Medicaid is the nation’s publicly financed health and long-term care coverage program for low-income individuals. Medicaid was enacted in 1965 under Title XIX of the Social Security Act. Over time, federal Medicaid eligibility criteria have changed and cover more Americans living below or near poverty. Medicaid currently covers low-income populations, which include parents and children in both working and nonworking families, individuals with diverse physical and mental conditions and disabilities, and seniors.
South Dakota Medicaid Plan Options
Low-Income Families
Low-income families in South Dakota (with or without private health insurance) may be eligible for free or low-cost South Dakota Medicaid, which includes checkups, Well-Child Care exams, dental care, and vision care. A family must consist of a parent or other adult caretaker relative and a dependent child under age 18 who is living with a parent or a caretaker relative to be eligible.
Children’s Health Insurance Program (CHIP)
The South Dakota Children's Health Insurance Program (CHIP) provides health care coverage (including check-ups, Well-Child Care exams, dental and vision care) for children who are under the age of 19 and are current residents of South Dakota. To qualify, there are specific income limits.
Pregnant Women
South Dakota Medicaid provides services to pregnant women who meet income and resource limits as well as general eligibility guidelines. Based on income limits and eligibility requirements, pregnant women may qualify for either limited coverage or full coverage.
- Limited Medical Coverage for Pregnant Women provides medical coverage limited to coverage directly related to their pregnancy and delivery. Coverage also includes 60 days postpartum care and family planning services.
- Full Medical Coverage for Pregnant Women provides full medical coverage to pregnant women including postpartum and family planning services during the two months following the end of the pregnancy.
South Dakota Medicaid for Newborns
South Dakota children born to women eligible for and receiving South Dakota Medicaid on the date of the child’s 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.
Disabled Children’s Program
The Disabled Children's Program provides South Dakota Medicaid for certain disabled children (following disability standards from the Social Security Act) in South Dakota that are under the age of 19. This program is intended for children with disabilities that have medically fragile conditions requiring skilled nursing care in a medical facility. Where care is provided at home, it requires a physician order and could only be performed by a physician or nurse (if the child were in a medical facility). The cost of the monthly health care services at home must be the equal or less than the cost of treating the child within a medical facility.
Breast and Cervical Cancer Program
The Breast and Cervical Cancer Program is for uninsured South Dakota women who need treatment for breast or cervical cancer, including precancerous conditions and early stage cancer, that fall under specific age and income guidelines. The screening for breast and cervical cancer must have been performed under the Breast and Cervical Cancer Control Program, administered by the Department of Health.
South Dakota Medicaid for Workers with Disabilities (MAWD)
The South Dakota Medicaid for Workers with Disabilities program provides services for South Dakotans that are employed and have a significant disability. This program allows individuals with disabilities to return to work or remain working.
Family Support Services
Family Support Services provide South Dakota Medicaid to residents of South Dakota with a diagnosed developmental disability such as Down’s Syndrome, autism, or cerebral palsy, allowing the individual to remain in the home with their family (as defined by the program). The individual must also meet specific income and resource limits.
Home and Community Based Services for Developmentally Disabled
Home and Community Based Services provides South Dakota Medicaid for individuals with developmental disabilities to remain in the home or community that would otherwise be institutionalized in a Medicaid-funded hospital, nursing facility, or an intermediate care facility. Individuals must meet specific guidelines regarding disability diagnosis, residence type, and income guidelines.
South Dakota Medicaid for Individuals in Adult Foster Care Facilities
Individuals in adult foster care homes that meet all eligibility criteria may qualify for South Dakota Medicaid. An individual must meet age, income, level of care and residence requirements.
South Dakota Medicaid for Individuals in Assisted Living Facilities, Nursing Facilities or Homes.
Individuals in assisted living centers, Nursing Facilities or Homes may qualify for South Dakota Medicaid. An individual must meet age, income, level of care, and residence requirements.
South Dakota Medicaid for Individuals with Chronic Renal Disease
The program provides services to individuals that are experiencing chronic renal failure and are unable to pay the total cost of lifesaving care and treatment of renal failure. An individual must meet income, residence, care and treatment criteria and are not covered by a third party payer.
Quadriplegics who would Require Nursing Home Care if not for Special Services Performed in their Home
This program provides services to Individuals with quadriplegia that are living independently in their own homes through South Dakota Medicaid. Individuals that are eligible are entitled to full South Dakota Medicaid coverage. Applicants must meet age, diagnosis, income and resource limits.
Elderly Individuals who would Require Nursing Home Care if not for Special Services Performed in their Home
Elderly individuals living independently in their own homes may qualify for South Dakota Medicaid when a level of care reflects the need for nursing home care. Applicants must meet age, income, and resource limits. In addition to the standard Medicaid covered services, South Dakota Medicaid will also cover Homemaker Services, Private Duty Nursing, Adult Day Care, Emergency Response Systems, and/or Meals-Nutritional Supplements.
Refugee South Dakota Medicaid
The Refugee South Dakota Medicaid (RMA) program provides healthcare to refugees in need that do not meet qualifications for any other healthcare program for eight months from the month of entry into the United States.
South Dakota Medicaid for Youth Formerly in Foster Care
The Former Foster Care Medical Program provides extended medical coverage for youth age 18 to 26 that are no longer in the State foster care after their 18th birthday. The individual must have been in foster care under the responsibility of the State of South Dakota on their 18th birthday and be a resident of South Dakota.
Medicare Costing Savings Programs
The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services; or Medicare Part B premiums only. The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part B premiums, coinsurance, and deductibles for eligible persons enrolled in Medicare Part A. The Specified Low Medicare Beneficiary (SLMB) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income. Qualified Individual-1 program provides payment for the Medicare Part B premium only for individuals who would be eligible for the QMB program except for excess income.
HIPP (Health Insurance Premium Payment) Program
Health Insurance Premium Payment (HIPP) Program provides financial assistance to families that qualify for healthcare support despite having insurance through their employer. This program allows the family to begin to increase their long-term health support system while being able to take advantage of Medicaid’s coverage options. To qualify for this program, one person in the family must be qualified for or currently using Medicaid.
South Dakota Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
Medicaid eligibility is limited to non-disabled adults for parents with incomes below 16% of poverty. Children who live with family whose household income is upto $74k. Adults with no dependents and undocumented immigrants are currently not eligible.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in South Dakota, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of South Dakota's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
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