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