On July 1, 2023, South Dakota became the 39th state to adopt the Affordable Care Act’s Medicaid Expansion. The expanded coverage comes after South Dakotans voted to approve a Constitutional Amendment D. This move will permit the state to access 90% of the costs in federal matching funds and to provide expanded coverage for individuals between 18 and 64 with incomes at or below 138% of the federal poverty level. The South Dakota Department of Social Services is implementing the expansion.