Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Medicaid Budget topic
No spam. Unsubscribe anytime.
House passes resolution to send constitutional amendment to voters tying Medicaid expansion mandate to federal 90/10 match
Summary
PIERRE — The South Dakota House passed House Joint Resolution 5,001 to send a proposed constitutional amendment to the ballot that would make the state's constitutional obligation to enter Medicaid expansion contingent on the federal match remaining at a 90%/10% split.
PIERRE — The South Dakota House passed House Joint Resolution 5,001 to submit a proposed constitutional amendment to the ballot that would make the state's constitutional obligation to enter Medicaid expansion contingent on the federal Medicaid matching rate remaining at 90 percent federal and 10 percent state.
Representative Enheisen, who presented the resolution, said the constitutional provision approved by voters in 2022 requires the state to enter expansion but does not specify the federal match rate. He argued the 2022 campaign prominently advertised a 90/10 federal match and that changing federal funding would materially change the state’s fiscal obligation. "Every 10% that they shift onto us would cost us $36,000,000 a year in general funds," Enheisen said, citing a floor estimate for the fiscal effect of a lower federal match.
Supporters of the resolution said it preserves the ability to revisit the policy with voters if the federal value proposition changes. Representative Mortensen said the resolution respects voters by returning the question to them under changed circumstances and does not automatically repeal expansion; instead it would allow the public to affirm or reject the policy if the federal match falls below 90/10.
Opponents warned the move undermines the 2022 voter decision and could harm vulnerable populations and rural hospitals. Representative Emery said the initial implementation placed burdens on Native American communities and asserted the Indian Health Service funds were used in part to subsidize expansion, citing $70,000,000 as an amount drawn from IHS funding that she said was redirected. Representative Healy noted the legislature had 14 prior chances to expand Medicaid and voters chose to put the mandate in the constitution.
Representative Muckey said actual enrollment and costs have been lower than campaign projections: he noted projected enrollment at the ballot was about 42,500 people, while December enrollment was under 29,000, and argued the state was "way below the expectation" presented to voters. He said that given uncertain federal action on matching rates, it was premature to change the constitutional requirement now.
Supporters countered that the ballot question should be revisited if the federal match changes because the 90/10 arrangement was central to voters' understanding. Representative Van Heisen said that if the voters approve the proposed amendment at the ballot it would take effect in July 2027, and that the legislature must prepare now for potential federal changes that could occur in the next 2½ years.
After debate the House voted to pass the resolution. The clerk reported 59 ayes, 7 nays and 3 excused on the displayed roll call. The resolution, if approved by the Senate and placed on the ballot, would give voters the opportunity to amend the constitution on this point; it would not by itself repeal Medicaid expansion.
