We have scoured the internet to provide all you need to know about the South Dakota Medicaid Benefits.
Medicaid is a joint federal-state program that provides health insurance to low-income individuals who meet certain requirements, including kids, pregnant women, the elderly, and individuals with disabilities. Applying for Medicaid in person, via telephone, or online is simple.
This post will teach you all you need to learn about Medicaid in South Dakota.
Table of Contents
What is the South Dakota Medical Program?
South Dakota Medicaid is a service for people and families with income and resources that fall within certain parameters. Resources primarily apply to the elderly, blind, or disabled population within the bounds of specified rules.
Who is eligible for the South Dakota Medical Program?
South Dakota Medicaid offers certain limited Medicare beneficiaries who are not eligible for the full Medicaid benefit package some partial financial help with Medicare premiums and copayments or coinsurance through the Medicare Savings Plan.
- Expectant mothers
- People who are blind or disabled or who have a spouse who is blind or disabled;
- People whom someone adopts;
- People whom someone adopted;
- People who are blind or disabled or have a spouse who is disabled.
The Annual Household Income Limits (before taxes)
| Household Size* | The Maximum Income Level (Per Year) |
| 1 | $18,075 |
| 2 | $24,353 |
| 3 | $30,630 |
| 4 | $36,908 |
| 5 | $43,186 |
| 6 | $49,463 |
| 7 | $55,741 |
| 8 | $62,018 |
*For households with more than eight people, add $6,277 per additional person.
How do I contact Medicaid in South Dakota?
Phone
800-597-1603
Mailing Address
State Medical Assistance Office, Department of Social Services of South Dakota
Fax: (605) 773-5246
What are the Medicaid plans in South Dakota?
Health Maintenance Organization (HMO)
Health Maintenance Organization (HMO) plans to provide member care through contracted local hospitals and doctors’ networks.
Except in emergencies, members are generally required to use these care providers to get covered services. For specialized care, some HMO plans don’t require referrals.
Point of Service (HMO-POS)
Point of Service (HMO-POS) plans have all the benefits of HMO plans plus the option to use some healthcare services outside the contractual network, usually at a higher cost. For specialist treatment, certain POS plans don’t require referrals.
Preferred Provider Organization (PPO)
Preferred Provider Organization (PPO) plans to collaborate with a network of contracted local doctors and hospitals.
Still, they also give members the freedom to access covered treatments from providers outside the contractual network, typically at a higher cost. Specialty care is not referred to members.
How do I apply for South Dakota Medicaid?
Call 800-597-1603 to enroll.
Apply in person at the Department of Social Services of South Dakota
Online: Download and print the application.
Mail: State Medical Assistance Office, Department of Social Services of South Dakota
Fax: (605) 773-5246
What is covered by South Dakota Medicaid?
South Dakota Medicaid covers the following services:
| Ambulatory surgery | Hospital stays |
| Audiology services | Laboratory tests |
| Behavioral health services | Vision care |
| Women’s health care | Non-emergency transportation |
| Dialysis | Orthotic and prosthetic devices |
| Doctor visits | Occupational therapy |
| Smoking cessation services | Pharmacy (medications) |
| Emergency care | Physical rehabilitation |
| Family planning services | Preventive care |
| Hearing aids | Hospital outpatient care |
| Home health care | X-rays and other radiology services |
Can I have both South Dakota Medicaid and Medicare?
In South Dakota, you might be eligible for both Medicaid and Medicare at the same time.
South Dakota Waiver
- CHOICES Waiver
- Family Support 360
- Assistive Daily Living Services (ADLS)
- HOPE Waiver
Copayments?
They do not have to pay a copayment. When a member is
- under 21 years old;
- pregnant;
- Held by the state
- Placed under government supervision
- Native American participants who qualify for Contract Health funding
- Services or Tribal Union of Indian Health Services
- The hospital (inpatient)
- A facility for skilled nursing
- A nursing home
What is not covered by South Dakota Medicaid?
In South Dakota, Medicaid is not mandated to offer in-home caregiving services or private nursing coverage. Bandages, adult diapers, and other disposable items are frequently excluded from insurance coverage, as are cosmetic surgery and other elective procedures.
What is the highest income limit for South Dakota Medicaid?
The highest income limit for South Dakota Medicaid is $18,075 for an individual and $24,353 for a family of two per year.
What if a person’s income is too high to qualify for regular Medicaid benefits?
If your income is too high, you may still be eligible for South Dakota Medicaid, thanks to the asset spend down option.
What documents do I need to apply for Medicaid?
The following documents are required with the application:
- The Social Security Number;
- Evidence of citizenship or authorized residency in the United States, such as a passport, driver’s license, birth certificate, green card, or job authorization card
- Evidence of all income sources, both legal and illegal
- Proof of origin
- Proof of residency
- Including the Medicare card, any insurance cards
- Pregnancy;
- When non-parents apply for Medicaid on their behalf, they must provide proof of their financial position.
What is the best Medicaid in South Dakota?
The best plan for you is the one that meets your demands and offers the most benefits in terms of health insurance and monetary help because it varies from person to person.
Where do I find the letter showing the reason(s) for denial or discontinuance from South Dakota Medicaid?
By signing into your account at Portal, you can see the progress of your South Dakota Medicaid application.
