South Dakota voters will once again be asked to make changes to the state’s Medicaid expansion constitutional provision—this time in November of 2026.
Senators are approving a joint resolution asking voters to allow the legislature to make changes to Medicaid if the Republican congress and Trump administration reduce the federal match to provide healthcare for low-income individuals.
Senator Casey Crabtree, R-Madison, is the prime sponsor of the idea in the Senate. He said if the feds start rolling back Medicaid it could cost the state millions.
“Really, what we need to do is make sure we’ve got the flexibility to negotiate terms, as well," Crabtree said. "If the voters go back and clarify they want us to have that flexibility, then, we’ll be able to adjust accordingly.”
If approved in November 2026, the change will allow the state to adjust or stop providing health care coverage to the expansion population. That is, if the federal government match dips below 90 percent.
According to the Department of Social Services, 30,444 people receive Medicaid healthcare coverage through expansion.
In 2024, state voters approved allowing the state to add work requirements for healthcare coverage.
