Jackley says Medicaid measure would trigger repeal

What Amendment I would change

South Dakota voters will face conflicting interpretations of Amendment I on the Nov. 3 ballot. Attorney General Marty Jackley’s ballot title says the constitutional amendment repeals expanded Medicaid coverage if the federal government’s funding share drops below 90%. His ballot explanation says the same funding change would end that coverage.

Republican lawmakers who referred the amendment to voters say that is not how the measure would work. Rep. Will Mortenson of Fort Pierre, who sponsored the referral, said it would remove the state Constitution’s expansion requirement if federal support falls below 90%, leaving lawmakers to decide whether to end, modify or maintain the program.

Lt. Gov. Tony Venhuizen, who sponsored the referral while serving as a legislator in early 2025, also said the ballot wording implies an automatic result that the measure does not require.

Why the distinction matters

South Dakota voters approved Medicaid expansion through a citizen-initiated constitutional amendment in 2022. It extended eligibility to adults with incomes up to 138% of the federal poverty level. Because the requirement is in the state Constitution, voters must approve any change to it.

Medicaid is jointly funded by the federal and state governments. Federal law currently covers 90% of South Dakota’s expansion costs. Lawmakers estimated that reducing the federal share to 70% would leave the state responsible for about more to maintain expanded coverage.

The dispute centers on what happens if federal support falls below 90%: automatic repeal under Jackley’s ballot explanation, or removal of the constitutional requirement followed by a legislative decision under the sponsors’ interpretation. Voters will see Jackley’s title and explanation when considering Amendment I.