A year ago, South Dakota voters initiated and overwhelmingly approved Amendment D, expanding Medicaid coverage to more than 50,000 residents who did not previously qualify. A year ago, South Dakota voters initiated and overwhelmingly approved Amendment D, expanding Medicaid coverage to more than 50,000 residents who did not previously qualify. Those folks fell into the coverage gap, with incomes above the state’s Medicaid eligibility level but also just barely above the poverty line, meaning they could not afford marketplace plans. What Medicaid expansion meant for people in the gap, in a practical sense, is that they no longer were forced to forego basic medical care to cover rent, food, childcare, or other basic needs.