South Dakotans Decide Healthcare submitted 47,000 signatures for their Medicaid expansion initiative on Nov. 8, 2021, the deadline for initiated constitutional amendment petitions in South Dakota. To qualify for the ballot, 33,921 valid signatures are required.

The measure would amend the constitution to require the state to provide Medicaid benefits to adults between 18 and 65 with incomes below 133% of the federal poverty level. Because the Affordable Care Act (ACA) includes a 5% income disregard, this measure would effectively expand Medicaid to those with incomes at or below 138% of the federal poverty level.

The ACA, also known as Obamacare, was signed into law on March 23, 2010. The ACA provided for the expansion of Medicaid to cover all individuals earning incomes up to 138% of the federal poverty level, which amounted to $17,236 for individuals in 2019. The law was designed to provide 100% of funding to cover the new recipients for the first three years and to cut off federal Medicaid funding to states that chose not to expand coverage. However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius (2012) that the federal government could not withhold Medicaid funds from states that chose not to expand eligibility. According to the Kaiser Family Foundation, this ruling had the practical effect of making Medicaid expansion optional for states.

As of 2021, a total of 38 states and Washington, D.C., had expanded or voted to expand Medicaid, while 13 states had not. Six states have expanded Medicaid through citizen initiatives.

To qualify initiated measures that amend state law for the 2022 ballot,16,961 valid signatures are required by May 3, 2022.

Dakotans 4 Health also circulated a Medicaid expansion initiated amendment but did not submit signatures by the deadline. Dakotans 4 Health also filed a Medicaid expansion initiative to amend state law (rather than the state constitution), for which signatures are due on May 3, 2022. Since the deadlines for initiated measures that amend state law was extended to May 3, 2022, Dakotans 4 Health said they would collect signatures for that measure and would support South Dakotans Decide Healthcare’s amendment. Rick Weiland of Dakotans 4 Health said, “In the interest of the 42,500 hard working low-income South Dakotans who struggle every day just to keep a roof over their head and food on the table, we have decided to unite behind one constitutional amendment, and we will continue to collect signatures to place our Medicaid initiated law on the November 2022 ballot. The last thing we need is to have two proposed constitutional amendments on the November 2022 ballot. We will continue petitioning for our initiated law giving voters the opportunity to pass both an amendment to the state’s constitution and a law next year.”

One other initiative measure facing the May 3, 2022, deadline was sponsored by Melissa Mentele of New Approach South Dakota. The measure would legalize marijuana use, possession, and distribution for individuals 21 years old and older. South Dakotans for Better Marijuana Laws and New Approach South Dakota supported Constitutional Amendment A on the 2020 ballot, which was approved in a vote of 54.18% to 45.82% but was overturned by a court ruling. Circuit Judge Christina Klinger ruled that the measure violated the state’s single-subject rule and constituted a revision of the constitution rather than an amendment. South Dakotans for Better Marijuana Laws said they would appeal to the state supreme court.