South Dakota Medicaid income limits
Last verified: June 2026
Verify current limits with South Dakota Medicaid
Income limits reflect Amendment D expansion effective July 1, 2023 — verify current figures with DSS
South Dakota Medicaid income limits by coverage group (2026)
South Dakota's income limits reflect the state's relatively recent expansion. Adults qualify at the standard ACA expansion level of 138% FPL — a group that did not exist in South Dakota Medicaid before July 2023. Children qualify at significantly higher income levels through Medicaid and the state's CHIP program.
| Coverage group | FPL % | Monthly limit (household of 1) | Monthly limit (household of 4) |
|---|---|---|---|
| Adults ages 19–64 (Amendment D expansion) | 138% FPL | ~$1,732/mo | ~$3,564/mo |
| Pregnant women | 133% FPL | ~$1,669/mo | ~$3,433/mo |
| Children (Medicaid and CHIP) | Up to 207% FPL | ~$2,598/mo | ~$5,345/mo |
Source: South Dakota DSS Medicaid eligibility information; 2026 HHS Federal Poverty Guidelines. Income figures are approximate monthly gross amounts. The 5% MAGI income disregard applies to the adult expansion group. Contact DSS at 1-888-828-0059 for exact current figures for your household size.
No asset test for MAGI-based South Dakota Medicaid
South Dakota does not use an asset test for MAGI-based Medicaid — the category covering adults 19–64 (expansion), children, and pregnant women. Savings, vehicles, and home equity are not assessed.
Long-term care Medicaid — for seniors needing nursing facility or home-based care — does apply income and asset limits. The asset limit for nursing facility care is $2,000 for a single applicant. Contact DSS for current income limits and look-back period rules for long-term care eligibility.
What Amendment D changed for South Dakota adults
Before Amendment D took effect on July 1, 2023, adults without dependent children generally could not qualify for South Dakota Medicaid unless they met a disability standard. Parents and caretakers qualified only at very low income levels. The expansion changed this substantially — any adult 19–64 earning at or below 138% FPL can now qualify, regardless of parental or disability status.
South Dakota is notable for having enacted expansion through a ballot initiative despite consistent legislative opposition. The amendment passed with constitutional language that requires the state to implement expansion — language designed to prevent future legislative reversal. Per DSS, the expansion population is funded at a 90% federal / 10% state match, the same rate that applies to all ACA expansion states.
How Medicaid income limits work
Medicaid eligibility is tied to the Federal Poverty Level (FPL), a measure the Department of Health and Human Services updates each January. States set their income limits as a percentage of FPL — so when FPL increases, the dollar thresholds for Medicaid also shift.
The Affordable Care Act established a standard income methodology called Modified Adjusted Gross Income (MAGI) for most Medicaid applicants. Under MAGI, the agency counts wages, salaries, self-employment income, Social Security benefits, and most other taxable income. Assets — a savings account, vehicle, home — are not counted for MAGI-based programs. That changed with the ACA and applies in all states.
States that expanded Medicaid under the ACA cover most adults at or below 138% FPL. In non-expansion states, income limits for adults without dependent children are far lower — sometimes as low as a few hundred dollars per month — or eligibility for that category simply doesn't exist.
These are federal guidelines — state limits may differ
What counts as income under MAGI
MAGI (Modified Adjusted Gross Income) is the income standard for most Medicaid applicants — children, adults under 65, pregnant women, and parents. It includes wages, salary, tips, self-employment income, unemployment benefits, Social Security retirement and disability benefits (SSDI), and most other taxable income.
It does not count child support received, gifts, loans, inheritances that are not generating income, or Supplemental Security Income (SSI) payments. One key MAGI rule: the ACA added a 5% FPL income disregard for most adults, which effectively raises the usable threshold by that amount. So a state with a 133% FPL limit effectively covers adults to about 138% FPL after the disregard.
Assets — a bank account, car, or home — are not counted for MAGI-based programs. That's a major difference from old-law Medicaid, where asset tests were common. If you previously didn't qualify because of assets, your eligibility may have changed after the ACA.
Asset limits and long-term care Medicaid
MAGI-based programs have no asset test. But Medicaid programs that cover long-term care — nursing home care, home and community-based services for seniors — use the old income and asset methodology, which does include asset limits.
Asset limits for long-term care Medicaid vary by state and are updated periodically. Generally, countable assets above the limit must be spent down before an applicant qualifies. Exempt assets — the primary home (in most circumstances), one vehicle, and certain personal property — are not counted.
Specific asset limits for South Dakota's long-term care programs are on the seniors and long-term care page. The thresholds change, so verify current figures with South Dakota Medicaid directly.