How to get Medicaid or low-cost care in South Dakota

South Dakota voters expanded Medicaid

Medicaid is a program that pays for health care for people with low incomes. In South Dakota the Department of Social Services, called DSS, runs it. Before expansion, most single adults with no kids at home could not get it.

That changed when the question went to voters. KFF, a health research group, says voters passed expansion in November 2022. The state's own expansion materials say coverage began on July 1, 2023. People could start applying in June of that year.

Under the expansion, adults who are 19 or older but not yet 65 can qualify, as long as they do not have Medicare. Their income must be at or below 138 percent of the federal poverty level. The federal poverty level is a yearly dollar amount the government uses to measure poverty. It rises with the number of people in your home.

Other groups can qualify under their own rules. DSS lists children under 19 and pregnant women, along with parents and caretakers who have children at home. People who are aged, blind or disabled are also on the list. For a plain-words look at each group, see who qualifies for Medicaid.

Where and how to apply

DSS says you can apply online or in person at its offices around the state. Applications are also taken at some schools, hospitals and clinics. That includes Indian Health Service sites and clinics run by tribes. The Medicaid and CHIP toll-free line is 877-999-5612, and callers who use a relay service can dial 711.

The state's system for Medicaid is called the Benefit Eligibility and Enrollment System, or BEES. After you sign up, you use BEES to check your application, renew your coverage and report changes. For questions about coverage and claims, DSS lists a constituent liaison at 800-597-1603.

There is no sign-up season for Medicaid, so you can apply in any month. The state decides from your answers, which makes it fine to apply when you are unsure. The papers you should have ready are listed in our guide to how to apply for Medicaid.

The 2027 work rule in South Dakota

DSS says that starting January 1, 2027, some adults on expansion Medicaid must show 80 hours a month of activity. That can be work, job training, community service or school at least half time, or a mix of these. The rule is for adults ages 19 through 64 in the expansion group. New applicants show the hours for the month before they apply. Current members face the rule at their first renewal in 2027.

The same change moves expansion adults to renewals every six months, while other adults and children stay on yearly renewals. DSS will look at its own records first. If that is not enough, it will ask you for more when you apply or renew.

DSS lists many groups that are excluded from the rule, which means they do not have to meet it. Some of those groups are listed here.

• American Indian and Alaska Native people can skip the rule, and so can anyone who can get Indian Health Service care.
• Parents and caregivers of a child 13 or younger, or of a person with a disability, can skip it as well.
• The rule leaves out people who are medically frail, meaning they have a serious health problem or a disability.
• Pregnant people are excluded, and so is anyone who has postpartum coverage, which is coverage for the months after a birth.
• People who already meet the work rules for food assistance or cash help from TANF are excluded as well.
• Veterans with a total disability rating are also excluded.

From January 1, 2027, you can check your status in your DSS notices or by logging in to BEES. For questions, call the main DSS number in Pierre at 605-773-3165 or visit a local DSS office. The Medicaid work requirement guide explains how proof usually works.

If you earn too much for Medicaid

South Dakota uses the federal Marketplace, which is HealthCare.gov. A Marketplace plan is private insurance you buy yourself. The site shows whether your income qualifies you for a tax credit, which is money that lowers the monthly cost. The sign-up window after a job loss is explained in our guide on losing your health insurance.

Community health centers and tribal clinics

Community health centers in the state get federal money and care for everyone, with or without insurance. The Community HealthCare Association of the Dakotas supports them in South Dakota and North Dakota, and its website has a Find a Health Center page. A federal tool with the same name comes from the Health Resources and Services Administration.

Ask each center about its sliding fee, which is a price scale based on what you earn. Then ask what papers to bring and how soon you can get a first visit. Enrolled members of a tribe may also have care available through the Indian Health Service. To compare prices, our guide to sliding-scale clinics can help.

Checking a South Dakota doctor

The state medical board has a Licensee Lookup on its website, where you can see whether a doctor holds a license. You can also call the board's office at 605-367-7781.

Paying a doctor monthly and getting emergency care in South Dakota

Some doctors here work in a model called direct primary care. You pay a flat monthly fee, and the doctor does not bill insurance for those visits. The fee does not pay for a hospital stay or the emergency room. Our directory lists cash-pay doctors, and you should ask for the fee in writing.

If you have a medical emergency, call 911 or go to the nearest emergency room. No emergency room can refuse to examine you because you lack insurance, and that comes from federal law. A later bill may qualify for help, and the guide to hospital financial assistance shows how to ask.