Humanitarianism

South Dakota's Constitutional Amendment I, on the November ballot, would repeal the state's Medicaid expansion if federal funding drops below the current 90-percent matching threshold. Voters approved Medicaid expansion in 2022 with 56 percent support, and lawmakers placed Amendment I before voters during this year's legislative session.

Supporters, including Republican State Senator Casey Crabtree, argue the state cannot absorb costs if Washington reduces its share, though he notes expansion could continue under state statute if lawmakers find funding. Opponents, including medical professionals and advocacy groups like the American Cancer Society Cancer Action Network, warn as many as 30,000 South Dakotans could lose coverage, calling the program critical in rural areas. Both sides acknowledge that any federal rollback of Medicaid's funding formula would face a difficult path through Congress, given that 40 states now rely on expansion dollars. Separately, other states are already seeing coverage losses tied to federal policy changes: Washington state expects about 14,000 residents, mostly lawfully present immigrants without green cards, to lose Medicaid eligibility starting October 1 under the new federal law known as HR1. The South Dakota vote will test public appetite for conditional entitlement guarantees tied to federal funding levels.