Cabinet Secretary
Matt Althoff
Medical Assistance
The Department of Social Services’ Division of Economic Assistance is responsible for determining eligibility for South Dakota Medicaid and the Children’s Health Insurance Program (CHIP) to help low income families and children.
South Dakota Medicaid and CHIP Programs provide coverage to help pay for necessary medical expenses individuals need to stay healthy such as: hospital stays, doctor visits, prescriptions, nursing home care and other health care needs.
Eligibility for Medicaid and CHIP varies depending on living arrangement, income, and resources available. You can learn more about eligibility requirements and how to apply by visiting the links below:
Long Term Care Application | Spousal Care Handbook
Medicare Savings Program Application | Brochure
- Apply faster online at dss.sd.gov/applyonline
- Find your local office
- Form 1095-B
- Frequently Asked Questions
- Medical Programs Available in South Dakota
How do I apply for South Dakota Medicaid?
It's easy to apply!
- You can print an application below and send the completed copy through mail, fax, or by delivering it to any Department of Social Services in South Dakota.
- You can contact any Department of Social Services, or call 800.305.3064, to request an application be sent to you.
- You can apply online by clicking the link below.
To process your application as quickly as possible, please thoroughly complete the application. If you need assistance completing an application, contact a Department of Social Services office nearest you or call 800.305.3064.
An interview is not required to apply for South Dakota Medicaid; however, you may request one.
The start date of medical coverage depends on the date the application is received by the Department of Social Services. 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. If you are interested in eligibility for the prior three months, include proof of income from month(s) prior to the month the application was submitted to the Department of Social Services.
Recipient Forms
Below are forms and applications to assist you with applying for the specific programs within South Dakota Medicaid.
Some documents are PDF files and require Adobe Acrobat to open them. If you do not have Adobe Acrobat, click here to download the latest version.
- Long Term Care (LTC) Application
- Specifically for nursing home, assisted living, home a community based services and adult foster care services.
- Children's Health Insurance Program/Pregnant Women Application
- Specifically for CHIP, pregnant women and low income families.
- SD
Medicaid/SNAP or SD Medicaid/TANF Application
- Specifically for Medical Assistance and Supplemental Nutrition Assistance Program and/or Temporary Assistance for Needy Families.
- Medicare Savings Program Application
- Non-Emergency Medical Travel Forms
Medicare Recipients
The Medicare Savings Program assists individuals with payment on their Medicare expenses. This program can save people up to $1,626 each year.
Coverage Groups- Qualified Medicare Beneficiary: Pays for the Medicare Part A and Part B premium, deductibles and co-insurance.
- Special Low-Income Medicare Beneficiary: Pays for the Medicare Part B premium only.
- Qualified Individiual: Pays for the Medicare Part B premium only.
- Income limit is $1,406 per month for an individual and $1,903 per month for a couple. The income limit may increase if there are additional people in the household.
- Resource limit is $7,730 for an individual and $11,600 for a couple. Resources includes items such as checking and savings accounts and certificates of deposit.
When you apply, you must send proof of Medicare enrollment. If you have questions concerning Medicare enrollment call 800.772.1213 or visit Medicare's Website.
Long Term Care Spousal Impoverishment Standards
The expense of nursing home or other institutional levels of care can rapidly deplete the savings of couples. Under the Medicaid spousal impoverishment provisions, a certain amount of a couple’s combined resources is protected for the spouse who is living in the community. Depending on the income of the spouse living in the community, they may have a certain amount of their spouse’s income set aside for their use as well.
- Community Spousal Resource Allowance:
- Minimum Resource Standard: $26,076
- Maximum Resource Standard: $130,380
- Home Equity Limit: $603,000
- Minimum Monthly Maintenance Needs Allowance: $2,155
- Maximum Monthly Maintenance Needs Allowance: $3,259.50
- Community Spouse Monthly Housing Allowance: $646.50
- Average Daily Nursing Home Private Pay Rate: $254.25
- SSI Federal Benefit Rate:
- Individual: $794
- Couple: $1,191
- 300% Special Income Limit: $2,382
Long-Term Care Partnership Program
Most people do not like to think about the fact that they may one day need nursing home, assisted living or other long-term care services. Most people are also surprised at the costs of long-term care and do not think of having to use their entire life savings to pay for those needs and services.
The reality is that about two-thirds of all Americans will likely need some type of supportive services after age 65.
Some common questions people ask are:
- Doesn’t the government pay for people to take care of me at home or in the nursing home?
- Isn’t that what health insurance or disability insurance is for?
- How can I plan ahead to take care of my own long-term care needs?
The Long-Term Care Partnership Program is a public-private partnership offering individuals quality, affordable long-term care insurance. Once private insurance benefits are used, special Medicaid eligibility rules are applied if additional coverage is necessary.
For more information on the Partnership Program in South Dakota, please visit the official website at: ltcpartnership.sd.gov.
Estate Recovery
The Office of Recoveries and Fraud Investigations also seeks reimbursement for actual costs of medical services and health premiums provided by the State of South Dakota from the estates of deceased individuals who received benefits.
The recipient and their legal representative is informed at the time of application for long-term care services. When the application is signed the recipient signs the notice of the Estate Recovery Program as well as other acknowledgments.
For more information about the Estate Recovery Program, see below:
Address:
Department of Social Services,
Office of Recoveries and Investigations
700 Governor’s Drive
Pierre, SD 57501-2291
Phone: 605.773.6353
Recoveries@state.sd.us
Medicare Part D
Do You Need Help Paying Prescription Drug Costs?
Medicare offers prescription drug coverage for all people with Medicare. If you have Medicare and a limited income, you may also qualify for extra help with paying your prescription drug costs.
Medicare Prescription Drug Coverage will:
- Be available to all people with Medicare.
- Help people with Medicare pay for the prescriptions that they need.
- Provide low-cost drug coverage for those with limited income and assets.
- Pay for both brand name and generic drugs.
- Allow people with Medicare to choose between at least two Medicare prescription drug plans.
- Allow convenient access to local pharmacies.
Medicare will contract with private companies to provide prescription drug benefits. To receive Medicare Prescription Drug Coverage, you must select and enroll in a plan. Enrollment in a plan is voluntary.