It has been another busy summer and fall for the SDAHO Advocacy Team. The Emergency Medical Services summer study is nearing its final meeting, the Rural Health Transformation Program is heading into its second year, and South Dakotans head to the polls on Tuesday, November 3rd. The team is also gearing up for our Fall Legislative Forums in November and the Governor’s Budget Address in December, which will set the table for the 2027 Legislative Session.
General Election
Election day is Tuesday, November 3rd, but early voting is already underway for those who want to beat the rush or won’t be available on election day. The deadline for registering is Monday, October 19th.
This is a big ballot. Voters will choose a Governor, a U.S. Senator, South Dakota’s lone U.S. House member (an open seat this year), several open statewide offices, and all 105 seats in the State Legislature. With turnover in the Legislature every two years, now is the best time to get to know your candidates. Ask them what they know about healthcare in your community and how they would approach issues like Medicaid rates, workforce, and EMS. Those relationships matter long before the first bill is heard in January.
Four constitutional amendments are also on the ballot: Amendments I, J, K, and L. SDAHO encourages all our members to become educated on these issues before going to your polling location. To learn more, visit the SD Secretary of State’s 2026 Ballot Question Pamphlet.
Amendment I: SDAHO Urges a NO Vote
Amendment I is “An Amendment to the South Dakota Constitution that Repeals Expanded Medicaid Coverage if Federal Funding for the Program Drops below 90%.” In 2022, voters approved Amendment D, which expanded Medicaid to certain low-income adults under 65. The federal government currently pays 90% of the cost of that population. If Amendment I passes and the federal share ever drops below 90%, expanded coverage would end, and Medicaid would again be limited to low-income children, pregnant women, people with disabilities, and the elderly.
Supporters argue the amendment protects the state budget, estimating that each 10% shift in cost would require about $36 million more per year in state funds. SDAHO understands those budget pressures, but we believe Amendment I is the wrong approach. Today, Medicaid expansion covers about 30,000 South Dakotans. For our hospitals, clinics, and nursing homes, many of those patients would become uninsured, increasing uncompensated care at the same time rural facilities are already operating on thin margins. Placing a funding trigger in the Constitution also takes away flexibility for future Legislatures to respond to whatever changes come from Washington. SDAHO urges our members to vote NO on Amendment I.
EMS Summer Study
The Legislature’s Executive Board selected emergency medical services as one of only three summer study topics for 2026, alongside Indian Medicaid managed care and developmental disability service delivery. The EMS Interim Committee has one meeting left on October 26 before it reports to the Executive Board later this year.
Three ideas have risen to the top this summer. The first is creating a permanent advisory committee to oversee EMS improvement and funding over the long term. Department of Health Secretary Melissa Magstadt has said an advisory board would be a good direction for possible regionalization of ambulance services, and that it should include a broad range of stakeholders. The second is draft policy on treatment in place, which would allow EMS to be reimbursed for treating patients without transporting them, building on the work of last year’s interim committee. The third is creating a regionalization approach with potential state, city, county, and other funding to help support each regional facility and ensure coverage for anyone within those boundaries
SDAHO has been engaged throughout the study, including work on what regional EMS hub models could look like across the state. We will continue to push for a seat at the table for hospitals and long-term care providers on any advisory committee, since our members are both partners in and, in many communities, operators of local ambulance services.
Rural Health Transformation Program: Year 2
Last fall, the State was preparing its application for the Rural Health Transformation Program (RHTP). In December, CMS awarded South Dakota about $189.4 million for the program’s first year, and the 2026 Legislature passed a bill authorizing the State to spend those dollars. Over the summer, year 1 funding began reaching providers, including more than $31 million in “Rural Strong” grants for 28 projects across 20 health systems and a $90 million investment in health IT, cybersecurity, and interoperability announced in August.
With the new federal fiscal year starting October 1st, the program is moving into year 2. The year 1 application cycle is now closed, and SDAHO will share information with members on what funding is available, who is eligible, and how to apply as soon as the State releases details for year 2. We also encourage members who received year 1 funding to share their stories with us. Showing results from the first year is the best way to make the case for continued investment in rural South Dakota.
What’s Next
Fall Legislative Forums. Once the election is behind us, the SDAHO Advocacy Team will be holding Legislative Forums across the state in November to bring our members together with newly elected and returning legislators. These forums are one of the best opportunities to introduce new members of the Legislature to your facility and the challenges you face before session begins.
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- November 9, Aberdeen
- November 10, Rapid City
- November 16, Yankton
- November 17, Sioux Falls
Governor’s Budget Address. On December 8th, the Governor will deliver the annual Budget Address to the Legislature, laying out recommendations for the coming fiscal year. This will be our first look at proposed Medicaid provider rates and how the State plans to balance its budget, and SDAHO will share a summary with members shortly after. We will continue to advocate for adequate funding and increases for Medicaid providers heading into the 2027 Legislative Session.
For more information about the forums, or anything else included in this update, please reach out to Jacob.Parsons@sdaho.org.
