Health care can be a big burden for many families in South Dakota. Medicaid helps by covering medical costs for people with low incomes.
In 2025, it’s more important than ever as prices for doctor visits and prescriptions keep rising. Income limits set who can join the program, and they update each year based on federal poverty levels.
These limits make sure aid goes to those who need it most. For South Dakota families, knowing them can mean the difference between getting care or skipping it.
This guide covers everything: eligibility rules, income charts for different groups, special programs like CHIP, and how to apply. We’ll make it simple so you can see if you qualify and take the next step.
How Medicaid Works in South Dakota
South Dakota’s Medicaid is managed by the Department of Social Services (DSS). It provides health coverage for low-income groups, including children, pregnant women, parents and caregivers, low-income adults, seniors, and people with disabilities.
The program includes doctor visits, hospital care, prescriptions, mental health services, dental for kids, vision, and long-term care.
The state expanded Medicaid in 2023, opening it to more adults between 19 and 64 with incomes up to 138% of the federal poverty level (FPL).
For 2025, the base FPL is $15,650 annual for one person, with $5,530 added for each extra household member.
Income limits change yearly to match living costs, so check often to see if you qualify.
South Dakota Medicaid Income Limits 2025
South Dakota uses modified adjusted gross income (MAGI) for most groups. This is your tax income minus some deductions, like child care costs. Gross income is your total before deductions.
Household size includes you, your spouse, and dependents you claim on taxes. For pregnant women, the unborn child counts as one more.
Limits differ by group. Children have higher limits than adults. Pregnant women get expanded coverage.
Parents and low-income adults use the expansion level. Seniors and disabled use different rules, often tied to SSI levels.
South Dakota Medicaid Income Limits 2025 (Monthly Income)
| Group | Income Limit (% FPL) | Notes |
| Children (0–18) | Up to 187% | Higher for CHIP up to 208% if over Medicaid. |
| Pregnant Women | Up to 194% | Unborn child counts in size. |
| Parents/Caretaker Relatives | Up to 138% | For families with kids under 19. |
| Low-Income Adults (19–64) | Up to 138% | Expansion category, no kids needed. |
| Seniors & Disabled (ABD) | $967 (SSI level) | Assets count; spend-down available. |
Income Limits by Household Size
South Dakota ties limits to household size. Add $462 monthly ($5,530 annual) for each extra person beyond eight. These are for expansion groups like adults and parents at 138% FPL. Use your group’s % for exact.
2025 Income Limits for South Dakota Medicaid by Household Size
| Household Size | Monthly Limit (138% FPL) | Annual Limit (138% FPL) |
| 1 | $1,800 | $21,597 |
| 2 | $2,433 | $29,196 |
| 3 | $3,065 | $36,795 |
| 4 | $3,698 | $44,394 |
| 5 | $4,330 | $51,993 |
| 6 | $4,963 | $59,592 |
| 7 | $5,595 | $67,191 |
| 8 | $6,228 | $74,790 |
| +1 | +$462 | +$5,530 |
Eligibility Requirements
To get Medicaid in South Dakota in 2025, you must live in the state and intend to stay. U.S. citizens, nationals, or qualified immigrants qualify. Qualified immigrants include lawful permanent residents after five years or refugees. Some non-citizens get emergency care.
Income must be below your group’s limit. For age, kids are 0-18, adults 19-64, seniors 65+. Disability means you can’t work due to a condition, proven by Social Security or doctor. Pregnancy requires proof like a doctor’s note, and you get higher limits.
Medical need matters for ABD groups. CHIP covers kids over Medicaid income up to 208% FPL. Assets don’t count for most, but for seniors and disabled, limits are $2,000 single, $3,000 couple. Spend-down lets you subtract medical bills to meet income rules.
Special Medicaid Programs in South Dakota
CHIP (Children’s Health Insurance Program): Covers kids up to 208% FPL if over Medicaid limits. Benefits include check-ups, dental, and vision.
Medicaid for Pregnant Women: Up to 194% FPL. Covers prenatal care, delivery, and postpartum for 12 months.
Long-Term Care Medicaid: For nursing homes or home care. Income up to $2,901 single monthly, assets $2,000. Spousal protections allow non-applicant to keep up to $157,920 assets and $3,948 monthly income.
Medicaid Waivers: HOPE Waiver for developmental disabilities, CHOICES for elderly/disabled at home. Income $2,901, assets $2,000.
Medicaid for Seniors & People with Disabilities: ABD program with SSI income level $967 single. Covers daily living help.
Breast & Cervical Cancer Program: Covers women with diagnosis up to 200% FPL. Includes treatment and screenings.
How to Apply for Medicaid in South Dakota
- Go online to benefits.sd.gov to apply anytime, it’s the fastest way.
- Call 1-800-597-1603 for phone help from DSS staff.
- Visit your local DSS office in person for forms and support.
- Bring required documents: ID like driver’s license, Social Security number, pay stubs or tax returns for income, utility bill for residency, medical records for disability or pregnancy.
- Approval takes 45 days for most, up to 90 for disability cases in 2025.
Renewal & Redetermination Rules in 2025
Renew your Medicaid every year to keep it. DSS sends a notice 45 days before your renewal date. Update income, address, or family changes with proof like recent pay stubs.
Delays happen if papers are missing or during busy times. To avoid losing coverage, respond fast and report changes right away. The pandemic unwinding ended, but some families still face reviews in 2025. Auto-renewals occur if your info matches state records.
Frequently Asked Questions
What are the South Dakota Medicaid income limits for 2025?
Limits vary: Children up to 187% FPL ($2,439 monthly for one), adults 138% ($1,800), pregnant 194% ($2,530).
How do I qualify for Medicaid in South Dakota in 2025?
Meet residency, citizenship, and income rules for your group. Apply online at benefits.sd.gov with proof.
Does South Dakota have Medicaid expansion in 2025?
Yes, since 2023, covering adults 19-64 up to 138% FPL.
What documents do I need for South Dakota Medicaid 2025?
ID, Social Security, income proof like pay stubs, residency bill, medical notes if disabled or pregnant.
Does Medicaid cover dental in South Dakota in 2025?
Yes for kids fully; adults get limited emergencies and preventive.
Can adults get Medicaid in South Dakota in 2025?
Yes, if income under $1,800 monthly for one and no kids needed due to expansion.
What is the asset limit for South Dakota Medicaid in 2025?
Most ignore assets; ABD and long-term $2,000 single, $3,000 couple.
How long does renewal take in South Dakota Medicaid 2025?
About 45 days; respond to notices fast to avoid gaps.
Does South Dakota Medicaid cover long-term care in 2025?
Yes, up to $2,901 monthly income, with waivers for home care.
What if my income is over the limit in South Dakota Medicaid 2025?
Check spend-down or Marketplace plans; reapply if income drops.
Conclusion
Knowing South Dakota Medicaid income limits for 2025 helps families get the care they need without stress. With rising costs, this program is a key support for health. Limits change each year, so stay on top of updates. Check eligibility at benefits.sd.gov or call DSS for help. You’re taking a good step by reading this, keep going and apply if it fits.
