide Amendment I in 2026

South Dakota voters will face a ballot measure in 2026 that could restrict Medicaid expansion eligibility.

Updated on Sept. 29, 2026 in Nursing Jobs

Isometric editorial illustration of a state capitol dome silhouette on a flat prairie landscape, representing state legislative policy. — South Dakota voters are set to decide the future of Medicaid expansion in the 2026 election, weighing potential funding-linked eligibility restrictions. AI Illustration. Upload story photo >

Live Poll

Should your state maintain expanded Medicaid coverage even if program costs increase?

South Dakota voters will decide the future of state Medicaid benefits in the 2026 election by voting on Amendment I. This measure proposes to roll back the expansion of benefits if federal funding falls below 90 percent of costs.

Why it matters

The legislature introduced the proposal due to concerns over rising Medicaid budget requirements. A reversal could impact the healthcare access of thousands of residents who gained coverage following the initial expansion.

Amendment I creates a 90 percent federal cost-share threshold for Medicaid expansion. If the federal contribution drops below this level, 30,000 South Dakotans could potentially lose their current health coverage.

The players

Deb Fischer-Clemens

She serves as the chair of the Vote No on Amendment I campaign.

The details

The state legislature proposed the amendment to address ongoing concerns regarding the long-term budget requirements for the program. A coalition of health and business leaders has formed to urge voters to reject the measure, arguing that removing coverage could ultimately lead to higher costs for the state.

Voters expanded Medicaid benefits in 2022.
Voters will decide on Amendment I during the 2026 election.

Market Landscape

This ballot measure represents a significant legislative attempt to reverse the 2022 South Dakota Medicaid expansion. The outcome will influence the broader trajectory of state-level healthcare policy and fiscal management.

Residents currently relying on Medicaid should monitor the election outcome as it directly dictates their future health coverage status. The decision could shift the state's budget priorities and long-term healthcare funding landscape.

The takeaway

Voters must weigh the immediate budgetary concerns cited by the legislature against the potential loss of coverage for thousands of residents. Assessing the long-term fiscal projections is essential for understanding the broader impact of this proposed rollback.