Medical Services

Medical Assistance for Parents and Other Caretaker Relatives

Frequently Asked Questions

What is the difference between Medicaid, Title XIX, Title XXI and CHIP?

There are several categories of medical assistance through the Department of Social Services available to families and children based on funding sources and eligibility criteria.  These programs are often referred to as Title XIX, Title XXI, CHIP, Medicaid, etc.  Based on the type of assistance an applicant is requesting and based on the information provided to the Department, staff will review which medical assistance programs an applicant may be eligible for.  Therefore, an applicant does not need to request a specific program (i.e., Title XIX).  Medical assistance programs administered by the Department of Social Services include, but are not limited to, families with dependent children (includes parent(s)/caretaker(s) with dependent children), children’s health insurance (includes only children up to age 19), and pregnancy programs for pregnant women.  Although eligibility criteria may be different for each program, in most cases, the coverage is the same.

We submitted an application for medical benefits about two weeks ago for my son and have not heard anything back about his eligibility.  I'm wondering how long it usually takes and when the medical assistance coverage will begin.

The Department of Social Services has 45 days to process an application; although it normally does not take that long.  Submitting the requested documentation (i.e., pay stubs) with the application or as soon as possible after submitting the application, will speed up the time required to complete an application.  The start of medical coverage is based on the date the application is received in the local office.  Example:  If an application is received in the Department of Social Services (DSS) office on July 31 and the applicant is found eligible, they will be eligible for the entire month of July.  Also, medical coverage may go back 3 months prior to the date the application was received in DSS if you have unpaid medical bills and you meet eligibility requirements during this time period.

I will be moving to South Dakota in a couple months.  When should I submit an application?

You should submit an application when you arrive in South Dakota.  You cannot be found eligible for South Dakota medical assistance until you are a resident of South Dakota.

How long does it take to become a resident of South Dakota for medical assistance?

In general, if you live in South Dakota voluntarily and intend to remain in South Dakota you are considered a resident of South Dakota for purposes of medical assistance.

I work Monday through Friday, eight to five so it is hard for me to get away from my job for paperwork and appointments.  Are appointments required to apply for medical assistance?

You do not have to go to the Department of Social Services (DSS) to apply for medical assistance.  You can mail or fax a completed application to your nearest DSS office along with the required documentation (as outlined in the application).  Download an application.

How do I determine the household size when determining eligibility for Low Income Families?

Generally, the household consists of the applicant, the applicants spouse, the applicants natural, adopted and step children under the age of 19 living in the home.

Who is a caretaker relative?

Caretaker relative means a relative of a dependent child by blood, adoption,k or marriage with whom the child is living, who assumes primare responsibility for the child's care.

My income is too high to qualify for Low Income Families.  Is there a program available that my children may qualify for?

The Children’s Health Insurance Program (CHIP) is a program specifically for children.  This program began as a way to reach children of lower-income working families with income above the traditional Medicaid program limits. View more information on the CHIP program.

I am pregnant and living with my boyfriend who is the father my unborn child.  Is he eligible for Low Income Families?

The spouse or man who claims to be the father of the pregnant woman’s unborn child is not eligible for Low Income Families (LIF) until the baby is born.

Are American Indian Children eligible even if they have Indian Health Services (IHS) coverage?

Yes. The federal statute is very specific about the inclusion of American Indians and the IHS as providers.