There’s something unclear about Constitutional Amendment I, a question on the Nov. 3 ballot that would change South Dakota’s Medicaid expansion program.

Medicaid expansion covers healthcare costs for South Dakotans making less than $22,000 a year. The federal government covers 90% of the cost. The state covers the remaining 10%.

For years, the Legislature refused that deal. So, in 2022, South Dakota voters approved it themselves by placing it in the state constitution.

Medicaid expansion coverage is crucial for 31,000 of our friends and neighbors. That’s especially so for those struggling to make ends meet. Housing and grocery costs have soared recently, and wages have not kept up.

Ballot measure could auto-repeal Medicaid expansion, attorney general says in contrast to lawmakers

Backers of Amendment I want to change the language, by saying if the federal government lowers its funding match, the state should get the flexibility to decide whether expansion is worth the new cost.

“It would NOT automatically end Medicaid expansion,” say Lt. Gov. Tony Venhuizen, Sen. Casey Crabtree and Rep. Will Mortenson, all Republicans, in the ballot questions pamphlet distributed by the Secretary of State’s Office.

Here’s where it gets confusing.

Their statement contradicts Republican Attorney General Marty Jackley’s explanation of the amendment.

“This proposed Constitutional Amendment ends the expanded Medicaid coverage if the federal funding for expansion drops below 90%,” reads the explanation, which is printed on the ballot.

The attorney general’s statement reads more like a trigger law to overturn Medicaid expansion, rather than a maneuver to give lawmakers more flexibility.

When asked about the discrepancy between lawmakers’ interpretation and his own, Jackley doubled down.

“When you look at what the legislative proposal was that the title is based upon and the language is, it’s very straightforward of how this would occur,” Jackley said to South Dakota Searchlight. “And again, the Legislature made that decision.”

So which one is it?

Amendment I is one of four amendments placed on the ballot by the Republican-controlled Legislature. Another asks voters to raise the threshold for approving constitutional amendments to 60%, which some lawmakers say would protect the constitution (voters have rejected similar measures twice already).

Urging voters to support one ambiguous constitutional amendment while asking them to protect the constitution with another feels incongruent.

Regardless of either interpretation, Amendment I opens the door to repealing Medicaid expansion — a program voters supported in 2022.

Proponents of Amendment I argue they’re safeguarding the state budget from a financial hit if the current presidential administration lowers the federal match.

Another safeguard against the feds changing the funding match could be reminding the administration about the effect Medicaid expansion has on states like ours. It’s brought $870 million to South Dakota since implementation.

But it’s about more than dollars. It’s about keeping rural hospitals open, communities thriving and South Dakotans healthy.