Medicaid Care Management

South Dakota’s health home program offers enhanced health care services to Medicaid recipients with chronic conditions like asthma, COPD, diabetes, heart disease, hypertension, obesity, substance use disorder, mental health conditions, pre-diabetes, tobacco use, cancer, hypercholesterolemia, depression, and musculoskeletal and neck/back disorders.

Keeping You Healthy

• Teaching you how to take care of yourself and make healthy choices.
• Helping you schedule screenings and appointments when you need them.
• Making sure you get the care you need to keep you from getting sick.

Planning Your Care

• Focusing health care on you as a whole person.
• Setting goals for your health needs and making a plan for when and how you receive care.
• Building a team to help you meet your health goals.
• Providing referrals to other providers or specialists.

Supporting You & Your Family

• Working with you, doctors, nurses, counselors, hospitals and other to make sure you get the care you need.
• Explaining tests and results to you to make sure you understand everything about your health.
• Making sure you don’t go back to the hospital or ER after you leave.

Connecting Your Care

• Working with you and your family or caregiver to make sure you can focus on your health.
• Helping you get other services you need in your community

For more information, view the Health Home Brochure.

As a health home recipient, you are required to receive non-emergent services from your Health Home Provider (HHP). You are also required to have a referral from your HPP for non-emergent specialty and hospital services. You can receive certain services called Health Home Exempt Services from other providers without a referral from your HPP.

Health Home recipients have the right to say no to the Health Home Program. If recipients do not wish to participate should submit the the Decline to participate form.

For additional questions, please contact Medical Services at 605.773.3495 or DSS.Medicaid@state.sd.us.

The Primary Care Provider Program (PCP) is designed to improve access to medical care for Medicaid recipients as well as improve the quality of care they receive by giving them a medical home.

The majority of recipients who qualify for Medicaid are required to participate in the Primary Care Provider Program. Recipients either choose or are assigned a Primary Care Provider (PCP). This allows the recipient and their physician to develop a relationship in which the best medical care can be provided. You can identify providers by either clicking on the map icon to find the provider closest to you or the list icon to view a list.

As a primary care provider program recipient, you are required to receive non-emergent primary care provider services from your Primary Care Provider (PCP). You are also required to have a referral (permission) from your PCP for non-emergent specialty and hospital services. You can receive certain services called Primary Care Provider Program Exempt Services from other providers without a referral from your PCP.

If you have any questions please contact Medical Services at 605.773.3495 or DSS.Medicaid@state.sd.us. You may also contact your local office for assistance.

BabyReady Medicaid whole pregnancy care is a no-cost program covering all checkups, labor, and delivery from the start of pregnancy until 3 months after your baby is born.  It also connects you to resources and provides ongoing, mom-centered support.  BabyReady is for all Medicaid-eligible moms who are less than 21 weeks pregnant.  To ensure you and your baby are healthy, it is important to see a provider as early in pregnancy as possible.

If you do not see your provider on the BabyReady provider list, please contact 605.773.3495 or email CMforms@state.sd.us