“An Amendment to the South Dakota Constitution that Repeals Expanded Medicaid Coverage if Federal Funding for the Program Drops below 90%.” Attorney General's ballot title
In 2022, voters wrote Medicaid expansion into the state constitution (Amendment D, 56 percent yes). It covers adults 18 to 64 earning up to about 138 percent of the federal poverty level. Federal law has the federal government paying 90 percent of the cost and South Dakota paying 10.
Amendment I adds one condition: if the federal share ever drops below 90 percent, the constitution no longer requires the state to keep the expanded coverage. Regular Medicaid for children, pregnant women, people with disabilities and the elderly is a separate program and is not touched.
Nothing changes on November 4. The federal share is still 90 percent today. This amendment only decides who holds the pen if that number moves.