South Dakota Medicaid

Updated August 2026

South Dakota Medicaid is administered by the Department of Social Services (DSS). South Dakota expanded Medicaid through Amendment D, a citizen initiative passed by voters in November 2022 with approximately 56% approval. Expansion took effect July 1, 2023 — making South Dakota one of the last states in the country to expand Medicaid under the ACA and the most recent state as of 2026 to have done so through a ballot initiative.

Federal Medicaid changes take effect October 2026 and January 2027

H.R. 1 (signed July 4, 2025) introduced new federal Medicaid requirements. Starting October 1, 2026, some non-citizen immigrants will no longer qualify for Medicaid. Starting January 1, 2027, most adults in the Amendment D expansion group must complete community engagement (work) activities and will renew their coverage every 6 months instead of annually, unless exempt. DSS begins notifying affected members in September 2026. Visit dss.sd.gov/medicaid/HR1.aspx for full details on exemptions and how these changes may affect your coverage.

What is South Dakota Medicaid?

Before Amendment D, South Dakota had not previously expanded Medicaid despite multiple legislative proposals. The ballot initiative bypassed the state legislature — a significant political development. As of 2025, approximately 160,000 South Dakotans are enrolled in Medicaid total, with tens of thousands having gained coverage through the expansion.

South Dakota uses a fee-for-service model for most Medicaid populations — members can see any South Dakota Medicaid-enrolled provider without MCO assignment. DSS administers the program from Pierre, with local county offices across the state handling applications and case management.

Who qualifies for South Dakota Medicaid?

Since July 1, 2023, South Dakota covers adults 19–64 at or below 138% FPL. Children and pregnant women have separate eligibility thresholds.

Adults ages 19–64 (Amendment D expansion): at or below 138% FPL — approximately $22,025/year for a single person in 2026
Children under age 19: up to 207% FPL through Medicaid or South Dakota CHIP
Pregnant women: up to 133% FPL
Seniors and people with disabilities: income and asset rules vary — contact DSS
Parents and caretaker relatives: income limits vary by household size
Medicare Savings Programs: help low-income Medicare beneficiaries with premium costs

Source: South Dakota DSS Medicaid eligibility information (dss.sd.gov/medicaid); DSS medical programs page. Verify current limits at dss.sd.gov or by calling 1-888-828-0059.

How South Dakota Medicaid is delivered

South Dakota operates Medicaid primarily through a fee-for-service model. Unlike managed care states where members are enrolled in an MCO, South Dakota Medicaid members can see any provider enrolled in the state Medicaid program without a plan assignment. DSS pays providers directly based on claims.

South Dakota does operate a Primary Care Provider (PCP) selection program for some Medicaid populations — members can choose a primary care provider to coordinate their care. Per DSS, the PCP selection portal is available at pcphhselection.appssd.sd.gov.

Apply online through the DSS Electronic Assistance Portal at eaportal.sd.gov, by printing a paper application at dss.sd.gov, or by visiting your local DSS county office. Call 1-888-828-0059 for help.

Amendment D: South Dakota's path to Medicaid expansion

Amendment D was notable for multiple reasons. South Dakota's Republican-controlled legislature had blocked Medicaid expansion for years. The 2022 ballot initiative succeeded with bipartisan support — a rural conservative state voting to expand Medicaid reflected both the popularity of the policy at the individual level and the economic argument that expansion brought federal dollars into the state. Per DSS, the federal government pays 90% of the costs of the expansion population, with South Dakota paying the remaining 10%.