South Dakota voters face conflicting interpretations of Amendment I, which will appear on the Nov. 3 ballot and address what happens if federal funding for expanded Medicaid falls below 90%. Republican lawmakers who sponsored the measure, including Rep. Will Mortenson, R-Fort Pierre, say it would remove the constitutional requirement to maintain the expansion and allow the Legislature to repeal, change or retain it. Republican Attorney General Marty Jackley, who wrote the ballot language, says the amendment would automatically repeal expanded Medicaid, a federal-state health insurance program for people with low incomes, if funding drops below the threshold. More than 31,000 South Dakotans were enrolled in the expansion as of last month, while total state Medicaid enrollment was about 143,000. Lawmakers estimate that maintaining the expansion with a 70% federal contribution would cost the state about $72 million. Health-care advocates warn that losing coverage would increase uncompensated care, while providers say the expansion currently directs about $400 million annually to hospitals, clinics and other providers. The amendment follows a 2024 constitutional change allowing lawmakers to establish federally approved work requirements, which the Department of Social Services estimates could disenroll 1,213 people after taking effect next year.