South Dakota Medicaid

Last verified: June 2026

What is South Dakota Medicaid?

South Dakota Medicaid is administered by the Department of Social Services (DSS). South Dakota expanded Medicaid through Amendment D, a citizen initiative passed by voters in November 2022 with approximately 56% approval. Expansion took effect July 1, 2023 — making South Dakota one of the last states in the country to expand Medicaid under the ACA and the most recent state as of 2026 to have done so through a ballot initiative.

Before Amendment D, South Dakota had not previously expanded Medicaid despite multiple legislative proposals. The ballot initiative bypassed the state legislature — a significant political development. As of 2025, approximately 160,000 South Dakotans are enrolled in Medicaid total, with tens of thousands having gained coverage through the expansion.

South Dakota uses a fee-for-service model for most Medicaid populations — members can see any South Dakota Medicaid-enrolled provider without MCO assignment. DSS administers the program from Pierre, with local county offices across the state handling applications and case management.

Who qualifies for South Dakota Medicaid?

Since July 1, 2023, South Dakota covers adults 19–64 at or below 138% FPL. Children and pregnant women have separate eligibility thresholds.

• Adults ages 19–64 (Amendment D expansion): at or below 138% FPL — approximately $20,783/year for a single person in 2026
• Children under age 19: up to 207% FPL through Medicaid or South Dakota CHIP
• Pregnant women: up to 133% FPL
• Seniors and people with disabilities: income and asset rules vary — contact DSS
• Parents and caretaker relatives: income limits vary by household size
• Medicare Savings Programs: help low-income Medicare beneficiaries with premium costs

Source: South Dakota DSS Medicaid eligibility information (dss.sd.gov/medicaid); DSS medical programs page. Verify current limits at dss.sd.gov or by calling 1-888-828-0059.

How South Dakota Medicaid is delivered

South Dakota operates Medicaid primarily through a fee-for-service model. Unlike managed care states where members are enrolled in an MCO, South Dakota Medicaid members can see any provider enrolled in the state Medicaid program without a plan assignment. DSS pays providers directly based on claims.

South Dakota does operate a Primary Care Provider (PCP) selection program for some Medicaid populations — members can choose a primary care provider to coordinate their care. Per DSS, the PCP selection portal is available at pcphhselection.appssd.sd.gov.

Apply online through the DSS Electronic Assistance Portal at eaportal.sd.gov, by printing a paper application at dss.sd.gov, or by visiting your local DSS county office. Call 1-888-828-0059 for help.

Amendment D: South Dakota's path to Medicaid expansion

Amendment D was notable for multiple reasons. South Dakota's Republican-controlled legislature had blocked Medicaid expansion for years. The 2022 ballot initiative succeeded with bipartisan support — a rural conservative state voting to expand Medicaid reflected both the popularity of the policy at the individual level and the economic argument that expansion brought federal dollars into the state. Per DSS, the federal government pays 90% of the costs of the expansion population, with South Dakota paying the remaining 10%.

South Dakota Medicaid topics

What does South Dakota Medicaid cover?

Medicaid covers a broad range of health services. Federal law mandates certain benefits — inpatient and outpatient hospital care, physician services, lab work, X-rays, and nursing facility services, among others. States add optional services on top of those. Dental, vision, and long-term home care coverage vary by state.

The national benefits overview lists required and commonly optional services. Check the South Dakota Medicaid website for the current state-specific benefit package.

How to apply

Most people can apply online through South Dakota's Medicaid portal, by phone, or in person at a local eligibility office. The how to apply page walks through each method, what documents you'll need, and what to expect during the review period.

Under 42 CFR 435.912, states must process most standard Medicaid applications within 45 days (90 days for disability-based applications). South Dakota must follow that federal timeline.