South Dakota Medicaid Phone Number


How Many People Are On Medicaid

Medicaid Expansion in South Dakota with Mitch Richter

According to the Centers for Medicare & Medicaid Services, as of November 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:

  • 78,521,263 individuals were enrolled in Medicaid and CHIP
  • 72,204,587 individuals were enrolled in Medicaid
  • 6,695,834 individuals were enrolled in CHIP

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.

Does South Dakota Help With My Medicare Premiums

Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program . In South Dakota, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and in some cases Part A premiums.

  • Qualified Medicare Beneficiary : The income limit is $1,063 a month if single and $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and if a beneficiary owes them it also pays their Part A premiums.
  • Specified Low-Income Medicare Beneficiary : The income limit is from QMB levels up to $1,276 a month if single and $1,724 a month if married. SLMB pays for Part B premiums.
  • Qualified Individuals : The income limit is from SLMB levels up to $1,436 a month if single and $1,940 a month if married. QI pays for Part B premiums.

MSP asset limits: The asset limits for QMB, SLMB and QI are $7,860 if single and $11,800 if married.

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Rapid City Sd Medicaid Food Stamp And Welfare Office

RAPID CITY SD Medicaid Food Stamp and Welfare Office administrates your local program under South Dakota State guidelines. Medicaid provides health care for low income people. Supplemental Nutrition Assistance Program or Food Stamps helps low-income families buy food. While Welfare program give assistance to those who have little or no income.


Good & Healthy South Dakota

Free North Dakota Medicaid Prior Authorization Form

The South Dakota Office of Chronic Disease Prevention and Health Promotion created Good & Healthy South Dakota to provide educational resources and assistance for South Dakotans in need.

Coupled with Good & Healthy South Dakota are several programs throughout the state for tobacco cessation, cancer screenings, newborn health, opioid addiction, and more.

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Income Limits When A Spouse Requires Long

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 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.

Primary Care Management Reform Presentations

North Dakota Medicaid is hosting informational presentations on primary care management reform. The state is considering a new primary care management model as an alternative to it Primary Care Case Management program. Several presentations are planned this year to learn from other state Medicaid programs that have implemented care management models.

  • South Dakota Medicaid’s Health Home Program
  • Video presentation
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  • Video presentation
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    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.

    American Disabilities Act Notice

    North Dakota’s New Medicaid Fraud Control Unit

    In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

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    Who Is Eligible For Medicaid In South Dakota

    Medicaid in South Dakota is available to eligible low-income families:

    • Pregnant women with household incomes up to 133% of the federal poverty level
    • Children aged 0 to 18 with household income up to 182% of FPL are eligible for Medicaid Children with household incomes up to 204% of poverty are eligible for CHIP .
    • Parents with dependent children are eligible with incomes up to 58% of poverty.

    How To Apply For Medicaid In Person South Dakota

    Medicaid application forms in South Dakota can also be submitted in person at your local Department of Social Services office. Local office information can be found directly on the states DSS website. South Dakotas DSS is dedicated to building strong families and there are several office locations dedicated to serving the community. Find an office close to your home by using the DSS website.

    Before you head down to a local office, please ensure you have all of the necessary identifying information with you. You may print an application beforehand to ensure all of your information is correct, and you have accompanying documentation.

    Discover all of the steps you must take when applying for Medicaid by .

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    How Does South Dakota Regulate Long

    Medicare beneficiaries increasingly rely on long-term services and supports or long-term care which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015. Medicaid fills this gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. Whats more eligibility rules vary significantly from state to state.

    Medicaid nursing home coverage

    Income limits: The income limit is $2,349 a month if single and $4,698 a month if married .

    How To Enroll In South Dakota Medicaid

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    South Dakota Medicaid is a safety net that acts as symbol of hope. If youre worried about losing health insurance because you had your hours cut or lost a job, you may now be eligible for coverage under Medicaid.

    Eligibility varies by state, so contact South Dakota Medicaid office to see if you qualify and to sign up.

    Watch this video to learn how to enroll in South Dakota Medicaid:

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    The South Dakota Department Of Social Services Medicaid Office In Sioux Falls South Dakota

    The South Dakota Department of Social Services Medicaid Office is a Medicaid office you can apply at in Sioux Falls, South Dakota. This facility is funded jointly by the federal government and the state government. You need to legally reside in South Dakota in order to apply for benefits at this facility. This is because you may only receive Medicaid benefits in your home state. Even though the South Dakota Department of Social Services Medicaid Office is required to follow state and federal guidelines regarding operation, it still maintains autonomy. This means that each Medicaid office in South Dakota may have rules that are slightly different from one another.

    For example, one Medicaid office in Sioux Falls may encourage you to schedule an appointment before you apply for benefits. An office in another city, however, may not. You may use the information below to help you understand which rules you need to follow when you apply for support at the South Dakota Department of Social Services Medicaid Office.

    How To Apply For Medicaid Online In South Dakota

    Have you ever asked Where do you sign up for Medicaid? The quickest and easiest way to apply for Medicaid in South Dakota is through the online health exchange. Start by logging into the South Dakota Medicaid website.

    Once you are there, you will need to create a username and password to access data for your region. Next, you will be asked a series of questions about your current health insurance status, your residency, and your current income.

    You will need to provide your social security number, and proof of South Dakota residency to be eligible to continue with your application. If you have a job, you will need to provide income verification.

    If you already have health insurance, you will have to answer questions about your coverage. You may still be able to qualify for Medicaid depending on your circumstances. If you are applying for Medicaid on the basis of disability, you will be asked to verify your disability information. Additional documentation from a doctor may be needed.

    Finally, you will be asked to verify all the information you have entered and to sign your application electronically.

    South Dakota uses electronic verification databases to ensure the information you submitted is correct. If there are discrepancies on your form, you will be notified and asked to further verify your information. Whether you qualify for Medicaid or not, you will receive a letter or phone call letting you know the status of your case.

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    South Dakota Medicaid Benefits

    South Dakota Medicaid covers physical, behavioral, and dental health services. All services must be medically necessary to be covered, and they must be administered by a Medicaid-enrolled provider. Any untested, excessive, or cosmetic treatments will not be covered.

    There may be some limitations to your coverage, and approval can depend on your doctors, but these are the general guidelines for popular covered services:

    Chiropractic: 30 spinal manipulations during one year

    Diabetes Management: 10 hours of diabetes management education upon diagnosis, and 10 hours per year

    Dietician/Nutritionist: 5 hours of services per year unless more is medically necessary

    Family Planning: Office visits, STD testing, birth control, and sterilization

    Home Health: In-home nursing and therapy during recovery, when ordered by a doctor

    Hospice: End-of-life care when ordered by a doctor

    Hospital: Inpatient & outpatient services not including self-administered drugs

    Medical Equipment/Supplies: Reusable and necessary equipment like wheelchairs and necessary disposable supplies covered. Nebulizers covered every five years

    Medical and Surgical Services: Most doctor-preformed services like exams, X-rays, and lab tests are covered, but you may need a referral from your primary physician to see a specialist

    Nursing Homes: Room and board, nursing care, therapy, meals

    Personal Care: Bathing, toileting, and medication assistance. Call Dakota At Home for more information on this service

    Mental Health Statistics For South Dakota

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    According to Mental Health America, South Dakota ranks 24 overall in access to care and prevalence of mental illness. This ranking is based on 15 different measures including data on adults, children, and behavioral health workforce availability. An overall ranking 1-13 indicates a lower prevalence of mental illness and higher rates of access to care. Rankings 39-51 indicate a higher overall prevalence of mental illness and lower rates of access to care. With South Dakotas ranking right in the middle of the two brackets, this suggests that there is an average prevalence of mental illness and average rates of access to care with the potential to improve with continued action.

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    How To Contact Your State Medicaid Department About Medicaid Or Chip

    Learn about how to contact your state Medicaid department to see if you and your family qualify for Medicaid or CHIP.

    TIP: This page helps you understand how you can contact your State Medicaid Agency for questions about Medicaid or CHIP. It is meant as a secondary resource for people using our site. The official resource for this information is

    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

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    Does South Dakota Have A Medicaid Work Requirement

    Instead of an effort to expand Medicaid, South Dakota state officials want to implement a work requirement for low-income parents in the existing Medicaid population. Former Governor Dennis Daugaard laid out the details in his State of the State address in January 2018, and the state published the proposed waiver application in May 2018 . After the states public comment period, the waiver application was sent to HHS, where it was deemed complete and is still under review nearly two years later.

    South Dakotas waiver proposal would roll out a Medicaid work requirement for low-income parents/caretakers as a pilot program in the two most populous counties in the state: Minnehaha and Pennington. The state chose those counties because of their population and access to job training and employment opportunities.

    Then-Governor Daugaards 2018 State of the State address did not mention Medicaid expansion, other than to point out that since the state has not expanded Medicaid, the existing Medicaid population is mostly exempt from a work requirement. There would be exemptions for children, the elderly, parents caring for children under the age of 1, pregnant women, and disabled individuals.

    Money Follows The Person

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    One of the problems that people with chronic illnesses sometimes face is difficulty returning back to normal life following treatment. The South Dakota Money Follows the Person program works to alleviate the stress from that transition process. It is for Medicaid recipients living in nursing homes, hospitals, or other care facilities return to their communities.

    MFP can help you find a new place to live that meets your needs and help you find services nearby. That sort of support is not normally covered by South Dakota Medicaid but can be covered through this program.

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    South Dakota Medicaid Office

    Below is the contact information for the Medicaid office in South Dakota. They can assist you with questions or concerns about the South Dakota Medicaid program, including the eligibility requirements and Medicaid enrollment in South Dakota. You can view their site online at To find out if you are eligible for this program, South Dakota Medicaid eligibility. The program is called Medical Assistance.

    The Medicaid program in South Dakota covers basic medical care. This may include doctor services, inpatient hospital care, laboratory and x-ray services, inpatient short-term skilled nursing or rehabilitation-facility care, outpatient hospital or clinic care, short-term home healthcare, ambulance service and prescription drugs for people not covered by Medicare. We suggest contacting the Medicaid office to find out specifically what coverage is provided as it can be different in each state.

    South Dakota Has Not Accepted Federal Medicaid Expansion

    • 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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    Unitedhealthcare Dual Complete Plans

    Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

    South Dakota Telepsychiatry Laws & Regulations

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    Understanding state laws and regulations is essential when starting a telepsychiatry program. No two states are alike and in the current climate, laws are changing rapidly. A resource we recommend for staying up to date is the Center for Connected Health Policys website.

    South Dakota Medicaid

    South Dakota Medicaid will reimburse for certain telemedicine services as long as they are conducted via live video. The maximum reimbursement for telehealth services is the amount that would be reimbursed if the service was conducted in-person. In order to be eligible for reimbursement, providers must comply with any prior authorization requirements. Additionally, services provided via telehealth are subject to the same requirements and limitations as in-person services. Psychotherapy is included in the reimbursable services, for complete details on eligible mental health clinicians and services see the South Dakota Medicaid Billing and Policy Manual for independent mental health practitioners.

    Private Payer & Parity Laws

    Many states have parity laws that prevent private payers from excluding certain services from their coverage. In South Dakota, health insurers are prohibited from excluding coverage just because a service was provided via telehealth. As long as accepted services provided via telehealth are in accordance with applicable law and healthcare guidelines, insurers cannot exclude coverage.

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