Medicaid Expansion Approved in South Dakota

Voters in South Dakota approved a ballot measure on Nov. 8, 2022, to expand Medicaid coverage in the state. The approved ballot measure requires South Dakota to implement expansion coverage beginning July 1, 2023, and prohibits the imposition of any additional burdens or restrictions on eligibility or enrollment for the expansion population.

The passage of the ballot measure by a wide margin of South Dakotans is the latest momentum to expand Medicaid coverage for the poor under the Affordable Care Act. In 2020, voters in Missouri and Oklahoma approved ballot initiatives to expand Medicaid, following successful ballot initiatives in 2018 in Nebraska, Idaho and Utah. Those states, similar to Maine in 2017, bypassed Republican governors and GOP-controlled legislatures to expand Medicaid by public referendum when the lawmakers refused.