South Dakota Medicaid is for low-income individuals and families living in South Dakota. It offers comprehensive health benefits at low or no cost, depending on income. Use this guide to learn what’s covered, who is eligible, and how to apply.
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 (July 1 - June 30)
Diabetes Management: 10 hours of diabetes management education upon diagnosis, and 10 hours per year
Dietician/Nutritionist: 5 hours of services per year (and only 1 per day) 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
Mental Health & Substance Abuse: 40 hours of mental illness therapy per year for adults, Community mental health centers available for support. Substance abuse screenings, interventions, and treatments covered
Nursing Homes: Room and board, nursing care, therapy, meals
Personal Care: Bathing, toileting, and medication assistance. Call Dakota At Home (833-663-9673) for more information on this service
Podiatry: Office visits, X-rays, blood sugar testing, and other tests and procedures
Prescription Drugs: Most drugs covered for up to 30-day supplies; birth control allowed in 90-day increments. Over-the-counter products are usually not covered, and pain prescriptions are limited. Some drugs may require prior authorization
Vision: Exams, lenses, and frames. Contacts only covered when necessary
Well Visits: Yearly check-ups, screenings, and immunizations (as well as prenatal exams)
The South Dakota Medicaid Dental program is different for kids and adults.
Kids can get:
Adults can get (up to $1,000 per year):
Emergency and Non-Emergency Transportation
Medicaid recipients will have ambulance transportation coverage for life-threatening emergency situations only. If you call an ambulance for a non-emergency situation, your transportation may not be covered.
South Dakota Medicaid can cover your transportation to and from your Medicaid-covered medical appointments, when medically necessary. Your transportation must be with a company that works with South Dakota Medicaid to be covered, and you will have to show your Medicaid ID card. If you need special arrangements, such as a vehicle with wheelchair access, remember to inform your provider of that need as soon as possible.
If the nearest provider that you can see for your treatment or diagnosis is 150 miles or more from your starting destination, you may be able to receive reimbursement for meals and lodging. For each medical trip, you’ll need to complete this travel reimbursement form. If you need to go out-of-state, you may need prior approval.
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.
South Dakota Health Homes are for Medicaid recipients with severe mental illnesses or certain chronic health conditions. Each Health Home coordinates patient care between doctors and hospitals and can offer connections to other benefits, like transportation. Your Health Home can also help you manage your medications and treatments. It is NOT a place of residence, and it is NOT in-home care.
If you are nominated to participate in a Health Home, you do not HAVE to accept, but you will have to complete this “Decline to Participate” form and mail it to the Division of Medical Services at 700 Governors Dr., Pierre, SD 57501.
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.
South Dakota Medicaid eligibility depends on your income and family size, as follows:
You may be able to get both Medicare and Medicaid at the same time in South Dakota. You can qualify for Medicare by:
If you do qualify for both programs, you may be eligible for a Medicare Advantage Dual-Eligible Special Needs Plan, or DSNP. DSNPs often have very low or no costs and can provide your Medicare and Medicaid benefits. For more information and for help finding plans in your area, call 833-438-3676.
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