South Dakotans will vote on Medicaid work requirements in the Nov. 5 general election.

The measure would not immediately impose work requirements on Medicaid recipients who qualify under recently expanded income guidelines, but would authorize state officials to impose work requirements if they so choose and if the federal government allows it.

On Tuesday at the Capitol in Pierre, the state House of Representatives voted 63-7 to send the measure to the ballot. The seven no votes came from the chamber’s seven Democrats. The measure previously passed the Senate 28-4, with the four no votes coming from that chamber’s four Democrats.

The Legislature does not need approval from the governor to place a measure on the ballot, so the House vote was the final action.

Rep. Tony Venhuizen, R-Sioux Falls, was the prime sponsor in the House.

“What we’re voting on today doesn’t say we’re going to do a work requirement,” Venhuizen said. “It doesn’t say we have to do one. It doesn’t even necessarily say we want to do one. What it says is, it shouldn’t be in our constitution that we can’t ever do one.”

Medicaid is a joint federal-state health insurance program for low-income adults, children, pregnant women, elderly adults and people with disabilities.

South Dakota voters approved a citizen-proposed constitutional amendment in 2022 that expanded Medicaid eligibility. That measure included language saying the state “may not impose greater or additional burdens or restrictions on eligibility or enrollment standards.”

The ballot question voters will consider this November would tack an exception onto the end of that prohibition, allowing the state to impose a work requirement on any person “who has not been diagnosed as being physically or mentally disabled.” The exception would also acknowledge that the state could do so only “to the extent permitted” by the federal government.

As Venhuizen explained, the Biden administration is not approving the waivers that states need to impose the work requirements.

“We know, though, that the time will come again when the federal government allows these to be considered,” Venhuizen said.

One of the Democratic no votes came from Rep. Kadyn Wittman, of Sioux Falls, who described the measure as an insult to voters who approved Medicaid expansion.

“I think the fact that we are even considering this resolution is deeply offensive to every individual that voted yes,” she said. “I know it’s offensive to me, insinuating that I did not understand what I was voting on.”

The measure joins one other question that legislators have already placed on this November’s ballot. That measure would replace numerous male pronouns in the state constitution — reflecting the notion held by the state’s founders that only men would ever hold statewide office — with gender-neutral terms or the titles of the offices referenced.

Citizens groups are circulating petitions for another eight ballot questions in hopes of gaining enough signatures from registered voters to include them in the general election. Those measures include efforts to change political primaries to open primaries, re-establish abortion rights, repeal the state sales tax on food, and legalize recreational marijuana.