MEDICAID

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 Medicaid is a program that provides health coverage to some low-income South Dakota residents. Medicaid covers families with children, pregnant women, the elderly, and people with disabilities, if state and federal guidelines are met.  Legal residents who are not U.S. citizens may be eligible for Medicaid However, questions concerning immigration status and eligibility should be directed to the South Dakota Department of Social Services. 

  • For certain categories of people, eligibility for Medicaid is based on the amount of your household income.

In South Dakota you may be eligible for Medicaid if you are an infant, a child, pregnant, the parent of a dependent child, elderly, or disabled and your family income meets the Medicaid income standards.

Income eligibility levels for these categories are described below.  Your assets and some expenses also may be taken into account, so you should contact the South Dakota Department of Social Services for more information.

Low income persons eligible for Medicaid in South Dakota*

Category                           Income eligibility (as percent of federal poverty level)Infant                                140%
Child 0-19                          200% (monthly income of about $ 2,861or family of 3)
Pregnant woman                 133%
Parents
    Working                          58%
    Non-working                    58%
* Eligibility information was compiled from State Health Facts Online, the Kaiser
Family Foundation, and may have changed since this guide was published.  Contact your state Medicaid program for the most up-to-date information and for other eligibility requirements that may apply.

To get an idea of how your income compares to the federal poverty level*, use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2007:

Size of Family Unit                Poverty Guideline (annual income)
           1                                  $ 10,210
           2                                  $ 13,690
           3                                  $ 17,170
      For larger families add $3,480 for each additional person
-So, for example, using this guideline, 133% of the federal poverty level for a family of 3 would be an annual income of $22,836, or a monthly income of $1,903.

*Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply

  • Parents who receive benefits under Temporary Assistance for Needy Families (TANF) should also know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period.
  • Parents and children with or without private health insurance who meet income and resource guidelines may be eligible for Medicaid through the Low Income Families (LIF) program. The family must consist of a parent or other adult caretaker relative and a dependent child. Parents should know that when your income earned from a job increases and your Low Income Families Medicaid benefits end, you generally can stay on Medicaid for a 12-month transitional period.
  • Poor elderly or disabled people who get Supplemental Security Income (SSI) benefits automatically qualify for Medicaid.

Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage for a limited time.                                                                                     

  • Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you.

If your household income is below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance.  This is called the Qualified Medicare Beneficiary (QMB) program. 

If your household income is above 100% but below 120% of the poverty level, Medicaid will pay for your monthly Medicare premiums only.  This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.


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