The South Dakota Children's Health Insurance Program, more commonly referred to as CHIP, provides quality health care (including regular check-ups, Well-Child Care exams, dental and vision care) for children and youth.
To be eligible for CHIP, children must be under the age of 19 and current residents of South Dakota.
Children who are uninsured or already have health insurance may be eligible for CHIP based on income and eligibility guidelines.
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Low income families in South Dakota (with or without private health insurance) may be eligible for FREE or low cost South Dakota Medicaid including regular checkups, Well-Child Care exams, dental care, and vision care.
To be eligible, the family must consist of a parent or other adult caretaker relative and a dependent child. A caretaker relative may be parent, grandparent, brother, sister, stepparent, etc. A dependent child is a child under age 18 who is living with a parent or a caretaker relative. If a child is 18 years old and still a fulltime student in high school, the child is considered a dependent child if he or she is expected to complete high school before reaching age 19.
Low-Income Families | |
Household Size | Maximum Gross Monthly Income |
1 | $624 |
2 | $785 |
3 | $900 |
4 | $1,010 |
5 | $1,123 |
6 | $1,238 |
7 | $1,349 |
8 | $1,460 |
The Department of Social Services provides South Dakota Medicaid to pregnant women who meet income and resource limits and general eligibility guidelines. Pregnant women may qualify for limited coverage or full coverage.
Limited Medical Coverage for Pregnant Women provides limited medical coverage to pregnant women meeting the income limits and general eligibility requirements. The income limits are more liberal than the Full Medical Coverage for Pregnant Women program. Medical coverage is limited coverage directly related to their pregnancy and delivery. Coverage also includes 60 days postpartum care and family planning services.
Limited Coverage Pregnancy | |
Household Size | Maximum Gross Monthly Income |
1 | $1,677 |
2 | $2,268 |
3 | $2,859 |
4 | $3,450 |
5 | $4,042 |
6 | $4,633 |
7 | $5,224 |
8 | $5,815 |
Full Medical Coverage for Pregnant Women provides full medical coverage to pregnant women meeting the income limits and general eligibility requirements. The income limits are more restrictive than the Limited Medical Coverage for Pregnant Women Program. Postpartum and family planning services are available during the two months following the end of the pregnancy.
Full Coverage Pregnancy | |
Household Size | Maximum Gross Monthly Income |
1 | $419 |
2 | $530 |
3 | $611 |
4 | $688 |
5 | $768 |
6 | $848 |
7 | $927 |
8 | $1,006 |
South Dakota children born to women eligible for South Dakota Medicaid are also eligible for South Dakota Medicaid.
Eligibility RequirementsThe Disabled Children's Program provides South Dakota Medicaid for certain disabled children in South Dakota. The program is intended for children with disabilities who have medically fragile conditions requiring skilled nursing care in a medical facility if they were not being cared for at home.
Eligibility RequirementsThe Breast and Cervical Cancer Program is for South Dakota women who need treatment for breast or cervical cancer, including pre-cancerous conditions and early stage cancer.
Eligibility RequirementsThe South Dakota Medicaid for Workers with Disabilities program is for South Dakotans who are employed and have a significant disability. This program allows individuals with disabilities to return to work or remain working.
Eligibility Requirements for MAWDFamily Support Services provide South Dakota Medicaid for South Dakotans with a developmental disability such as Down’s Syndrome, autism or cerebral palsy.
Eligibility RequirementsService Coordination: Includes services that will assist the individual to access needed services and the full range of South Dakota Medicaid, as well as needed medical, social, educational and other services.
Respite Care: Includes services provided to individuals unable to care for themselves. It is furnished on a frequency determined in the individual’s care plan because of the absence or need for relief of those persons normally providing care.
Specialized Medical and Adaptive Equipment and Supplies: Includes devices, controls or appliances, that enable individuals to increase their abilities to perform activities of daily living, or to perceive, control or communicate with their environment.
Nutritional Supplements: Certain nutrition supplements that are not a covered service under the full range of South Dakota Medicaid.
Personal Care: Assistance with eating, bathing, dressing, personal hygiene, or activities of daily living. This service may include assistance with preparation of meals, but does not include the cost of the meals themselves. When specified in the plan, this service may also include such housekeeping chores as bed making, dusting, and vacuuming, which are incidental to the care furnished, or which are essential to the health and welfare of the individual, rather than the individual’s family.
Companion Care: Non-medical service specifically for children in transition from childhood to adulthood and includes supervised integrated socialization, role modeling, and independent living skill development. This is a skill development service and may include such tasks as assistance and/or supervision of meal preparation, laundry, and shopping.
Environmental Accessibility Adaptations (Home/vehicle modifications): Those physical adaptations required by the individual’s plan of care, which are necessary to ensure the health, welfare and safety of the individual, or which enables the individual to function with greater independence without which, the individual would require institutionalization.
Home and Community Based Services provides South Dakota Medicaid for individuals with developmental disabilities who would otherwise be institutionalized in a Medicaid-funded hospital, nursing facility or an intermediate care facility.
Eligibility RequirementsCase Management and Consumer Support: This includes adaptive equipment needed not to exceed $500 per person per year. Examples of adaptive equipment would be communication devices, eyeglasses, hearing aids, etc.
Habilitation and Consumer Training: Habilitation and training includes instruction and training in community living skills, personal living skills, social and communication skills, gross and fine motor skills and activities of daily living.
Other Information for Home and Community Based Services can be found here: Department of Human Services' Division of Developmental Disabilities
Individuals in adult foster care homes that meet all eligibility criteria may qualify for South Dakota Medicaid.
Eligibility RequirementsIndividuals in assisted living centers, Nursing Facilities or Homes who meet all eligibility criteria may qualify for South Dakota Medicaid.
Eligibility RequirementsThe program is intended for individuals who are experiencing chronic renal failure and are unable to pay the total cost of lifesaving care and treatment of renal failure.
Eligibility RequirementsCovered services are limited to those provided for long-term dialysis or transplants due to irreversible, chronic renal failure. The following services may be paid under this program:
Individuals with quadriplegia living independently in their own homes may be eligible for South Dakota Medicaid. Individuals who are eligible are entitled to full South Dakota Medicaid coverage.
Eligibility RequirementsElderly individuals living independently in their own homes may be eligible for South Dakota Medicaid.
Eligibility RequirementsHomemaker Services: Teaching and providing home management skills, promoting self-care, making beds, changing linens, washing dishes, laundry work, floor care and housecleaning. Providing meal preparation, shopping and menu planning. Providing non-South Dakota Medicaid in mobility, personal comfort and grooming of the individual. Arranging for transportation.
Private Duty Nursing: Nursing services provided by a licensed nursing professional for recipients with chronic and stable conditions who require more individual and continuous care than is available from a part-time or intermittent nursing service.
Adult Day Care: Services providing out-of-home structured health and social services on a regularly scheduled basis and in daytime settings.
Emergency Response Systems: An emergency response system is an electronic device enabling individuals to alert neighbors or family and summon assistance in the event of an emergency.
Meals-Nutritional Supplements: Meals may be arranged in those areas where no home delivered meals program is available. The service may include a prepared meal, a frozen entrée or a nutritional supplement.
The Refugee South Dakota Medicaid (RMA) program was established to provide health care to refugees in need who do not meet qualifications for any other health care program. Refugee South Dakota Medicaid is available to eligible refugees for twelve months from month of entry into the United States.
The Former Foster Care Medical Program provides extended medical coverage for youth age 18 to 26 that are leaving State foster care after their 18th birthday. Referrals for this program are normally generated by the Division of Child Protection Services’ staff. You may also call 877.999.5612 for further information.
Eligibility Requirements