Medical Eligibility

Children's Health Insurance Program

Frequently Asked Questions

I heard CHIP is for children whose parents can't afford health care and make too much to qualify for Medicaid.  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 CHIP 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.

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 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.

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). 

How do I determine the household size when determining eligibility for CHIP?

Generally, the household consists of the applicant, the applicant's natural, adopted and step siblings under age 19 living in the home, and the applicant's parents or caretaker relatives.

My children are currently on the CHIP program.  My boyfriend is moving in with me.  Will this affect my children’s eligibility for CHIP?

If your boyfriend is not the father of any of your children, his presence in the household will not affect your children’s eligibility for CHIP.

My 10-year old daughter lives with me during the summer months and some holidays in South Dakota.  She lives with her mother in Nebraska the remainder of the year.  Is my daughter eligible for CHIP while she lives with me in South Dakota?

You are encouraged to apply for medical assistance so an evaluation can be made regarding your specific situation.  When your application is received, the Benefits Specialist can see if your child is receiving benefits in Nebraska, etc. and if she would be eligible for South Dakota medical assistance.

My daughter is 18 and attending college in another state.  If we meet the eligibility guidelines for CHIP, can she still be covered until she is 19?

Yes, as long as she intends to return and live in South Dakota when she is not attending college. NOTE: You must contact your Benefits Specialist to complete an ‘Exemption Form’ for managed care when a child is temporarily absent from the home due to attending school out-of-state.

I have children on private health insurance.  It is very expensive.  My income is too high for my children to qualify for CHIP (with private health insurance), but it appears my children may be eligible for CHIP (without private health insurance).  Can I drop my insurance so my children will be eligible for CHIP?

If you drop your private health insurance in the immediate three months prior to your application for CHIP, your children may not be eligible.  Individuals are generally not allowed to drop private health insurance so they can meet the eligibility criteria for CHIP.  This requirement may be waived if the private health insurance was dropped for good cause (i.e., cost of insurance to cover the parent’s children exceeds 5% of gross income; the parent providing primary insurance is fired or laid off;  the employer discontinued the insurance).  Good cause determinations are made on a case-by-case basis.

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.