If you live in South Dakota and need affordable health coverage, Medicaid could be the answer. South Dakota Medicaid is a joint federal and state program that pays for doctor visits, hospital stays, prescriptions, dental care, vision care, and other medically necessary services. Since South Dakota expanded Medicaid in July 2023, tens of thousands of additional residents now qualify for free or low-cost coverage. This guide walks you through everything you need to know about how to apply for Medicaid in South Dakota, including who qualifies, income limits for 2026, and the exact steps to submit your application.
Not sure if you qualify for Medicaid or other benefits? Check your eligibility in minutes with our free screener.
Who Qualifies for South Dakota Medicaid?
South Dakota Medicaid covers several groups of residents. Thanks to Medicaid expansion, adults between 19 and 64 years old can now qualify based on income alone, without needing to have children or a disability. Here are the main coverage groups:
- Adults (ages 19 to 64) under the Medicaid expansion program
- Children and youth under 19 through the Children's Health Insurance Program (CHIP)
- Pregnant women regardless of insurance status
- Low-income families with a dependent child and a parent or caretaker relative
- Seniors age 65 and older who are also eligible for Medicare
- Individuals with disabilities including those who are blind
- Newborns born to mothers on Medicaid at the time of birth
To qualify for any of these groups, you must be a resident of South Dakota and meet certain citizenship or immigration requirements.
South Dakota Medicaid Income Limits for 2026
Income limits vary depending on which coverage group you fall into and the size of your household. The tables below show the maximum gross monthly income allowed for each group.
Medicaid Expansion (Adults 19 to 64)
| Household Size | Maximum Gross Monthly Income |
|---|---|
| 1 | $1,835 |
| 2 | $2,488 |
| 3 | $3,142 |
| 4 | $3,795 |
| 5 | $4,448 |
| 6 | $5,102 |
| 7 | $5,755 |
| 8 | $6,407 |
This is approximately 138% of the Federal Poverty Level (with a 5% income disregard).
Children's Health Insurance Program (CHIP)
Children under 19 may qualify for CHIP. Income limits depend on whether the child already has private health insurance.
Children Without Private Health Insurance:
| Household Size | Maximum Gross Monthly Income |
|---|---|
| 1 | $2,780 |
| 2 | $3,768 |
| 3 | $4,759 |
| 4 | $5,748 |
| 5 | $6,736 |
| 6 | $7,727 |
| 7 | $8,715 |
| 8 | $9,704 |
Children With Private Health Insurance:
| Household Size | Maximum Gross Monthly Income |
|---|---|
| 1 | $2,487 |
| 2 | $3,372 |
| 3 | $4,258 |
| 4 | $5,143 |
| 5 | $6,027 |
| 6 | $6,913 |
| 7 | $7,798 |
| 8 | $8,682 |
Pregnant Women
| Household Size | Maximum Gross Monthly Income |
|---|---|
| 1 | $1,835 |
| 2 | $2,488 |
| 3 | $3,142 |
| 4 | $3,795 |
| 5 | $4,448 |
| 6 | $5,102 |
Pregnant women who qualify receive full medical coverage during pregnancy and for 12 months following the end of the pregnancy.
Low-Income Families
| Household Size | Maximum Gross Monthly Income |
|---|---|
| 1 | $590 |
| 2 | $740 |
| 3 | $842 |
| 4 | $941 |
| 5 | $1,042 |
| 6 | $1,145 |
| 7 | $1,244 |
| 8 | $1,343 |
This traditional Medicaid pathway requires the household to include a parent or caretaker relative and a dependent child under 18 (or under 19 if still a full-time high school student).
How to Apply for Medicaid in South Dakota: Step by Step
South Dakota offers three ways to apply. Choose whichever method works best for you.
Option 1: Apply Online (Fastest)
- Visit the online portal at https://eaportal.sd.gov
- Create an account with your name, email address, and a password
- Complete the application by entering information about your household, income, and citizenship status
- Upload supporting documents such as proof of income, identification, and residency
- Submit your application and save your confirmation number
The online portal is the fastest way to apply and is available 24 hours a day, 7 days a week.
Option 2: Apply by Paper
- Download the paper application from the South Dakota DSS website at https://dss.sd.gov/formsandpubs/docs/MEDELGBLTY/FSSA.pdf
- Fill out the form completely, making sure to include information about everyone in your household
- Attach copies of required documents (do not send originals)
- Mail or deliver the application to your local Department of Social Services office
Option 3: Apply in Person
- Find your local DSS office using the office locator at https://dss.sd.gov/findyourlocaloffice/
- Bring your documents including proof of identity, income, and residency
- Meet with a caseworker who will help you complete the application
Staff at local offices can answer questions and walk you through the entire process.
Documents You Will Need
Having the right documents ready before you start will speed up your application. Gather the following:
- Proof of identity such as a driver's license, state ID, or passport
- Social Security numbers for everyone in your household
- Proof of income including recent pay stubs, tax returns, or a letter from your employer
- Proof of residency such as a utility bill, lease agreement, or piece of mail with your South Dakota address
- Proof of citizenship or immigration status such as a birth certificate or immigration documents
- Proof of pregnancy (if applying under the pregnant women category)
- Proof of disability (if applicable)
- Information about current health insurance if you or your children already have coverage
What Happens After You Apply
After you submit your application, the South Dakota Department of Social Services will review your information and verify your eligibility. Here is what to expect:
- Your application is received and assigned to a caseworker
- DSS may contact you if they need additional information or documents
- A determination is made and you will receive a notice in the mail telling you whether you have been approved or denied
- If approved, your coverage start date will depend on when you applied. Medicaid coverage can sometimes be backdated up to three months before your application date if you were eligible during that time
- If denied, the notice will explain the reason and your right to appeal the decision
Other Medicaid Programs in South Dakota
Beyond the standard coverage groups, South Dakota offers several specialized Medicaid programs:
- Medicare Savings Program: Helps pay Medicare premiums, deductibles, and coinsurance. This program can save eligible individuals up to $2,434.80 per year. The resource limit is $9,950 for an individual and $14,910 for a couple.
- Medicaid for Workers with Disabilities (MAWD): Covers employed individuals with disabilities whose income is up to 250% of the Federal Poverty Level.
- Breast and Cervical Cancer Program: Provides Medicaid coverage for uninsured women screened through the state's Breast and Cervical Cancer Control Program. The yearly income limit is up to $39,125.
- Nursing Facility and Long-Term Care Medicaid: For individuals age 65 and older (or those who are blind or disabled) who need nursing home level care. The monthly income limit is $2,982 in 2026 with a resource limit of $2,000.
For a complete overview of programs available to South Dakota residents, visit our South Dakota Benefits Overview page.
Tips for a Successful Application
- Apply as soon as possible. Do not wait until you have a medical emergency. Coverage can take time to process.
- Be thorough and accurate. Incomplete applications cause delays. Double check all information before submitting.
- Respond quickly to requests. If DSS asks for additional documents, send them right away to avoid having your application delayed or denied.
- Keep copies of everything. Save a copy of your application and all documents you submit.
- Ask for help if you need it. Visit a local DSS office or call for assistance if you have questions.
Frequently Asked Questions
How long does it take to get approved for Medicaid in South Dakota?
Processing times vary, but most applications are reviewed within 45 days. Applications based on disability may take up to 90 days. You can check the status of your application through the online portal at https://eaportal.sd.gov or by contacting your local DSS office.
Can I apply for Medicaid if I already have health insurance?
Yes. Having private health insurance does not automatically disqualify you from Medicaid. In fact, CHIP has specific income limits for children who already have private insurance. Apply to find out if you qualify for additional coverage.
Does South Dakota have Medicaid expansion?
Yes. South Dakota expanded Medicaid effective July 1, 2023. This means adults ages 19 to 64 with household incomes at or below 138% of the Federal Poverty Level can qualify for Medicaid, even if they do not have children or a disability.
What does South Dakota Medicaid cover?
South Dakota Medicaid covers a wide range of services including doctor visits, hospital stays, prescriptions, dental care, vision care, mental health services, and preventive care such as immunizations and screenings.
Can I get Medicaid if I am pregnant?
Yes. Pregnant women in South Dakota can qualify for full Medicaid coverage during pregnancy and for 12 months after the pregnancy ends. Income limits for pregnant women are the same as the Medicaid expansion group (approximately 138% FPL).
What if my application is denied?
If your application is denied, you will receive a written notice explaining the reason. You have the right to request a fair hearing to appeal the decision. The notice will include instructions on how to file an appeal and the deadline for doing so.
Can I apply for other benefits at the same time?
Yes. When you apply through the South Dakota online portal or at a local DSS office, you may also be screened for other programs such as SNAP (food assistance), TANF (cash assistance), and energy assistance. You can also use our free benefits screener to check your eligibility for multiple programs at once.
Start Your Application Today
Applying for Medicaid in South Dakota is straightforward whether you choose to apply online, by paper, or in person. The quickest way to get started is through the online portal at https://eaportal.sd.gov. If you are unsure whether you qualify, use our free eligibility screener to check in just a few minutes. You may also qualify for additional programs like SNAP, CHIP, or energy assistance that can help your family save money.
For more information about all the benefits available in your state, visit our South Dakota Benefits Overview.
