Medical Services

Medicaid State Plan

Medicaid MAGI Eligibility
The South Dakota Department of Social Services intends to make changes to the South Dakota Medicaid State Plan concerning the methodology used to determine eligibility for infants and children, pregnant women, parents and other caretaker relatives, and former foster care children up to age 26. The proposed State Plan Amendment will also update the organizational structure of the state agency.  Read a letter summarizing the changes here.

As pages of the State Plan Amendment are completed, they will be posted below:

Single State Agency
These SPA pages designate the Department of Social Services as the single state agency operating the Medicaid program in South Dakota, the sole agency making eligibility determinations, and the sole agency responsible for conducting fair hearings with respect to denials of eligibility.

Residency
This SPA page assures that South Dakota provides Medicaid to eligible residents of the State of South Dakota.

Citizenship & Immigration Status
This SPA page assures that South Dakota provides Medicaid to eligible citizens and nationals of the United States.

Eligibility Process
These SPA pages detail South Dakota’s eligibility and enrollment process, including the application for Medical Assistance, the renewal process, and assurance that the state will coordinate eligibility and enrollment with the federally facilitated exchange as required by 42 CFR 435.

MAGI Income Methodology
These SPA pages designate the income methodology South Dakota will use to make eligibility determinations in 2014.  South Dakota will use the Modified Adjusted Gross Income (MAGI) standards as required by the PPACA.  MAGI is an income calculation method that uses tax information to calculate household income for use in eligibility determinations. The Department has converted current income requirements to MAGI-equivalent standards.

MAGI-based Eligibility Groups
These SPA pages define the MAGI income standards used to determine eligibility for  infants and children, pregnant women, parents and other caretaker relatives,  and former foster care children up to age 26. MAGI income standards will not be used to determine eligibility for the disabled and adults over age 65.