How to Apply for South Dakota Medicaid Coverage

South Dakota Medicaid is a federal and state-funded program providing health coverage for people who meet certain eligibility standards. Medicaid acts as an insurance company for individuals and pays for medically necessary services. Medicaid provides health coverage to help pay for necessary medical expenses individuals need to stay healthy such as hospital stays, doctor visits, prescriptions, and other health care needs.

Adults under age 65 are eligible for Medicaid with income up to 138% of the poverty level. This took effect in July 2023, as a result of a ballot measure passed by voters in 2022. Pregnant women with household incomes up to 133% of FPL qualify; children with household incomes up to 204% of FPL qualify for CHIP; parents with dependent children are eligible with incomes up to 58% of FPL.

South Dakota Medicaid covers medically necessary health care services. The program includes comprehensive benefits such as doctor visits, hospital stays, prescription medications, preventive care, and long-term care services. The state offers Home and Community Based Services waiver programs to meet the needs of individuals who prefer to receive long-term services and supports in their home or community instead of an institutional setting.

The start date of medical coverage depends on the date the application is received by the Department of Social Services. Medical coverage may go back three months prior to the month the application is received if you have unpaid medical bills and meet eligibility requirements during this time period. An interview is not required to apply for South Dakota Medicaid, however you may request one.