Amy Iversen-Pollreisz
Interim Secretary

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Do I have to participate in the Primary Care Provider Program?

Recipients eligible for the following programs must participate in the Primary Care Provider Program:

  • Supplemental Security Income (SSI) recipients: blind, disabled people age 19 and older.
  • Parent and other caretaker relatives
  • Children on Medicaid or Chilren’s Health Insurance Program (CHIP)
  • Pregnant women

You will receive a letter shortly after you are approved for South Dakota Medicaid if you are required to participate in the Primary Care Provider Program 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.

Primary Care Provider Program

The Primary Care Provider 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 Primary Care Provider 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 primary care provider program recipient, you are required to receive non-emergent primary care provider 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 Primary Care Provider Program Exempt Services from other providers without a referral from your PCP.

Recipient Information: