South Dakota Amendment I would condition the state Constitution’s requirement for expanded Medicaid on the level of federal medical assistance. It was placed on the 2026 ballot by the Legislature. Medicaid is jointly financed by federal and state governments, so changes in the federal contribution can materially alter the state cost of maintaining eligibility. The constitutional question is whether expansion should remain a fixed voter mandate even if Washington reduces its contribution, automatically loosen when federal support falls, or leave lawmakers more discretion to adjust coverage and spending. Coverage should not disappear casually when Washington changes a budget formula, but a constitutional mandate can expose the state to costs voters never anticipated. A sensible rule needs both continuity for patients and a fiscal escape valve.