South Dakota’s eight-year hold out from Medicaid expansion is coming to an end.

Voters Tuesday resoundingly approved Constitutional Amendment D, which requires the state to offer Medicaid to able-bodied adults without children whose income is at or below 138 percent of the federal poverty level. More low-income parents and disabled adults at higher incomes than currently qualify will also now be eligible for the federal health insurance program.

And when all the ballots had finally been counted early Wednesday morning, Amendment D claimed an impressive a 12-point advantage.