PIERRE, S.D. (SDBA) — The South Dakota Senate overwhelmingly approved a measure today (Monday) asking voters to amend the state constitution to end Medicaid expansion if federal funding drops below 90 percent.

House Joint Resolution 5001 passed with a 31-3 vote after senators rejected an attempt to move the question from the November 2026 general election to the June 2026 primary ballot.

The resolution proposes a constitutional amendment that automatically terminates expanded Medicaid coverage if federal support decreases from its current 90 percent level.

Sen. Casey Crabtree, R-Madison, prime sponsor of the measure, said the amendment provides necessary financial protection for the state.

“One of the key points made by the proponents of Medicaid expansion was that the feds were going to pay 90 percent of the cost, and South Dakota taxpayers would only have to pay 10 percent,” Crabtree said. “Right now, that 10 percent is projected to cost South Dakota taxpayers about $36 million a year.”

Senators voted 14-19 against an amendment that would have moved the ballot question to the June primary.

Sen. Tom Pischke, R-Dell Rapids, opposed the primary election amendment, citing past voter concerns.

“I had a lot of people in my district that just were very upset that we put that amendment on the primary election,” Pischke said. “The comments were, we think not everybody votes at the primary.”

Sen. Liz Larson, D-Sioux Falls, spoke against the resolution itself, arguing that healthcare access should take priority.

“People shouldn’t die because they can’t afford to live,” Larson said. “Medicaid expansion has been a lifeline for 28,000 South Dakotans, and it’s saved lives.”

The proposed amendment follows South Dakota’s 2022 voter-approved Medicaid expansion. It increased coverage to adults with incomes up to 138 percent of the federal poverty level.