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 whose income is at or below one hundred thirty-three percent of the federal poverty level, plus an additional five percent for family size, starting from July 1, 2023, until the federal assistance percentage drops below the specified threshold.

Additionally, the amendment stipulates that South Dakota cannot impose stricter eligibility or enrollment standards than those already in place for Medicaid, although it may implement work requirements for eligible individuals who are not physically or mentally disabled. The Department of Social Services is tasked with submitting necessary state plan amendments to federal authorities by March 1, 2023, to ensure compliance and maximize federal funding for the program. The resolution emphasizes that if any part of the amendment is deemed invalid or unconstitutional, the remaining provisions will still be enforceable.