Cabinet Secretary
Matt Althoff

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Medicaid State Plan

The South Dakota Medicaid State Plan is a contract between the state of South Dakota and the Federal government describing how South Dakota administers its Medicaid Program. The plan information listed here is for informational purposes only. The official plan is maintained by the South Dakota Department of Social Services.

State Plan Amendments (SPA) in Public Comment Period
SPA# Description Effective Public Comment Start Date Public Comment Period Ends
         

State Plan Amendments in CMS Review
SPA# Description Effective Public Comment Start Date Public Comment Period Ends Submitted to CMS
25-0015

SUD/IMD Template and School-Based Administrative Claiming
Replaces the current Attachment 3.1-L Substance Use Disorders / Institutions for Mental Diseases State Plan pages with the new template pages provided by CMS and separately updates the random moment time study cost pool list of providers that may perform school-based direct services and/or administrative claiming activities.

 10/01/25 09/29/25 10/29/25 11/07/25
25-0012 SFY26 Provider Inflationary Increase and Rural Emergency Hospitals
Implements inflationary rate increases appropriated by the state legislature during the 2025 legislative session effective July 1, 2025, and coverage and reimbursement for Rural Emergency Hospitals under the Clinic Services benefit.		 07/01/25 06/23/25 07/23/25 07/31/25

Approved State Plan Amendments
SPA# Description Effective Public Comment Start Date Public Comment Period Ends Submitted to CMS Approved
25-0016 CHIP Eligibility - Incarcerated Beneficiaries
Provides assurance that the State is in compliance with requirements in Section 5121 of the Consolidated Appropriations Act, 2023 regarding eligibility of Targeted Low-Income Children (TLIC) who are or become incarcerated. 		07/01/25 12/15/25 01/14/26 01/23/26 03/30/26
25-0010 SFY26 Health Home Inflationary Increase
Implements the inflationary rate increases appropriated by the state legislature during the 2025 legislative.		 06/01/25 05/12/25 06/11/25 09/09/25 12/01/25
25-0014 CHIP Benefits
Clarifies that pregnancy-related doula services, community health worker (CHW) services, and peer support services are covered under the CHIP State Plan to align with benefits under the Medicaid State Plan. 		01/01/25 06/23/25 07/23/25 06/27/25 09/04/25
25-0007 Behavioral Health Peer Support Services and Inflationary Increase
Implements community mental health center (CMHC) and substance use disorder (SUD) agency rate increases appropriated by the state legislature during the 2025 legislative session and adds coverage and provider qualifications for non-clinical individual and group peer support services.		 06/01/25 04/28/25 05/28/25 06/13/25 09/03/25
25-0011 CY24 Care Coordination Supplemental Payments
Updates the care coordination provider list and supplemental payment amounts. 		 06/01/25 05/12/25 06/11/25 06/13/25 09/02/25
25-0013 Doula Services - Alternative Benefit Plan
Brings the Alternative Benefit Plan for the expanded adult population into alignment with the Medicaid State Plan amendment (SPA #24-0017) to add coverage of doula services.		 01/01/25 04/14/25 05/14/24 05/23/25 08/14/25
25-0003 Juvenile Justice and Targeted Case Management
Implements targeted case management services in the 30 days prior to release from public institutions for eligible juveniles under 21 years of age or between ages 18-26 for recipients in the former foster care group in accordance with Section 5121 of the Consolidated Appropriations Act, 2023.		 01/01/25 12/16/24 01/15/24 01/30/25 07/11/25
25-0004 Targeted Case Management
Implements targeted case management services in the 30 days prior to release from public institutions for eligible juveniles under 21 years of age or between ages 18-26 for recipients in the former foster care group in accordance with Section 5121 of the Consolidated Appropriations Act, 2023.		 01/01/25 12/16/24 01/15/24 01/30/25 06/17/25
25-0008 Clinic Services Four Walls Exception
Provides assurance that South Dakota Medicaid covers clinic services furnished outside the clinic to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address and outside a clinic operated by the IHS or by a Tribe or Tribal organization by clinic personnel under the direction of a physician as required by CMS.		 01/01/25 03/17/25 04/16/25 03/18/25 06/13/25

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South Dakota Medicaid State Plan
Table of Contents

1.0 SINGLE STATE AGENCY ORGANIZATION

2.0 COVERAGE AND ELIGIBILITY

2.1 Application, Determination of Eligibility and Furnishing Medicaid

2.2 Coverage and Conditions of Eligibility

2.3 Residence

2.4 Blindness

2.5 Disability

2.6 Financial Eligibility

2.7 Medicaid Furnished Out of State

3.0 SERVICES: GENERAL PROVISIONS

3.1 Amount, Duration, and Scope of Services

3.2 Medicaid, Medicare and Other Insurance

3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases

3.4 Special Requirements Applicable to Sterilization Procedures

3.5 Families Receiving Extended Medicaid Benefits

4.0 GENERAL PROGRAM ADMINISTRATION

5.0 PERSONNEL ADMINISTRATION

6.0 FINANCIAL ADMINISTRATION

7.0 GENERAL PROVISIONS

A MEDICAID ADMINISTRATION

S MEDICAID ELIGIBILITY

ALTERNATIVE BENEFIT PLAN