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South Dakota Medicaid

The Medical Assistance for Low-Income Families (LIF) program is designed to help low-income South Dakota families (with or without private health insurance) receive full medical assistance coverage. LIF is funded through the Medicaid program.

Program Name South Dakota Medicaid
Expanded Medicaid No
Website https://dss.sd.gov/medicaid/
Phone 877-999-5612
Apply Online https://apps.sd.gov/ss36snap/web/Portal/Default.aspx
Appeal a Denial Request a Fair Hearing
Find a Local Office https://dss.sd.gov/findyourlocaloffice/

Eligibility Requirements

To be eligible for South Dakota Medicaid, you must be a resident of the state of South Dakota, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

You must also be one of the following:

  • Pregnant
  • Be responsible for a child 18 years of age or younger
  • Have a disability or a family member in your household with a disability

Annual Household Income Limits (before taxes)

Household Size* Maximum Income Level (Per Year)
1 $17,131
2 $23,169
3 $29,207
4 $35,245
5 $41,284
6 $47,322
7 $53,360
8 $59,398

*For households with more than eight people, add $6,038 per additional person.

Available Services Include:

Chiropractic Medical equipment and supplies
Dental Mental health
Diabetes education Nursing home
Dietician and nutritionist Personal care
Family planning Podiatry
Home health Prescription drugs
Hospice Substance use disorder
Hospital Transportation coverage
Medical and surgical services Vision

Copayments

Ambulatory Surgical Centers 5% up to $50.00
Chiropractic Services $1.00
Dental Services $3.00
Dentures $3.00
Diabetes Education $3.00
Dieticians and Nutritionist Services $3.00
Durable Medical Equipment 5% of allowable reimbursement
Rural Health Clinics $3.00
Independent Mental Health Practitioners $3.00
Inpatient Hospital Services $50.00
Mental Health Clinics 5% of allowable reimbursement
Nutrition Services $2.00 – $5.00
Optometric Services $2.00
Optical Supply $2.00
Outpatient Hospital Services 5% of allowable reimbursement ($50.00)
Physician Services $3.00
Podiatry Services $2.00
Prescription Drugs $1.00 – $3.30

Individuals exempt from cost sharing include:

  • Children under age 21
  • Individuals receiving hospice care
  • Individuals residing in a long-term care facility
  • Some Native American Indians
  • Individuals eligible for Medicaid through the Breast and Cervical Cancer program

Services exempt from cost sharing include:

  • True emergency services
  • Family planning services and supplies
  • Services relating to a pregnancy
  • Provider-preventable services
  • Laboratory services
  • Psychiatric inpatient and rehabilitation services;
  • Radiological services
  • Substance use disorder treatment

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