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HJR 5001

Proposing and submitting to the voters at the next general election an amendment to the Constitution of the State of South Dakota, conditioning the requirement of expanded Medicaid on the level of federal medical assistance.

2025 Regular Session Introduced by Aaron Aylward and 35 co-sponsors

South Dakota proposes constitutional amendment tying Medicaid expansion eligibility to federal funding levels, requiring voter approval and creating automatic enrollment triggers based on federal assistance thresholds.

Delivered to the Secretary of State H.J. 476
#ballotmeasures #constitutionalamendments #housejointresolution #medicaid
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Bill Summary · HJR 5001

Legislative bill overview

HJR 5001 proposes a constitutional amendment for South Dakota voters that would tie the state's participation in Medicaid expansion to the level of federal funding the state receives. Specifically, it conditions expanded Medicaid eligibility on maintaining a threshold of federal medical assistance dollars. The amendment requires voter approval in the next general election.

Why is this important

This measure directly affects healthcare access for approximately 50,000-70,000 South Dakotans who would be eligible for Medicaid expansion under current federal guidelines. The outcome determines whether the state maintains its current Medicaid program scope or expands coverage, which has significant implications for hospital financing, rural healthcare provider sustainability, and state budget obligations.

Potential points of contention

  • Federal funding uncertainty: Tying expansion to federal assistance levels creates volatility since Congress frequently debates Medicaid funding formulas; a change in federal policy could automatically trigger expansion or contraction without legislative action
  • Healthcare access equity: Conditioning coverage on federal dollars may result in coverage gaps if federal support decreases, leaving vulnerable populations without predictable access to care
  • State autonomy vs. federal dependency: The amendment embeds federal policy decisions into state constitutional law, raising questions about whether this appropriately delegates state healthcare decisions to federal funding levels

Compiled from official sources — confirm details with the bill’s official record.

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