South Dakota Medicaid Income Limits 2026: Eligibility & Requirements ($22,025/yr)

South Dakota Medicaid Income Limits 2026

The following table shows the key income thresholds for South Dakota in 2026:

Household Size	100% FPL	138% FPL (Medicaid Limit)	400% FPL (Subsidy Limit)
1	$15,960	$22,025	$63,840
2	$21,640	$29,863	$86,560
3	$27,320	$37,702	$109,280
4	$33,000	$45,540	$132,000
5	$38,680	$53,378	$154,720
6	$44,360	$61,217	$177,440

If your household income falls below the 138% FPL column, you qualify for South Dakota Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.

About South Dakota Medicaid

Who Qualifies for South Dakota Medicaid

In South Dakota, you may qualify for South Dakota Medicaid if your household income is at or below 138% of the Federal Poverty Level (FPL). For a single adult, this means an income of approximately $20,782 per year in 2024. For a family of four, the income limit is around $43,056 per year. South Dakota Medicaid also covers other groups, including children up to 187% FPL, pregnant women up to 138% FPL, and individuals who are aged, blind, or disabled. The Children's Health Insurance Program (CHIP) in South Dakota extends coverage to children in households with incomes up to 209% of the FPL. As of 2024, approximately 120,800 people in South Dakota were covered by Medicaid, making it one of the largest health insurers in the state.

If You're Near the Income Line

If your income is slightly above the Medicaid threshold, you won't be left without options. You'll likely transition to the federal HealthCare.gov marketplace, where you can receive subsidies to help pay for your health insurance. For example, if the benchmark Silver plan in South Dakota costs around $643 per month, subsidies can significantly reduce what you actually pay. Since income changes can shift your eligibility between Medicaid and marketplace subsidies, it's important to report any income fluctuations to ensure you have continuous coverage. South Dakota experienced a loss of approximately 30,000 Medicaid enrollees during the "unwinding" period after the COVID-19 public health emergency, and many of these individuals can reapply if they believe they still qualify.

What South Dakota Medicaid Covers

South Dakota Medicaid provides comprehensive health coverage, including doctor visits, hospital stays, dental care, vision care, and prescription drugs, with little to no cost-sharing for most services. The state also offers several Home and Community-Based Services (HCBS) waivers designed to help seniors and individuals with disabilities remain in their homes and communities rather than entering nursing facilities. These include the HOPE Waiver, which provides services like adult day care, personal care, and homemaker services to those at risk of institutionalization. Additionally, specific waivers like CHOICES and Family Support 360 cater to children and adults with intellectual and developmental disabilities, often waiving parental income for eligibility for children.

Tips for Applying

Be aware that processing times for Medicaid applications and claim reconsiderations can sometimes experience delays due to unforeseen circumstances. You'll need to provide thorough documentation to support your eligibility and any claims. For instance, providers are required to keep detailed medical and financial records for at least six years. If you are required to participate in the Primary Care Provider Program, you will receive instructions on how to choose your primary care provider, and if you don't choose one, the state will assign one for you. If you lose your Medicaid coverage, you'll receive a notice by mail, and you should reapply if you believe you are still eligible. Make sure your contact information is always up-to-date with the Department of Social Services to avoid missing important communications.

Marketplace Insurance in South Dakota

South Dakota residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in South Dakota costs approximately $643/month for a 40-year-old in 2026.

Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in South Dakota might pay for a Silver plan after subsidies, based on the $643/month benchmark:

Income Level	Annual Income	Your Cost	Monthly Subsidy
150% FPL	$23,940	~$80/mo	$563/mo
200% FPL	$31,920	~$173/mo	$470/mo
250% FPL	$39,900	~$277/mo	$366/mo
300% FPL	$47,880	~$392/mo	$251/mo
400% FPL	$63,840	~$523/mo	$120/mo

These estimates are for a 40-year-old individual on a benchmark Silver plan in South Dakota. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. South Dakota uses the federal marketplace at HealthCare.gov.

How to Apply for South Dakota Medicaid

Medicaid enrollment is open year-round — there's no deadline. You can apply through any of these channels:

• Online: Apply through HealthCare.gov — the system automatically checks your South Dakota Medicaid eligibility when you enter your income. Or apply directly through South Dakota Medicaid.
• Phone: Call South Dakota's Medicaid helpline for guided help with your application.
• In person: Visit your local human services office or a certified application counselor.

You'll need proof of income (pay stubs or tax returns), proof of South Dakota residency, and Social Security numbers for household members.