Your Comprehensive

South Dakota

Guide

Published on
February 8, 2024
Last updated
February 8, 2024
Written by
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Katie Wilkinson
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Quick Overview of South Dakota

Medicaid in South Dakota is a joint federal and state program designed to provide health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

As part of the broader Medicaid program, South Dakota offers various benefits, including primary care, hospital services, prescription drugs, long-term care services, and more, tailored to meet the needs of its diverse beneficiary population. The state has specific eligibility criteria based on income, age, and other factors determining who can receive Medicaid benefits.

While South Dakota has not expanded Medicaid under the Affordable Care Act, it continues to provide critical health services to a significant portion of its population through this program. The administration and details of Medicaid services are managed by the South Dakota Department of Social Services, which also oversees the application process and works to ensure that eligible residents receive the health coverage they need.

This system plays a vital role in supporting the health and well-being of South Dakota's most vulnerable populations, offering a safety net for those who may otherwise be unable to afford medical care.

Benefits you get with South Dakota

Medicaid in South Dakota covers a wide range of services to meet the health needs of its beneficiaries. Here is an overview of the covered services, each with a brief description:

  1. Primary Care Services - Includes visits to healthcare providers for routine check-ups, preventive care, and treatment of common illnesses.
  2. Hospital Services - Covers inpatient and outpatient hospital care, including emergency services, surgeries, and other medical procedures.
  3. Prescription Drugs - Provides coverage for prescribed medications, subject to state formulary restrictions and prior authorization requirements.
  4. Long-term Care Services - Offers support for individuals needing long-term care in nursing facilities or through community-based services for the elderly and disabled.
  5. Mental Health Services - Includes counseling, therapy, and treatment for mental health conditions and substance use disorders.
  6. Dental Services - Covers preventive dental care and treatment for children; adults may have limited coverage.
  7. Vision Services - Provides eye exams and eyeglasses for children, with limited services available for adults.
  8. Rehabilitative Services - Offers therapies such as physical, occupational, and speech therapy to help individuals recover from an injury or illness.
  9. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services - Offers comprehensive preventive and treatment services for children and adolescents under 21.
  10. Transportation Services - Provides non-emergency transportation to and from medical appointments for eligible beneficiaries.
  11. Home Health Services - Covers medically necessary nursing care, home health aide services, and therapy in a beneficiary's home.
  12. Family Planning Services - Includes access to contraceptive services, pregnancy testing, and counseling.

These services are designed to ensure comprehensive coverage for the health needs of Medicaid beneficiaries in South Dakota, emphasizing preventive care, treatment of illnesses and conditions, and support for long-term health challenges.

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South Dakota eligiblity rules

Various factors, including income, family size, age, and specific health needs, determine eligibility for Medicaid in South Dakota. The eligibility levels are often expressed as a percentage of the Federal Poverty Level (FPL), updated annually. Here's a breakdown of the Medicaid eligibility requirements in South Dakota, focusing on key groups and their respective income limits based on the FPL:

Children

South Dakota provides Medicaid coverage to children from low-income families. The eligibility threshold can vary, with programs like CHIP (Children's Health Insurance Program) extending coverage to children in families with higher incomes.

  1. Children under six years old: Up to 142% FPL
  2. Children aged 6-18: Up to 133% FPL

Pregnant Women

Medicaid offers comprehensive coverage to pregnant women, including prenatal, delivery, and postpartum care. Up to 138% FPL.

Parents/Caretaker Relatives

Eligibility for parents and other caretaker relatives living with children depends on their income and household size. Up to 50-60% FPL, varying by specific circumstances.

Adults Without Dependent Children

In states that have not expanded Medicaid under the Affordable Care Act, non-disabled adults without dependent children often have limited or no access to Medicaid. South Dakota has not expanded Medicaid, so many low-income adults without children do not qualify solely based on income.

Elderly and Individuals with Disabilities

Eligibility for this group is based on income, resources, and specific medical criteria. Those receiving Supplemental Security Income (SSI) are typically eligible for Medicaid. The income limit for individuals is often set at a percentage of the FPL. Still, eligibility must consider income and assets, with the income limit around 74% FPL for individuals and higher for couples.

Medically Needy Pathway

This option allows individuals with high medical expenses to "spend down" their income on medical bills to qualify for Medicaid. Eligibility thresholds vary by state and individual circumstances.

These eligibility levels are subject to change and may vary based on specific program requirements and annual updates to the Federal Poverty Level. South Dakota may also have additional specific criteria for different populations, considering assets, household composition, and other factors. It's best to consult the South Dakota Department of Social Services or a similar authoritative source for the most current and detailed eligibility information.

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How to apply for South Dakota

Applying for Medicaid in South Dakota involves several steps, and applicants have multiple options for submitting their application. Here's how to apply for Medicaid in South Dakota:

Online Application

The most convenient way to apply for Medicaid in South Dakota is through the online portal. You can submit your application via the South Dakota Department of Social Services (DSS) website at DSS.sd.gov. This website provides access to the electronic application form, which can be filled out and submitted online.

In-Person Application

You can apply in person by visiting your local Department of Social Services office. To find the nearest office, visit the DSS website or call the DSS office locator at 605-773-3165. You can fill out a paper application at the office and submit it directly to a DSS representative.

Mail or Fax

If you prefer to apply via mail or fax, you can download and print the application form from the DSS website. Once completed, the application can be mailed or faxed to your local Department of Social Services office. Each office's mailing address and fax number are available on the DSS website.

Over the Phone

South Dakota also allows you to apply for Medicaid over the phone. You can call the Department of Social Services at 605-773-4678 to speak with a representative who can assist you with the application process over the phone.

After you submit your application, the Department of Social Services will review your information to determine your eligibility for Medicaid. You may be contacted for additional information or documentation. Once your application is processed, you will receive a notification about your eligibility status.

How to renew South Dakota

Medicaid coverage in South Dakota typically needs to be renewed once a year. However, the exact timing can vary based on individual circumstances and changes to your eligibility status.

Notification

Before your renewal date, the South Dakota Department of Social Services (DSS) will notify you that it's time to renew your Medicaid coverage. This notification will include instructions on completing your renewal and the deadline by which the renewal must be completed.

Renewal Process

The renewal process may require you to update your information and verify your current income, household composition, and any other relevant changes in your circumstances that could affect your eligibility.

  1. Online: Renewing online is convenient and can be done through the South Dakota Department of Social Services website at DSS.sd.gov. Look for the section on Medicaid renewal to update your information and submit your renewal application.
  2. In-Person: You can visit your local Department of Social Services office to renew your Medicaid coverage. To find the nearest office, visit the DSS website or call the office locator number.
  3. Mail or Fax: If you received a renewal form by mail, you could complete it and return it via mail or fax to your local Department of Social Services office. Your renewal notification will provide the specific mailing address and fax number.
  4. Over the Phone: To renew your coverage over the phone, call the Department of Social Services at the general inquiry number and speak with a representative who can assist you with the renewal process.

It's crucial to complete your Medicaid renewal by the specified deadline to avoid any interruption in your coverage. If your situation has changed significantly, or you need help with the renewal process, don't hesitate to contact the Department of Social Services.

Additional programs through South Dakota

These programs are available to help family caregivers get paid for caring for loved ones on South Dakota.

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