Red States Are Prepping More Medicaid Cuts if Republicans Keep Congress

South Dakota voters will decide on Tuesday whether to approve a Republican-led ballot measure that would automatically repeal Medicaid expansion if Congress reduces federal matching payments. This follows a similar measure approved by South Dakota voters four years ago. Ten states have now implemented "trigger laws" to eliminate Medicaid expansion if federal funding drops below a certain threshold.

Republican-controlled legislatures in other conservative states, such as Oklahoma and West Virginia, have also been pushing for such laws since President Donald Trump took office in 2025. The federal matching funds were created to help states cover the costs of Medicaid expansion under the Affordable Care Act in 2010. Right-wing policy think tanks like the Heritage Foundation have advocated for cuts to these funds.

The Trump administration's 2025 budget bill, the "One Big Beautiful Bill Act," proposes significant cuts to Medicaid, including work requirements and reduced services. Despite efforts to reduce Medicaid matching funds below 90 percent, the threshold currently stands at 90 percent. If the measure passes in South Dakota and federal matching funds are reduced, the state will face severe consequences, particularly for its rural population.

Republican legislators have argued that Medicaid expansion trigger laws are less deceptive than direct cuts, as they must explicitly state their intention to cut off health insurance if federal funding falls short. However, both approaches have detrimental effects on healthcare access for millions of Americans.