Lynne A. Valenti
Cabinet Secretary

DSS Mobile Logo Mobile Menu Button

Do I have to participate in Managed Care?

Recipients eligible for the following programs must participate in Managed Care:

  • Supplemental Security Income (SSI) recipients: blind, disabled people age 19 and older.
  • Families eligible for the Low Income Families (LIF) Program .
  • Low income children eligible for Medicaid.
  • Children eligible for CHIP.
  • Women eligible for low income pregnancy coverage.

You will receive a letter shortly after you are approved for South Dakota Medicaid if you are required to participate in Managed Care with instructions on how to choose your Primary Care Provider (PCP).

If you do not choose a PCP in the timeframe that is provided, one will be selected for you.

Managed Care Program

The Managed Care Program is designed to improve access to medical care for Medicaid recipients as well as improve the quality of care they receive by giving them a medical home.

The majority of recipients who qualify for Medicaid are required to participate in the Managed Care Program. Recipients either choose or are assigned a Primary Care Provider (PCP). This allows the recipient and their physician to develop a relationship in which the best medical care can be provided.

As a managed care recipient, you are required to receive non-emergent managed care services from your Primary Care Provider (PCP). You are also required to have a referral (permission) from your PCP for non-emergent specialty and hospital services. You can receive certain services called Managed Care Exempt Services from other providers without a referral from your PCP.

Recipient Information: