South Dakota Medicaid Income Limits

Updated August 2026

South Dakota's income limits reflect the state's relatively recent expansion. Adults qualify at the standard ACA expansion level of 138% FPL — a group that did not exist in South Dakota Medicaid before July 2023. Children qualify at significantly higher income levels through Medicaid and the state's CHIP program.

South Dakota Medicaid income limits by coverage group (2026)

Coverage group	FPL %	Monthly limit (household of 1)	Monthly limit (household of 4)
Adults ages 19–64 (Amendment D expansion)	138% FPL	~$1,732/mo	~$3,564/mo
Pregnant women	133% FPL	~$1,669/mo	~$3,433/mo
Children (Medicaid and CHIP)	Up to 207% FPL	~$2,598/mo	~$5,345/mo

Adults ages 19–64 (Amendment D expansion)

FPL %: 138% FPL
Monthly limit (household of 1): ~$1,732/mo
Monthly limit (household of 4): ~$3,564/mo

Pregnant women

FPL %: 133% FPL
Monthly limit (household of 1): ~$1,669/mo
Monthly limit (household of 4): ~$3,433/mo

Children (Medicaid and CHIP)

FPL %: Up to 207% FPL
Monthly limit (household of 1): ~$2,598/mo
Monthly limit (household of 4): ~$5,345/mo

No asset test for MAGI-based South Dakota Medicaid

South Dakota does not use an asset test for MAGI-based Medicaid — the category covering adults 19–64 (expansion), children, and pregnant women. Savings, vehicles, and home equity are not assessed.

Long-term care Medicaid — for seniors needing nursing facility or home-based care — does apply income and asset limits. The asset limit for nursing facility care is $2,000 for a single applicant. Contact DSS for current income limits and look-back period rules for long-term care eligibility.

What Amendment D changed for South Dakota adults

Before Amendment D took effect on July 1, 2023, adults without dependent children generally could not qualify for South Dakota Medicaid unless they met a disability standard. Parents and caretakers qualified only at very low income levels. The expansion changed this substantially — any adult 19–64 earning at or below 138% FPL can now qualify, regardless of parental or disability status.

South Dakota is notable for having enacted expansion through a ballot initiative despite consistent legislative opposition. The amendment passed with constitutional language that requires the state to implement expansion — language designed to prevent future legislative reversal. Per DSS, the expansion population is funded at a 90% federal / 10% state match, the same rate that applies to all ACA expansion states.

Medicare Savings Programs (QMB) in South Dakota

Medicare doesn't adjust its premiums for low income on its own — that's handled separately through Medicare Savings Programs (MSPs), which in South Dakota are administered by the Department of Social Services (DSS) rather than by Medicare. DSS runs three tiers: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI), each tied to a different income ceiling.

Program	Situation	Monthly income limit
QMB	Individual	$1,350
QMB	Married couple	$1,824
SLMB	Individual	$1,616
SLMB	Married couple	$2,184
QI	Individual	$1,816
QI	Married couple	$2,455

QMB

Situation: Individual
Monthly income limit: $1,350

QMB

Situation: Married couple
Monthly income limit: $1,824

SLMB

Situation: Individual
Monthly income limit: $1,616

SLMB

Situation: Married couple
Monthly income limit: $2,184

QI

Situation: Individual
Monthly income limit: $1,816

QI

Situation: Married couple
Monthly income limit: $2,455

QMB is the strongest of the three. It covers the Part A premium if one is owed, the full $202.90 monthly Part B premium in 2026, and all Medicare deductibles, coinsurance, and copayments — and federal law bars providers from billing a QMB enrollee for any of it, regardless of whether that provider accepts South Dakota Medicaid.

SLMB and QI only pay the Part B premium, with no cost-sharing help attached. QI in particular runs on a fixed yearly federal allotment distributed first-come, first-served, so South Dakotans near the QI income limit shouldn't wait to apply. Enrollment in any of the three tiers also triggers automatic Extra Help, which limits 2026 covered prescription costs to no more than $12.65 per drug.