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.