South Dakota Voters Reject Medicaid Expansion Repeal Measure

South Dakota voters rejected Amendment I in the November 4, 2026, election, blocking a measure that would have repealed the state's Medicaid expansion mandate if federal funding fell below 90%. The measure failed with 56% of the vote against and 44% in favor, according to the Associated Press, with over 80% of ballots counted.

South Dakota voters also decided on three other constitutional amendments. They approved Amendment J, restricting state and local voting to U.S. citizens, and Amendment K, which creates a permanent trust fund for unclaimed property. They rejected Amendment L, which sought to raise the approval threshold for future constitutional amendments from a simple majority to a 60% supermajority.

Republican state lawmakers supported Amendment I, arguing that a drop in federal funding would threaten the state's balanced budget, schools, and nursing homes. Opponents, including healthcare officials, argued the measure would have jeopardized access for roughly 31,000 residents. The expansion was originally established via a 2022 citizen-initiated amendment after the legislature had previously declined the federal offer. Since then, the state has spent $76 million and received $870 million in federal funding.