Medicaid South Dakota Income Guidelines


South Dakota Medicaid Expansion Update

Federal vaccine deadline extended, South Dakota joins lawsuit against mandate

South Dakota has not yet accepted federal funding to expand its Medicaid program under the Affordable Care Act .

Former Governor Dennis Daugaard supported Medicaid expansion by 2015 but the issue did not have lawmakers support.

However, current Governor Kristi Noem is opposed to Medicaid expansion.

Furthermore, instead of expanding Medicaid, South Dakota is seeking federal approval for a work requirement for low-income parents in the existing Medicaid program.

That waiver application is pending CMS approval.

Medicaid expansion advocates have until November 2021 to gather enough signatures to get Medicaid expansion on the 2022 ballot.

Who’s Eligible For Medicaid For The Aged Blind And Disabled In South Dakota

Medicare covers many services including hospitalization, physician services, and prescription drugs. However, Original Medicare doesnt cover vision and dental benefits. Medicare can also leave its beneficiaries with significant out-of-pocket expenses. Some beneficiaries those whose incomes make them eligible for Medicaid can receive coverage Medicare cost sharing and some Medicaid-covered services through Medicaid for the aged, blind and disabled .

Medicaid ABD doesnt ordinarily cover Long Term Services and Supports . People who need those services usually have to complete a separate application and interview process, and satisfy different income limits.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.

I Have Pregnancy Only Coverage What Does Medicaid Cover

Pregnancy-only coverage only covers services related to or caused by the pregnancy. Please talk to your PCP or South Dakota Medicaid about whether a service will be covered if you are unsure.

Routine dental and vision services are not covered in this program. If you feel you have a health issue that may put you and your baby at risk, contact your PCP.

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South Dakota Medicaid Income Limit Charts

The South Dakota Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in South Dakota who qualify for Medicaid.

South Dakota Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

South Dakota Medicaid Income Limit Children
Children Medicaid Ages 0-1

How to Read the South Dakota Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 133% of the Federal Poverty Level which for a family of two is $23,169 as shown in the chart above.

What Does South Dakota Medicaid Cover

Modern Era Medicaid  Medicaid and CHIP Eligibility ...

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

  • Annual physicals
  • 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.

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Will My Child Be Covered This Summer When He/she Goes To Stay With His/her Mother/father

Your child will remain eligible for Medicaid provided all other eligibility factors remain the same. However, it is important to remember that if your child needs medical services out-of-state, the provider must be a SD Medicaid provider and obtain a prior authorization for out-of-state services.

In addition, if your child is in the Primary Care Provider Program, he/she will need to get a referral from his/her primary care provider.

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


However, there are some exceptions to these income limits. Disabled children who receive Supplemental Security Income 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 , 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.

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South Dakota Medicaid For Workers With Disabilities

The South Dakota Medicaid for Workers with Disabilities program is for South Dakotans who are employed and have a significant disability. This program allows individuals with disabilities to return to work or remain working.

Eligibility Requirements for MAWD

  • The individual must be employed.
  • The individual must have a significant disability.
  • The individual must have resources less than $8000.
  • The individual must have less than $814 of monthly unearned income (money such as VA or SSDI not money earned from your job or business.

Learn About The Cost And Coverage Of Medicaid In South Dakota

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South Dakota Medicaid cost estimates are in line with the requirements of the federal government. According to federal guidelines, states have the option to establish cost sharing spending requirements and charge premiums for Medicaid enrollees. SD Medicaid cost estimates for cost sharing expenses vary from member to member. The costs may include copayments, deductibles, coinsurance and other similar charges.

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North Dakota Medicaid Expansion Update

North Dakota expanded Medicaid effective January 2014, but the legislature revisits the decision periodically.

Enrollment began in October 2013, with coverage effective January 2014.

Medicaid expansion in North Dakota is provided via Sanford Health Plans Medicaid managed care program.

According to U.S. Census data, the uninsured rate in North Dakota fell from 10.4 percent in 2013 to 7.9 percent in 2014 a 24 percent reduction.

What Are The Requirements For Medicaid In South Dakota

South Dakota Medicaid eligibility requirements include income and age restrictions. To apply for the Childrens Health Insurance Program , children must be 19 or under and reside in the state of South Dakota. Low-income families who meet Medicaid benefits eligibility may be qualified to receive free or low-cost Medicaid coverage if the household consists of a parent or other adult caretaker relative and at least one dependent child.

Additionally, Medicaid benefits eligibility SD automatically applies to refugees in need under the Refugee South Dakota Medicaid program. This program provides Medicaid benefits eligibility to refugees who are not eligible to receive any other health care program. The program is available to refugees for eight months after they enter the U.S.

SD Medicaid benefits eligibility also applies to pregnant women and their newborn babies. Pregnant women who meet income, resource and general eligibility requirements may qualify to receive full or limited Medicaid coverage. Newborns meet Medicaid benefits eligibility until turning one year of age.

Additionally, uninsured women may be eligible to receive Medicaid benefits from the Breast and Cervical Cancer Program if they are being treated for breast or cervical cancer. Medicaid benefits eligibility ends after treatment is completed or when the state determines that a woman is no longer eligible to receive Medicaid benefits under this category.

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What Is South Dakota Medicaid

Medicaid is a federal and state-funded program providing health coverage for people who meet certain eligibility standards. If you are eligible, Medicaid will act as your insurance company and may pay for medically necessary services such as visits to the doctor, hospital, dentist, optometrist and chiropractor.

South Dakota Long Term Care

North Dakota Medicaid Beginner

South Dakota is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.

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Who Meets The Requirements For Medicaid In South Dakota

In South Dakota, several medical assistance programs are available to low-income residents who need medical assistance. Medicaid eligibility requirements are made available to uninsured children under age 19, low-income families, pregnant women, newborns, disabled children and women with cervical or breast cancer.

Additionally, SD Medicaid benefits eligibility is also available to disabled and elderly candidates. Eligible applicants include workers with disabilities, South Dakotans with developmental disabilities, applicants in adult foster care facilities, certain adults in assisted living facilities or nursing homes, South Dakotans with chronic renal disease who meet Medicaid benefits eligibility, quadriplegics, certain elderly adults, refugees and youth between the ages of 18 and 26 who are from former foster homes. to learn about the different requirements for Medicaid.

Home And Community Based Services For Developmentally Disabled

Home and Community Based Services provides South Dakota Medicaid for individuals with developmental disabilities who would otherwise be institutionalized in a Medicaid-funded hospital, nursing facility or an intermediate care facility.

Eligibility Requirements

  • A person must be developmentally disabled.
  • A person must be aged, blind or disabled.
  • A person must reside in the home of a parent, other relative, legal guardian, adult foster care home licensed by the state, special therapeutic foster home licensed by the state, community residential facilities approved by the Department of Human Services, supervised apartment approved by the Department of Human Services, or community habilitation facilities approved by the Department of Human Services of an individuals own home.
  • A person’s monthly income must be less than 300 percent of the SSI Standard Benefit Amount . The resource limit is $2,000 for an individual. Resources include items such as checking and savings accounts and certificates of deposit.

to the standard Medicaid covered services

Case Management and Consumer Support: This includes adaptive equipment needed not to exceed $500 per person per year. Examples of adaptive equipment would be communication devices, eyeglasses, hearing aids, etc.

Other Information for Home and Community Based Services can be found here: Department of Human Services’ Division of Developmental Disabilities

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South Dakota Medicaid Expansion Initiative

South Dakota Medicaid Expansion Initiative
Election date

The South Dakota Medicaid Expansion Initiative may appear on the ballot in South Dakota as an initiated state statute on .

Sponsors of the initiative are also circulating a similar measure that would amend the state constitution to expand Medicaid.

Penalty Information In South Dakota For Medicaid

Judge voids 2 state Medicaid work requirements

If a gift of any amount is given in South Dakota during a period of 5 years before applying to Medicaid, a penalty period will be initiated. This penalty period in South Dakota is called a look-back period and it can make an individual not eligible for Medicaid. Medicaid will not pay for care until the penalty period is over. The penalty is calculated by taking the total amount of any gifts given, and dividing it by $ 6,215, which creates a number of months before Medicaid kicks in.

The average cost of Nursing home care in South Dakota is $6,509, so penalties can become very costly for a family that has not planned appropriately for Medicaid.

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Who Can Get Medicaid In North Dakota

You should apply for Medicaid if your income is low and you match one of the descriptions below:

  • You think you are pregnant
  • The parent or caretaker of a child and/or teenager under the age of 19.
  • You are a child or teenager age 18 or under.
  • An adult age 65 or older.
  • You are legally blind.
  • Living with a disability or disabled.
  • You are in need of nursing home care.

I Have Medicaid Why Am I Still Getting A Bill

There are many reasons you may get a bill. Do NOT ignore medical bills. Some common issues include:

  • You were not eligible for Medicaid on the date you received care.
  • The provider is not enrolled with South Dakota Medicaid.
  • You did not get a referral from your PCP if you are in the Primary Care Provider Program or Health Homes Program.
  • You did not get the service prior-authorized and the service requires a prior authorization.
  • The provider may have incorrect information and needs you to contact them in order to bill South Dakota Medicaid.
  • You did not provide your Medicaid card number.
    • Remember to provide your newborns Medicaid card number to both the hospital and the provider.

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South Dakota Health Insurance Consumer Help

South Dakota does not operate a Consumer Assistance Program under the Affordable Care Act. The consumer protections and benefits of the law still apply to you.

The agencies listed below can help you take advantage of some of these protections and benefits. They can answer your questions about different types of coverage.

If you need health insurance, be sure to check out HealthCare.govs Plan Finder. It will help you find and compare health care coverage options in your area.

If you have questions about insurance you bought for yourself and/or your family or you have insurance provided by an employer who does business only in South Dakota, contact:

South Dakota Department of Labor and Regulation123 W Missouri Ave

South Dakota Has Not Accepted Federal Medicaid Expansion

Medicaid and CHIP Eligibility and Enrollment Policies as ...
  • 127,829 Number of South Dakotans covered by Medicaid/CHIP as of May 2021
  • 45,000 Number of additional South Dakota residents who would be covered if the state accepted expansion
  • 16,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
  • $384 million Federal money Mississippi is leaving on the table in 2022 by not expanding Medicaid

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South Dakota Medicaid For Newborns

South Dakota children born to women eligible for and receiving South Dakota Medicaid on the date of the childs birth are also eligible for South Dakota Medicaid. There is no resource or income limit associated with this child. Coverage will continue from the month of birth until the end of the month the child turns one year of age, so long as the child continues to live in South Dakota.

North Dakota Medicaid Income Limits Summary

We hope this post on North Dakota Medicaid Income Limits was helpful to you.

If you have any questions about Medicaid in the state of North Dakota, you can ask us in the comments section below.

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Be sure to check out our other articles about Medicaid.

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Medicaid Expansion Likely Headed To Ballot Box In South Dakota

PIERRE, S.D. A group seeking to bring Medicaid eligibility to more South Dakotans says they’ve hit an important threshold, collecting enough signatures to deliver the measure directly to the voters at the 2022 election.

A Friday, Nov. 5, news release from South Dakotans Decide Healthcare a coalition including the state’s three biggest hospital systems, Sanford, Avera and Monument says it has collected nearly 34,000 valid signatures.

In a statement, Zach Marcus, the group’s campaign manager, said expanding the federal low-income health program would aid over 42,000 South Dakotans.

“It’s time to bring South Dakotans’ tax dollars home, instead of sending them to New York and California to pay for their health care instead,” Marcus said.

A coalition member says the signatures will be dropped off on Monday, Nov. 8, to the Secretary of State’s Office in Pierre. Nov. 8 is the signature deadline for voter-approved constitutional amendments to make next year’s ballot.

Since Medicaid expansion was included in the Affordable Care Act enacted by President Barack Obama over a decade ago, South Dakota’s Republican-led state government has remained one of the so-called “holdouts” that has not opted to adopt the program, often criticizing expanded Medicaid’s cost to state government.

A is also underway in the state, but it’s not yet clear whether they’ve hit the 33,000-vote threshold required by law to make the ballot.

Avera Health Addiction Care Center Sioux Falls South Dakota

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Relapse management, partial hospitalization, opioid abuse programs, and more are available here with Medicaid coverage.

Avera Health also has an addiction recovery program in Aberdeen, South Dakota.

Some of the top qualities of Avera Health are:

  • recognition as one of the 15 top health systems in 2021 and 2019 by IBM Watson Health
  • recognition on the Forbes list of Americas Best-in-State Employers in 2019
  • a 4.7-star Google rating for the Addiction Care Center

Location and contact information:


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What Is A Health Home

South Dakotas health home program offers enhanced health care services to Medicaid recipients with chronic conditions like asthma, COPD, diabetes, heart disease, hypertension, obesity, substance use disorder, mental health conditions, pre-diabetes, tobacco use, cancer, hypercholesterolemia, depression, and musculoskeletal and neck/back disorders.

The full definition of core services can be found by clicking here.

Health Homes are encouraged to utilize health information technology to more efficiently and effectively coordinate the care of Health Home patients.

Through the provision of the six core services, the Health Home initiative aims to reduce inpatient hospitalization and emergency room visits, increase the integration between physical and behavioral health services and enhance transitional care between institutions and the community.


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