By Seth Tupper, South Dakota Searchlight
South Dakota voters will decide next year whether to continue requiring Medicaid expansion if federal support for the program declines.
The state Senate voted 31-3 on Monday at the Capitol in Pierre to support a resolution that will send the question to voters. The House had already approved the measure, which does not require a signature from the governor.
The question will appear on the ballot in the November 2026 general election.
Medicaid is government-funded health insurance for people with low incomes, and for adults and children with disabilities. In 2022, South Dakota voters expanded Medicaid eligibility to adults with incomes up to 138% of the poverty level, to capitalize on a 90% federal funding match included in the Obama-era Affordable Care Act. The expansion is part of the state constitution and can only be altered by voters.
The resolution approved Monday will ask voters to authorize the termination of Medicaid expansion if federal support falls below 90%. Speculation about a reduction in federal Medicaid expansion funding has been swirling as the Trump administration and a Republican-controlled Congress look for spending cuts.
Sen. Casey Crabtree, R-Madison, sponsored the resolution in the Senate. He said if the federal government reduces its support to 70%, the state would be responsible for an additional $72 million to sustain Medicaid expansion.
“South Dakotans at that point would have to consider whether they want cuts to other programs, including public safety, education and others,” Crabtree said.
Nearly 30,000 South Dakotans have enrolled in expanded Medicaid coverage so far. Sen. Liz Larson, D-Sioux Falls, unsuccessfully argued against the resolution. She said Medicaid expansion has saved lives in South Dakota.
“People shouldn’t die because they can’t afford to live,” Larson said.
Last fall, South Dakota voters authorized state officials to consider imposing work requirements on people covered by Medicaid expansion. The state has not yet applied for federal permission to impose those requirements.
South Dakota Searchlight is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. South Dakota Searchlight maintains editorial independence.
