Voters in Florida, South Dakota and North Dakota either rejected or appeared poised to reject state ballot initiatives to legalize marijuana early Wednesday, while Nebraska voters approved a ballot initiative that would legalize the use of up to five ounces of marijuana for medical purposes for qualified patients.

Those health initiatives were among the 146 statewide ballot initiatives on various topics nationwide. While nearly a dozen of those initiatives focused on abortion access, other health-related ballot issues focused on Medicaid, psychedelic drugs and long-term care.

Marijuana

In Florida, more than half of voters backed a measure to legalize recreational cannabis use for adults ages 21 and up, but the vote did not reach the 60 percent threshold needed for passage in the state. The state already permits medical use of marijuana.

As of early Wednesday morning, meanwhile, initiatives to legalize recreational marijuana in South Dakota and North Dakota were trailing but too close to call. Medical marijuana is already legal in both states.

In Nebraska, voters approved initiative measures 437 and 438, which would legalize and regulate medical marijuana. But those results remain in flux because of court challenges.

Recreational cannabis use is currently legal in 24 states, and medical marijuana is legal in 38 states and the District of Columbia.

In Massachusetts, voters rejected Question 4, which would have legalized plant-based psychedelic drugs, such as psilocybin mushrooms, for people ages 21 and older.

Drug crimes

Voters in California approved Proposition 35, which would classify certain drug offenses as felonies that require drug treatment. That initiative would also increase penalties for certain drug crimes and require courts to warn individuals convicted of distributing illegal drugs of future potential criminal liability if they distribute deadly drugs.

And in Arizona, voters approved Proposition 314, an immigration-related measure that would also make it a felony to knowingly sell fentanyl if the drug results in another person's death.

Medicaid

Voters in South Dakota appeared likely Wednesday morning to approve an amendment that would impose Medicaid work requirements on eligible beneficiaries who have not been diagnosed with a physical or mental disability. Such a requirement would need to be approved by the federal government. President-elect Donald Trump's previous administration supported work requirements, though they faced blowback from the courts.

Californians, meanwhile, approved Proposition 35 to permanently authorize a tax on managed health care insurance plans and reserve revenue for Medicaid services.

Care services

Voters in New Mexico approved a question to authorize the state to issue up to $30 million in bonds to fund senior citizen facilities. And Washington voters rejected a question to require people to opt in for coverage under the state's new long-term services and support health care program.

Miscellaneous

Illinois voters approved a ballot question to advise elected officials to provide coverage for assisted reproductive treatments like in vitro fertilization.

And a ballot measure dubbed the "revenge measure" in California was too close to call Wednesday morning.

That measure would impose new requirements on health care providers spending more than $100 million in a 10-year period on anything other than direct patient care who have operated multifamily housing with more than 500 severe health and safety violations.

Under the initiative, those providers would be required to spend 98 percent of their 340B Drug Pricing Program discounts on direct patient care. The 340B Drug Pricing program is a federal program that allows eligible health care organizations to buy prescription drugs at a discount from drug companies.

Opponents of the California ballot issue note that it's backed by the California Association of Realtors and appears to target the AIDS Healthcare Foundation, which has supported three state rent-control measures.

Meanwhile, a ballot measure in West Virginia asking voters if they favor prohibiting medically assisted suicide and euthanasia in the state constitution was too close to call as of Wednesday morning.

Ariel Cohen contributed to this report.

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