South Dakota Medicaid expansion ballot measure passes

South Dakotans voted to expand Medicaid coverage to low-income adults at the polls Tuesday.

An amendment to the state constitution passed with 56% of voters in support, according to state election data. The Mount Rushmore State will join 38 states and the District of Columbia in expanding Medicaid eligibly under the Affordable Care Act. South Dakota is also the seventh Republican-led state to enact Medicaid expansion via a ballot initiative.

Starting July 1, 42,500 South Dakota adults with incomes below 133% of the federal poverty level—or about $18,000 a year for a single person—will be eligible for Medicaid coverage, according to the state legislature’s nonpartisan budget analysis office. The federal government will cover 90% of the expansion’s cost and provide a two-year, 5% bonus in its share of the state’s entire Medicaid budget. The legislature’s analysis predicts expansion will save South Dakota $162.5 million over five years because of the extra federal dollars and lower spending on state-run healthcare programs.

“South Dakotans know their families and neighbors deserve healthcare without going into debt or avoiding check-ups, procedures and medication they need,” Kelly Hall, executive director of the Fairness Project, a progressive organization that supports ballot initiatives, said in a news release. “Citizens took matters into their own hands to pass Medicaid expansion via ballot measure—showing us once again that if politicians won’t do their job, their constituents will step up and do it for them.”

Gov. Kristi Noem (R) opposes Medicaid expansion but has pledged to carry out the policy. Noem handily won reelection Tuesday over Democrat Jamie Smith, the minority leader of the South Dakota House of Representatives.

The South Dakota Association of Healthcare Organizations, the South Dakota State Medical Association, and the South Dakota health systems Avera Health, Sanford Health and Monument Health supported the measure, which they contend will reduce uncompensated care and benefit rural providers.

“Avera thanks voters for seeing the importance in expanding Medicaid so that over 42,000 South Dakotans, including farmers, parents and small-business employees, have expanded access to healthcare. This is especially important to our rural population who are more likely to be uninsured,” the health system said in a statement.

Expansion also attracted the support of community health centers and physicians who argued that broader Medicaid coverage would help clinics expand services. “Extending coverage will help resource our work, enabling us to sustain care in some of the state’s most rural and frontier communities and expand needed services such as behavioral health and dental care,” Shelly Ten Napel, CEO of Community HealthCare Association of the Dakotas, said in a statement.

Other organizations that endorsed the measure include the South Dakota Nurses Association, the South Dakota Farmers Union, the American Heart Association, the American Diabetes Association and AARP South Dakota.