South Dakota Medicaid provides free or low-cost health coverage to eligible residents, including adults, children, pregnant women, and seniors. Since voters approved Medicaid expansion through Amendment D in November 2022, adults ages 19 to 64 can now qualify for coverage at higher income levels than ever before. This guide covers everything you need to know about South Dakota Medicaid eligibility in 2026, including current income limits, available programs, and how to apply.
Not sure if you qualify? Check your eligibility in minutes with our free screening tool.
South Dakota Medicaid Expansion: What Changed
South Dakota became one of the most recent states to expand Medicaid when voters approved Constitutional Amendment D in the November 2022 election with 56% of the vote. Expansion took effect in July 2023, opening coverage to adults ages 19 to 64 with household incomes up to 138% of the Federal Poverty Level (FPL).
Before expansion, non-disabled adults without dependent children had very limited pathways to Medicaid coverage. Now, tens of thousands of additional South Dakotans can access health insurance through the program.
For more state benefits information, visit our South Dakota Benefits Overview.
2026 Income Limits by Coverage Group
South Dakota Medicaid has several coverage groups, each with its own income thresholds. The following tables reflect the current income limits published by the South Dakota Department of Social Services (DSS).
Medicaid Expansion: Adult Group (Ages 19 to 64)
Adults ages 19 to 64, with or without private health insurance, may qualify for free or low-cost Medicaid coverage including regular checkups, dental care, and vision care.
| 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 |
These limits correspond to approximately 138% of the Federal Poverty Level.
Children's Health Insurance Program (CHIP)
CHIP covers children under age 19 who are South Dakota residents. Income limits differ depending on whether the child already has private health insurance.
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 |
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 |
Uninsured children qualify at higher income thresholds than those who already carry private coverage.
Low-Income Families
Families with a parent or caretaker relative and a dependent child under 18 (or under 19 if still a full-time high school student) may qualify under the low-income families group.
| 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 |
These limits are significantly lower than the expansion adult group. If your income exceeds these thresholds, you may still qualify under the Medicaid expansion adult group described above.
Pregnant Women
Pregnant women who meet income limits and general eligibility requirements can receive full medical coverage through South Dakota Medicaid. Coverage includes the pregnancy and extends for 12 months following the end of the pregnancy (postpartum coverage).
| 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 |
Note: The unborn child counts as a household member when determining household size.
Newborns
Children born to women who are eligible for and receiving South Dakota Medicaid at the time of birth automatically qualify for Medicaid. There is no income or resource test for the newborn. Coverage continues from the month of birth through the end of the month in which the child turns one year old, as long as the child remains a South Dakota resident.
Seniors and Individuals with Disabilities (Nursing Home/Long-Term Care)
Individuals who are 65 or older, or who are blind or disabled, may qualify for Medicaid coverage for nursing home or long-term care.
- Monthly income limit: $2,982 (300% of the SSI Standard Benefit Amount in 2026)
- Resource limit: $2,000 (includes checking and savings accounts, certificates of deposit)
- Must require a nursing home level of care
Medicare Savings Program
The Medicare Savings Program helps eligible individuals pay Medicare expenses, potentially saving up to $2,434.80 per year. This program covers Medicare Part A and Part B premiums, deductibles, and coinsurance depending on the specific coverage group.
- Resource limit: $9,950 for an individual, $14,910 for a couple
- Income limits are based on family size and adjusted household income
Breast and Cervical Cancer Program
Uninsured women screened through South Dakota's Breast and Cervical Cancer Control Program who need treatment may qualify for Medicaid. The annual income limit for this program is up to $39,125.
What South Dakota Medicaid Covers
South Dakota Medicaid covers a wide range of medically necessary services, including:
- Doctor visits and preventive care
- Hospital stays (inpatient and outpatient)
- Prescription medications
- Dental care
- Vision care
- Mental health and substance abuse treatment
- Lab tests and X-rays
- Well-child checkups and immunizations
- Family planning services
- Home and community-based services (for eligible seniors and individuals with disabilities)
How to Apply for South Dakota Medicaid: Step by Step
Applying for South Dakota Medicaid is straightforward. The South Dakota Department of Social Services offers three ways to apply:
Step 1: Gather Required Documents
Before starting your application, collect the following:
- Social Security numbers for all household members
- Proof of income (pay stubs, tax returns, or employer statements)
- Proof of South Dakota residency (utility bill, lease, or ID)
- Proof of citizenship or immigration status
- Information about any current health insurance
- Bank account and asset information (for certain programs)
Step 2: Choose Your Application Method
Option 1: Apply Online (Fastest)
Visit the South Dakota Economic Assistance Portal at eaportal.sd.gov to submit your application electronically. This is the quickest and most convenient method.
Option 2: Paper Application
Download and print the application form from the DSS website. Complete it and mail or deliver it to your local DSS office.
Option 3: Visit a Local Office
Find your nearest DSS office at dss.sd.gov/findyourlocaloffice. Staff can help you complete and submit your application in person.
Step 3: Submit Your Application
Send in your completed application along with all required documentation. Missing documents can delay processing.
Step 4: Wait for a Determination
South Dakota DSS will review your application and notify you of your eligibility. Processing typically takes up to 45 days for most Medicaid applications (90 days for disability-based applications). You may be contacted for additional information during the review process.
Step 5: Receive Your Benefits
If approved, you will receive information about your coverage, including how to select a Primary Care Provider and begin using your benefits.
General Eligibility Requirements
In addition to meeting income limits for a specific coverage group, applicants must:
- Be a resident of South Dakota
- Be a U.S. citizen or meet qualifying immigration status requirements
- Provide a Social Security number
- Not be currently incarcerated (with limited exceptions)
Frequently Asked Questions
Who qualifies for South Dakota Medicaid in 2026?
Adults ages 19 to 64 with household incomes up to 138% of the Federal Poverty Level qualify under Medicaid expansion. Children, pregnant women, seniors, and individuals with disabilities each have their own eligibility groups with varying income limits. Use our free screening tool to check your eligibility quickly.
Does South Dakota have Medicaid expansion?
Yes. South Dakota voters approved Medicaid expansion through Constitutional Amendment D in November 2022, and it took effect in July 2023. This extended coverage to adults ages 19 to 64 earning up to 138% of the Federal Poverty Level.
How do I apply for Medicaid in South Dakota?
You can apply online at eaportal.sd.gov, submit a paper application by mail, or visit a local DSS office in person. The online portal is the fastest option.
What is the income limit for a family of 4 on South Dakota Medicaid?
For the Medicaid expansion adult group, a family of 4 can earn up to $3,795 per month in gross income. For CHIP (uninsured children), the limit is $5,748 per month for a household of 4.
Does South Dakota Medicaid cover dental and vision?
Yes. South Dakota Medicaid covers dental care and vision care for eligible enrollees, including regular checkups.
How long does it take to get approved for Medicaid in South Dakota?
Most applications are processed within 45 days. Disability-based applications may take up to 90 days. Applying online through the state portal can help speed up the process.
Can I have private insurance and still qualify for Medicaid?
Yes. Having private health insurance does not automatically disqualify you from South Dakota Medicaid. The adult expansion group and CHIP both allow enrollment for individuals who already have private coverage, though income limits for CHIP may vary based on insurance status.
What happens if my income changes after I am approved?
You are required to report changes in income, household size, and other circumstances to the Department of Social Services. Your eligibility will be reviewed, and your benefits may be adjusted accordingly.
Check Your Eligibility Today
Navigating Medicaid eligibility can feel overwhelming with so many coverage groups and income thresholds. Our free benefits screening tool simplifies the process by checking your eligibility for Medicaid and 10 or more other programs in just a few minutes.
Check your eligibility now with our free screener to see what benefits you and your family may qualify for in South Dakota.
