Medicaid Eligibility in South Dakota: Income Limits & How to Apply

Medicaid Eligibility in South Dakota

South Dakota has expanded Medicaid under the Affordable Care Act. This means adults aged 19-64 with household income at or below 138% of the federal poverty level (FPL) qualify for South Dakota Medicaid. This is approximately $21,597 per year for an individual or $44,367 per year for a family of four in 2026.

Medicaid expansion in South Dakota covers:

• Adults aged 19-64 with income up to 138% FPL
• Children in families with income up to 200-300% FPL (varies by age)
• Pregnant women with income up to 185-200% FPL
• Seniors and people with disabilities who meet income and asset requirements

About 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 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.

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.

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.

South Dakota Medicaid Income Limits 2026

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

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.

Marketplace premiums in South Dakota run high — the benchmark Silver plan costs roughly $643/month, significantly above the national average. The silver lining is that subsidy amounts are proportionally larger, keeping net premiums manageable for most subsidized enrollees.

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 after subsidies:

These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.

Residents of South Dakota shop for marketplace insurance through HealthCare.gov, the federal exchange. The application process screens for Medicaid eligibility first, so you'll be directed to South Dakota's program if you qualify.

Since expanding Medicaid, South Dakota has enrolled hundreds of thousands of adults in South Dakota Medicaid. Residents whose income fluctuates around the 138% FPL threshold can move between Medicaid and subsidized marketplace coverage as their circumstances change.

How to Apply for South Dakota Medicaid

1. Start online at HealthCare.gov — the application automatically screens for South Dakota Medicaid eligibility based on your household income.
2. Go through the state directly — South Dakota's Medicaid office accepts applications year-round with no enrollment window.
3. Get phone support — South Dakota's Medicaid hotline can walk you through the process and verify eligibility.
4. In-person options — Local social services offices and community health navigators can assist with your application.

Have the following ready: recent pay stubs or tax returns, proof that you live in South Dakota, Social Security numbers for everyone in your household, and details on any existing health insurance.

Frequently Asked Questions

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