The resolution proposes an amendment to the South Dakota Constitution that would condition the expansion of Medicaid on the federal medical assistance percentage remaining at or above ninety percent. If approved by voters in the next general election, the amendment would allow the state to provide Medicaid benefits to individuals aged eighteen to sixty-five with incomes at or below 133% of the federal poverty level, plus an additional five percent, starting July 1, 2023. The coverage must meet or exceed federal benchmark requirements, and the state cannot impose stricter eligibility criteria than those already established for Medicaid, although a work requirement may be applied to eligible individuals who are not disabled.

Additionally, the resolution mandates that the South Dakota Department of Social Services submit necessary state plan amendments to the federal government by March 1, 2023, to implement the changes. The state is also required to take actions to maximize federal funding for medical assistance under this amendment. The provisions of the amendment are designed to be severable, meaning that if any part is found invalid or unconstitutional, the remaining provisions will still be effective.