Understanding Medicaid in South Dakota

In this article...
  • Find out what South Dakota Medicaid covers and who is eligible for benefits. This guide also covers income limits and how to apply for Medicaid coverage.

What Is South Dakota Medicaid? 

Medicaid in South Dakota functions as a health insurance provider for low-income families and some individuals who need long-term care. The Medicaid program helps ensure that qualifying state residents have access to vital medical services.

The federal government established the Medicaid program and some of its general rules. However, state governments set eligibility guidelines, and the South Dakota Department of Social Services (DSS) administers the state's Medicaid program. The program is funded by the federal government and the state of South Dakota. 

What Does South Dakota Medicaid Cover?

South Dakota Medicaid covers a variety of medically necessary care. Covered care and services may include: 

  • Annual physicals 
  • Immunizations 
  • Eye exams
  • Dental care 
  • Prenatal and pregnancy care
  • Home health and hospice
  • Medical and surgical services 
  • Prescription drugs
  • Emergency care
  • Mental health care 

There are some limits on covered services. For example, although regular physicals are covered, each enrollee is typically limited to one exam per year. Specialist and out-of-state care usually require pre-authorization, and emergency room coverage is only available for serious medical emergencies. 

Who Is Eligible for Medicaid in South Dakota? 

South Dakota offers Medicaid coverage may be available to low-income residents in the following categories: 

  • Pregnant women 
  • Children
  • Parents or caregivers for a child under the age of 18
  • Older adults living in nursing homes 
  • People with physical or developmental disabilities 

Only U.S. citizens and legal residents can obtain Medicaid benefits in South Dakota, but children may qualify for Medicaid even if their parents do not meet South Dakota's immigration requirements. 

What Is the Income Level to Qualify for Medicaid?

Eligibility is also based on annual household income before taxes. The maximum allowable income in South Dakota varies by household size, as displayed in the table below: 

Household Size

Maximum Annual Income for Eligibility

1

$16,971

2

$22,930

3

$28,888

4

$34,846

5

$40,805

 

However, there are some exceptions to these income limits. Disabled children who receive Supplemental Security Income (SSI) are automatically eligible for Medicaid in South Dakota. Pregnant women and families may qualify for low-cost health coverage, such as the Children's Health Insurance Program (CHIP), even if they have a higher income. For example, a family of 4 can earn up to $95,400 per year and qualify for some benefits. South Dakota residents who are unsure of their eligibility can fill out an application or contact a local DSS office for more information. 

Income Limits When a Spouse Requires Long-Term Care

South Dakota recognizes that having a spouse in a nursing home or other institution can cause significant financial hardship. Therefore, the state sets special income rules for married couples when one spouse requires long-term institutionalized care. 

Unmarried individuals requiring long-term care may need to use up their assets and income before they can qualify for Medicaid. However, for married couples, some marital assets and income are protected for the use of the spouse who is not in long-term care. The spouse still living in the community (the non-applicant) may keep up to $603,000 of home equity and $130,380 of other assets. Additionally, the income of the non-applicant spouse is not considered in the eligibility determination. If the non-applicant spouse's total income doesn't exceed $3,259.50 per month, they may be entitled to keep a portion of the beneficiary spouse's income as well. 

How Do I Enroll in Medicaid in South Dakota?

South Dakota requires an application for all Medicaid benefits. One application is available for pregnant women, children and low-income families. Those applying for Medicaid based or long-term care needs must file a different application. Both applications should be printed and submitted to a local DSS office by mail, fax or hand delivery.

Providing as much information as possible on the application will help DSS process your application quickly. South Dakota does not require an interview as part of the Medicaid application process, but applicants can request one. Additionally, assistance in completing the application may be available through a local DSS office. 

Contact Information for South Dakota Medicaid

Questions about South Dakota Medicaid, including questions about applying for benefits, may be directed to the Department of Social Services South Dakota Medicaid Office at 1-800-597-1603. Information is also available on the DSS website

Local DSS offices may also be able to answer questions and provide assistance. These local offices are also responsible for processing Medicaid applications. A directory of all local DSS offices is available online.