Medical Eligibility

Pregnant Women

Frequently Asked Questions

I am 21 years old and I recently became pregnant.  How soon can I apply for coverage for pregnant women?

You can apply for coverage for pregnant women as soon as you become aware you are pregnant.

Is Medical Verification of a pregnancy required?

Medical verification is not required.

Can I go to the doctor before eligibility for medical coverage is determined?

Although we cannot advise you on when you should seek medical attention, the following information may assist you.  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. 

Medical coverage may go back three months prior to the month the application is received in the Department of Social Services if you have unpaid medical bills and you meet eligibility requirements during this time period.

I am pregnant and 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 am pregnant and have two children.  I have too much income to qualify for medical assistance for a family of three.  Can I include the unborn child in the family size?

Yes, an unborn child is considered in the family size for most of our medical assistance programs.

I am a 29-year old adult with three children.  I am planning on moving back in with my mother before the baby is born.  Will my mother’s income be included in the eligibility process?

No.  If the pregnant woman is over age 18, her parent(s) income and resources are not counted.

I live with my boyfriend and I am pregnant.  He is the father of my unborn child.  Does my boyfriend's wages count in the family size? 

The father of an unborn child is not included in the family size for pregnancy related medical assistance unless he is married to the pregnant woman.

I am currently ten weeks pregnant and have been approved for coverage for pregnant women.  My fiancé and I will be getting married before the baby is born.  How will this affect my benefits?

Once you have been determined eligible for one of the coverage for pregnant women programs, medical coverage will continue until the pregnancy ends regardless of any changes in income unless you leave the state; however, other changes may affect eligibility, for example an increase in resources.

Is my pregnancy covered if I am currently on the Children’s Health Insurance Program or the Parent/Caretaker Relative program?

Yes, pregnancy is a covered service under the Children’s Health Insurance Program and the Low Income Family Program.

A few months ago I applied for medical assistance for myself because I was expecting my first child.  At that time I did not qualify, but it appears that my child may qualify for CHIP.  I am wondering if I need to reapply and how soon I can do that into my pregnancy to be sure my child has insurance when s/he is born.

Yes, you will need to reapply for CHIP for your child.  You should complete an application as soon as the child is born.  Medical coverage may go back three months prior to the application date if the child has unpaid medical bills and s/he meets the eligibility requirements during this time period.

Is it possible to be covered by private health insurance and coverage for pregnant women?

Yes.  Pregnant women who already have health insurance may be eligible for pregnant women programs based on family size and income.  Medical assistance may include paying deductibles, co-payments and other medical services not covered by their private policy.

If I am eligible for medical assistance, am I also eligible for WIC?  Where can I find information regarding the WIC program?

The WIC program is administered through the Department of Health.  Mothers, infants & children who meet WIC criteria and are on Medicaid, TANF or SNAP automatically meet income guidelines for WIC.  You will need to show proof of Medicaid card, TANF or SNAP information.  If you are not eligible for Department of Social Services programs, you must (1) meet residency guidelines (South Dakota resident); (2) have a nutrition or health risk; and (3) meet income guidelines. View additional information on WIC.

What other resources are available for pregnant women?