Below you will find information on the services NOT covered by the South Dakota Medical Assistance Program, also referred to as Medicaid. Recipients of the program are required to pay for the services listed below.
If you should have any questions in regards to what is covered and what is not covered, please call 1-800-597-1603 or visit with your medical provider.
- Items or services which have been determined by the State Dental or Medical Consultant or through peer reviews to be not medically necessary.
- Items or services for which the beneficiary has no legal obligation to pay or which are charges imposed by immediate relatives or members of the beneficiary’s household.
- Over-the-counter drugs, home remedies, food supplements, nutritional items, vitamins, or alcoholic beverages except as covered under chapter 67:16:14 or 67:16:42.
- Diagnosis or treatment given in the absence of the patient.
- Cosmetic surgery to improve the appearance of an individual when not incidental to prompt repair following an accidental injury or any cosmetic surgery which goes beyond that which is necessary for the improvement of the functioning of a malformed body member.
- Items or services provided by practitioners or agencies in the employ of or under contract with the federal, state, or local government, except state institutions for the developmentally disabled which are certified as skilled nursing or intermediate care facilities and the state psychiatric hospital.
- Organ transplants except as authorized under chapter 67:16:31.
- Chronic pain rehabilitation program services or chronic pain management services except as allowed under chapter 67:16:14.
- Alcohol and drug rehabilitation therapy, except for services provided under 67:16:11:03.04.
- Procedure for implanting an embryo.
- Medical equipment for a resident in a health care facility.
- Custodial care.
- Nursing facility services for individuals age 21 and over and under age 65 in institutions for mental disease.
- Broken appointments.
- Reports required solely for insurance or legal purposes unless requested by the Department of Social Services, the Department of Health, or the Department of Human Services.
- Concurrent care by more than one provider of the same discipline for the same diagnosis without a medical referral detailing the medical necessity of the concurrent care. For concurrent care without medical referral, the department will pay only the first claim submitted.
- A health service that is not documented in the recipient’s medical record as required by chapter 67:16:34.
- Vocational training, educational activities, teaching, or counseling.
- Record keeping, charting, or documentation related to providing a covered service, unless specifically allowed in this article.
- Payment of mileage unless specifically covered under this article.
- Drugs and biological which the federal government has determined to be less than effective as listed in subdivision 67:16:14:05(13).
- Services, procedures, or drugs which are considered experimental by the United States Department of Health and Human Services or another federal agency.
- Incontinence items and pads.
- Procedures and services to reverse sterilization.
- Computers, computer hookups, or computer printers.
- Gambling addiction services or therapy.
All information concerning applicants and recipients of medical assistance is limited to purposes directly connected with the administration of the Medical Assistance Program and shall be treated as confidential. Information may only be released upon the approval of the patient. No list of names of applicants or recipients shall be published. No materials sent or distributed to applicants, recipients, fiscal agents or medical providers directly related to the administration of the Medical Assistance Program shall be used for political or commercial purposes.