Medical Eligibility

Families and Children

Disabled Children's Program

The Disabled Children's Program provides Medical Assistance for certain disabled children in South Dakota. The program is intended for children with disabilities who have medically fragile conditions requiring skilled nursing care in a medical facility if they were not being cared for at home.

Eligibility Requirements

  • The child must be under age 19.
  • The child must be found disabled by the Social Security Administration or the Department of Social Services using disability standards from the Social Security Act.
  • The child must require medical care in the home comparable to a level of care needed in a hospital, nursing facility or intermediate care facility. A child who is medically stable, even though disabled, is not considered in need of a level of care. A child is medically stable if his or her health care and medical needs are such that he or she would not require care in a medical institution.
  • Health care services received in the home must have been ordered by a physician and could only be performed by a physician or nurse if the child were in a medical facility.
  • Cost of the child’s monthly health care services at home must be the same or less than the cost of treating the child within a medical facility.
  • The child’s monthly income must be less than 300 percent of the SSI Standard Benefit Amount ($2,094) and resources must be less than $2,000. (Resources include items such as checking and savings accounts and certificates of deposit.) Income and resources of the parents are not considered to determine eligibility.

Covered Services

Eligible children are entitled to full Medical Assistance coverage. Covered services include:

  • doctor appointments,
  • hospital stays,
  • dental and vision services,
  • prescription drugs,
  • rehab/therapy,
  • chiropractic services

Medical coverage may begin three months prior to the application date. The start of medical coverage is based on the date the application is received in the local office.

Application

For an application, please call (605) 773-4678 or contact us online.

After the application is returned, the benefits specialist will obtain medical documentation about your child's health care services provided in the home. This information is used to determine if your child meets the medical and disability requirements. The benefits specialist also determines if other non-medical eligibility criteria are met such as income and asset limits. A decision about eligibility is made within 90 days of the day your child's application is received.