South Dakota Medicaid Income Limits for Adults (2026)
Adults age 19 to 64 qualify under the Medicaid expansion at up to 138% of the Federal Poverty Level (FPL). South Dakota expanded Medicaid on July 1, 2023. As of 2026, work requirements have not been implemented, though voters approved Amendment F in November 2024 allowing the legislature to pursue them pending federal approval.
| Household Size | Annual Income Limit (138% FPL) | Monthly Income Limit |
|---|
| 1 | $20,783 | $1,732 |
| 2 | $28,207 | $2,351 |
| 3 | $35,632 | $2,969 |
| 4 | $43,056 | $3,588 |
| 5 | $50,480 | $4,207 |
| 6 | $57,905 | $4,825 |
| 7 | $65,329 | $5,444 |
| 8 | $72,754 | $6,063 |
For each person beyond 8 in the household, add approximately $7,424 to the annual limit.
Income counted generally includes wages, self-employment income, Social Security benefits, pensions, and other regular income before taxes.
South Dakota Medicaid Income Limits for Children (2026)
South Dakota covers children under different thresholds depending on whether they qualify for full Medicaid or CHIP (Children's Health Insurance Program).
| Program | FPL Percentage | Who It Covers |
|---|
| Medicaid for Children | Up to 187% FPL | Children ages 0 to 18 |
| CHIP (without private insurance) | Up to 209% FPL | Children ages 0 to 18 |
| CHIP (with existing private insurance) | Up to 204% FPL | Children with private coverage |
Monthly income limits for children's Medicaid (187% FPL) range from approximately $2,487/month for a household of 1 to $8,682/month for a household of 8. CHIP limits are slightly higher.
Newborns born to mothers enrolled in Medicaid are automatically eligible through age one with no separate income or resource test.
South Dakota Medicaid Income Limits for Pregnant Women (2026)
Pregnant women qualify for full Medicaid coverage at the same income thresholds as the adult expansion group: up to 138% FPL. Coverage continues for 12 months after the end of the pregnancy under the postpartum extension.
| Household Size | Monthly Income Limit |
|---|
| 1 | $1,835 |
| 2 | $2,480 |
| 3 | $3,125 |
| 4 | $3,770 |
| 5 | $4,415 |
Note: The DSS lists slightly higher figures for pregnant women in some program documents. Confirm the exact limit for your household size with DSS when you apply.
South Dakota Medicaid for Seniors and People with Disabilities (2026)
Seniors and people with disabilities who do not qualify under the expansion group are covered through different eligibility tracks with separate income and asset rules.
Regular Medicaid (Aged, Blind, Disabled)
| Household Size | Monthly Income Limit | Asset Limit |
|---|
| Single | $994/month | $2,000 |
| Married couple | $1,491/month | $3,000 |
Nursing Home and Long-Term Care Medicaid
| Applicant Status | Monthly Income Limit | Asset Limit |
|---|
| Single applicant | $2,982 | $2,000 |
| Married (both applying) | $5,964 combined | $3,000 combined |
| Married (one applying) | $2,982 | $2,000 (applicant); up to $162,660 (spouse) |
The $2,982 income limit reflects 300% of the SSI standard benefit amount for 2026.
Home and Community-Based Services (HCBS) Waivers
South Dakota runs several HCBS waiver programs for people who need nursing-home-level care but want to remain in the community. The income limit for all HCBS waivers is $2,982/month with a $2,000 asset limit for a single applicant.
Waiver programs include:
- HOPE Waiver (assisted living and home-based care for seniors)
- CHOICES Waiver (adults with developmental disabilities)
- Family Support 360 Waiver
- ADLS Waiver (adults with quadriplegia)
Other Medicaid Coverage Groups
Medicaid for Workers with Disabilities (MAWD): Adults who are employed and have a significant disability may qualify with incomes up to 250% FPL and assets under $8,000.
Chronic Renal Disease Program: Income limit is 150% FPL with asset limits of $4,000 for individuals and $6,000 for couples.
Breast and Cervical Cancer Program: Annual income limit of approximately $39,125 for uninsured women screened through the state program.
Former Foster Care Youth: Adults age 18 to 26 who were in foster care at age 18 qualify with no income or resource limit.
Low-Income Families (Parents and Caretakers): Parents with dependent children qualify at lower income thresholds, ranging from approximately $590/month for a household of 1 to $1,343/month for a household of 8.
Refugee Medical Assistance: Refugees may qualify for four months of coverage from their U.S. entry date if they meet income and resource criteria.
Medicare Savings Programs
South Dakota Medicaid includes Medicare Savings Programs for low-income seniors who already have Medicare. These programs help pay Medicare premiums, deductibles, and copays. The resource limits are $9,950 for individuals and $14,910 for couples, with potential annual savings of approximately $2,434.80 or more depending on the program tier.
Asset Limits in South Dakota Medicaid
Asset limits vary by program. Some assets are exempt from counting, including:
- Your primary home (if you or your spouse lives there)
- One vehicle
- Household goods and personal belongings
- Life insurance with cash value under $1,500
- Burial funds up to certain limits
For long-term care Medicaid, there is a 60-month look-back period. Gifts or transfers of assets made in the five years before applying may trigger a penalty period during which Medicaid will not pay for nursing home care.
The home equity limit for long-term care Medicaid in South Dakota is $752,000 in 2026.
For married couples where one spouse applies for nursing home care, the community spouse (the one at home) can keep up to $162,660 in assets and a minimum monthly income of $2,643.75, which can increase up to $4,066.50 depending on shelter costs.
How to Apply for Medicaid in South Dakota
Step 1: Check Your Eligibility
Use the free screener at BenefitsUSA to see which programs you may qualify for based on your income, household size, and situation. This takes about 5 minutes and covers Medicaid alongside other programs you may not know about.
Step 2: Gather Your Documents
Before applying, collect:
- Proof of identity (driver's license, passport, birth certificate)
- Proof of South Dakota residency (utility bill, lease, bank statement)
- Social Security numbers for all household members
- Proof of income (pay stubs, tax returns, Social Security award letters)
- Bank statements and information on assets (for long-term care programs)
- Proof of immigration status if applicable
Step 3: Submit Your Application
You can apply in three ways:
Online: Apply at https://dss.sd.gov/economicassistance/medical_eligibility.aspx through the South Dakota DSS portal. This is the fastest method.
By mail or in person: Download the paper application from the DSS website and mail it or bring it to your local DSS office. Find your local office at dss.sd.gov.
By phone: Call the South Dakota DSS at 1-800-597-1603 to get help with your application.
Step 4: Attend an Interview if Required
Some applicants may need to participate in a phone or in-person interview. DSS will contact you if this is needed.
Step 5: Receive Your Decision
Most applications are processed within 45 days. Applications for people who are aged, blind, or disabled may take up to 90 days. If approved, you will receive a Medicaid card and information about your coverage. If denied, you have the right to appeal the decision.
What Does South Dakota Medicaid Cover?
South Dakota Medicaid covers a broad range of services including:
- Doctor visits and preventive care
- Hospital stays (inpatient and outpatient)
- Emergency care
- Prescription drugs
- Mental health and substance use treatment
- Dental and vision care for children
- Long-term care services (nursing home and home-based)
- Behavioral health services
Coverage specifics depend on which Medicaid category you qualify under.
Reporting Changes
If your income, household size, or other circumstances change after you enroll, you are required to report those changes to DSS within 10 days. Changes can affect your eligibility or the amount of any cost-sharing you owe. You can report changes by logging into your online account, calling DSS, or visiting a local office.
Check Your Eligibility Today
Not sure which program you qualify for? The BenefitsUSA screener checks Medicaid eligibility alongside 11 other programs in about 5 minutes. It is free, confidential, and available for residents throughout South Dakota.
Frequently Asked Questions
What is the income limit for Medicaid in South Dakota in 2026?
For adults age 19 to 64, the income limit is 138% of the Federal Poverty Level. That works out to $1,732/month for a single person and $2,351/month for a household of 2. Children qualify at 187% FPL, and CHIP covers children up to 209% FPL.
Did South Dakota expand Medicaid?
Yes. South Dakota voters approved Medicaid expansion by ballot measure, and coverage for adults under the expansion took effect on July 1, 2023. Adults ages 19 to 64 earning up to 138% FPL can now qualify regardless of whether they have children or a disability.
Are work requirements in place for South Dakota Medicaid in 2026?
As of May 2026, work requirements are not yet in effect. Voters approved Amendment F in November 2024, which allows the legislature to create work requirements, but any such requirement also needs federal approval before it can be enforced.
Can I get Medicaid if I have a job?
Yes. Medicaid is not limited to people who are unemployed. If your income falls below the threshold for your household size, you may qualify even if you are working. South Dakota also has the Medicaid for Workers with Disabilities (MAWD) program for employed people with disabilities who earn up to 250% FPL.
What assets are counted for South Dakota Medicaid?
For most Medicaid programs (not long-term care), there is no asset test. For long-term care Medicaid, the asset limit is generally $2,000 for a single applicant. Exempt assets include your home, one vehicle, household goods, and certain burial funds.
How long does it take to get approved for Medicaid in South Dakota?
Most applications are decided within 45 days. Applications involving disability determinations may take up to 90 days. If you are approved, your coverage may be backdated to the first of the month you applied or up to three months before your application in some cases.
What if I am denied Medicaid in South Dakota?
If your application is denied, you have the right to appeal. The denial notice will include instructions for how to request a fair hearing. You can also contact the South Dakota DSS at 1-800-597-1603 for help understanding why you were denied.
Is there a difference between Medicaid and CHIP in South Dakota?
Yes. Medicaid is federally funded health coverage for qualifying individuals. CHIP (Children's Health Insurance Program), known in South Dakota as the Children's Health Insurance Plan, covers children in families that earn too much to qualify for Medicaid but cannot afford private coverage. CHIP in South Dakota covers children up to 209% FPL (or 204% FPL for children who already have private insurance).
How do I find a Medicaid provider in South Dakota?
Once enrolled, you can search for Medicaid-accepted providers through the South Dakota DSS provider directory at dss.sd.gov/medicaid. You can also call DSS at 1-800-597-1603 for help finding doctors and specialists near you.
