South Dakota Medicaid Eligibility: Income Limits, Asset Rules & How to Apply

South Dakota expanded Medicaid — but not through the legislature.

In November 2022, South Dakota voters approved Constitutional Amendment D by a 56–44 margin, expanding Medicaid to adults aged 19–64 earning up to 138% FPL.

Coverage began July 1, 2023, making South Dakota the seventh state to expand Medicaid via ballot initiative — joining Maine, Utah, Idaho, Nebraska, Oklahoma, and Missouri.

About 28,000–40,000 South Dakotans have enrolled under expansion so far, generating nearly $1.35 billion in additional federal Medicaid funding for the state over five years.

But expansion in South Dakota comes with a unique political layer:

In 2024, voters approved Amendment F — allowing the state legislature to establish work requirements for expansion adults, pending federal approval.

And on the November 2026 ballot is Amendment I, which would condition the expansion on federal funding remaining at 90% or above.

If you’re a low-income adult in South Dakota, your Medicaid eligibility exists because voters chose it — and its future remains actively contested.

This guide covers every South Dakota Medicaid program, 2026 income limits, the HOPE Waiver for home care, the $30/month Personal Needs Allowance (one of the lowest in the country), the tribal health context, and how to apply. For income limits across all states, see Medicaid income limits by state.

A Note on the Source Document Error

The source document states South Dakota “has not expanded Medicaid under the ACA.”

This is incorrect. South Dakota expanded Medicaid through Amendment D, effective July 2023. Adults 19–64 earning up to 138% FPL now qualify.

This article reflects the accurate current status of South Dakota Medicaid eligibility.

South Dakota Medicaid Programs

South Dakota administers Medicaid through the Department of Social Services (DSS) under the program name South Dakota Medicaid.

Medicaid Expansion Adults (19–64) — Since July 2023, adults 19–64 with income up to 138% FPL (~$1,799/month for a single person) qualify for South Dakota Medicaid under Amendment D, regardless of whether they have dependent children or a disability.

No asset test applies. Work requirements for this group are authorized but not yet implemented — they require federal waiver approval under Amendment F.

Medicaid for Children (CHIP) covers children up to age 19 with incomes up to 200% FPL (~$2,608/month for a single-person household).

No asset test applies.

Medicaid for Pregnant Women covers pregnant women up to 200% FPL.

Coverage extends 12 months postpartum. No asset test.

Medicaid for Parents and Caretaker Relatives covers parents or caretakers of dependent children with incomes up to 18% FPL (~$235/month for a single parent) — one of the lowest parent thresholds in the United States.

Regular Medicaid (Aged, Blind, and Disabled — ABD) covers low-income elderly, blind, or disabled South Dakotans who do not need nursing home care.

Income limit: $967/month (single). Asset limit: $2,000 (single).

Nursing Home / Institutional Medicaid covers long-term care in Medicaid-certified nursing facilities and ICF/IID facilities.

This is an entitlement — anyone meeting financial and functional criteria cannot be denied. Income limit: $2,901/month (single). Asset limit: $2,000 (single).

HOPE Waiver (Home and Community-Based Options and Person Centered Excellence) is South Dakota’s primary HCBS program — formerly called the HCBS Waiver for the Elderly.

The HOPE Waiver serves seniors and physically disabled adults who would otherwise require nursing home placement. Services include: adult day care, private duty nursing, homemaker services, personal care assistance, home modifications, emergency response systems, structured family caregiving, and more.

This is not an entitlement — enrollment slots are limited and waiting lists exist.

Money Follows the Person (MFP) helps institutionalized Medicaid recipients transition back to home or community settings.

South Dakota participates in this federal program. Contact DSS at 1-877-999-5612 for transition assistance.

Youth Formerly in Foster Care — South Dakota provides Medicaid to former foster care youth up to age 26 regardless of income, under the federal ACA provision.

Quadriplegics and Medically Complex Adults — South Dakota maintains specific Medicaid pathways for quadriplegics who would otherwise require nursing home placement, and for other medically complex populations requiring specialized home care.

Income Limits — 2026

All figures are monthly gross income. The Federal Benefit Rate (FBR) is $967/month for 2026.

Key Notes on South Dakota’s Income Rules

The $30/month Personal Needs Allowance — South Dakota’s nursing home resident Personal Needs Allowance is just $30/month — the lowest in this state Medicaid series.

When a nursing home resident’s income exceeds $2,901/month, the excess goes toward care costs. The resident retains $30/month for personal spending, plus Medicare premiums, and any applicable spousal allowance.

By comparison: Oregon protects $183.90/month, Rhode Island $50/month, Pennsylvania $45/month, South Carolina $65/month. South Dakota’s $30 represents the floor.

MMMNA = $2,643.75/month (base): When one spouse enters a nursing facility or HOPE Waiver, the community spouse may receive income up to $2,643.75/month as a base Minimum Monthly Maintenance Needs Allowance.

This increases if housing and utility costs exceed $793.13/month (eff. July 1, 2025 – June 30, 2026), with a maximum of $3,948/month.

VA Aid & Attendance not counted: South Dakota does not count the VA Aid & Attendance Pension (the amount above the Basic VA Pension) as income for Medicaid purposes.

This matches Rhode Island’s approach and is meaningful for veterans receiving this benefit alongside Social Security.

Expansion work requirements — pending: Amendment F (approved by voters in 2024) authorizes the legislature to require expansion adults to work or participate in community engagement. Requirements have not yet been implemented and require a federal waiver.

Federal Poverty Level Reference — 2026

Use the FPL Calculator to find the exact threshold for your household size.

Asset Rules for South Dakota Medicaid

No asset test applies to expansion adults, children, pregnant women, or parents.

Asset limits apply to nursing home, HOPE Waiver, and ABD Regular Medicaid.

Home equity limit: The primary home is exempt while the applicant or spouse resides there or intends to return. Home equity cap: $730,000.

Exempt (Non-Countable) Assets

• Primary home (within the $730,000 cap)
• One vehicle
• Household goods and personal effects
• Irrevocable Funeral Trusts (IFTs)
• Medicaid Compliant Annuities
• Life insurance with face value $1,500 or less

South Dakota’s 60-Month Look-Back Period

South Dakota enforces a 60-month (5-year) look-back for Nursing Home Medicaid and the HOPE Waiver.

When you apply, DSS reviews all asset transfers within the 5 years before the application date. Transfers below fair market value — gifts, below-market sales, or certain trust transfers — trigger a penalty period of ineligibility calculated from the date you otherwise qualify.

Exempt transfers:

• Transfers to a spouse
• Transfers to a blind or disabled child
• Home transfer to a caregiver child who lived there for at least 2 years before institutionalization and whose care delayed nursing home placement
• Transfer to a sibling with an equity interest who lived in the home for at least 1 year before institutionalization

No look-back applies to ABD Regular Medicaid, expansion adults, children, pregnant women, or parents.

Consult a Certified Medicaid Planner before any asset transfer if long-term care may be needed within 5 years.

Medical and Functional Requirements

To qualify for Nursing Home Medicaid or the HOPE Waiver, applicants must demonstrate a Nursing Facility Level of Care (NFLOC) through documented limitations in:

ADLs: Mobility, bathing, dressing, eating, and toileting.

IADLs: Cooking, shopping, managing finances, medication management.

Cognitive or behavioral issues: Alzheimer’s or dementia — though diagnosis alone is not sufficient. Functional limitations must be formally assessed.

For ABD Regular Medicaid, proof of disability or blindness per SSA standards is required — NFLOC is not necessary.

Medicaid and South Dakota’s Tribal Nations

South Dakota is home to nine federally recognized tribal nations — Oglala Lakota (Pine Ridge), Rosebud Sioux, Cheyenne River Sioux, Standing Rock Sioux, Crow Creek Sioux, Lower Brule Sioux, Flandreau Santee Sioux, Sisseton Wahpeton Oyate, and Yankton Sioux.

American Indians and Alaska Natives make up about 8% of South Dakota’s total population but represent 30% of the state’s uninsured population before expansion.

Five of the eight South Dakota counties with the highest proportions of uninsured adult workers are entirely tribal land.

The Indian Health Service (IHS) provides health care to tribal members through federally funded facilities, but IHS is historically underfunded and cannot meet all health care needs. Medicaid coverage — including expansion — works alongside IHS coverage to fill critical gaps.

Tribal members on reservations like Pine Ridge or Rosebud can apply for Medicaid through DSS. Tribal Medicaid outreach programs assist with applications on reservation lands. See how to apply for SNAP in South Dakota for related tribal SNAP context.

Medicaid Estate Recovery

South Dakota’s Medicaid Estate Recovery Program may seek reimbursement for long-term care costs paid by Medicaid from a beneficiary’s estate after death.

Recovery most commonly targets the primary home when not protected through a surviving spouse, qualifying disabled child, or caregiver child exemption.

Early planning with a Certified Medicaid Planner is the most effective protection.

Options If You Exceed the Limits

Qualified Income Trusts (QITs): If income exceeds $2,901/month, a QIT redirects excess into an irrevocable trust, restoring nursing home or HOPE Waiver eligibility while protecting the $30/month Personal Needs Allowance, Medicare premiums, and spousal income allowance.

South Dakota Medicaid must be named as the trust beneficiary.

Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses in an irrevocable trust are exempt from asset limits.

Spend Down: Convert countable assets into exempt ones — home improvements, vehicle purchase, paying off debt, medically necessary equipment.

Medicaid Compliant Annuities: Convert excess assets into an income stream, reducing countable assets while directing income toward care.

The Amendment I Situation — What It Means for Expansion

On the November 2026 ballot is Constitutional Amendment I, which would condition South Dakota’s Medicaid expansion on federal funding remaining at 90% or above.

Currently, the federal government funds 90% of expansion Medicaid costs. If federal funding falls below that threshold — due to budget cuts or restructuring — Amendment I would remove the constitutional requirement for South Dakota to maintain expansion.

This matters because the One Big Beautiful Bill and ongoing federal budget debates have raised the possibility of reduced federal Medicaid match rates for expansion populations.

For current expansion enrollees, Amendment I is a relevant policy development to monitor.

See our coverage of Big Beautiful Bill changes for the broader federal Medicaid funding context.

Federal Policy Changes Coming to South Dakota

Work Requirements: Authorized by Amendment F (2024), but not yet implemented.

Expansion adults who are not disabled would potentially need to meet work or community engagement requirements once a federal waiver is approved and the legislature acts. For context on how Medicaid work requirements function, see SNAP work requirements.

Reduced Retroactive Coverage (January 2027): Medicaid will cover only 2 months prior to application, down from 90 days.

Apply promptly once you believe you qualify — delayed applications create exposure to uncovered medical bills.

More Frequent Renewals (December 2026): Renewals shift to every 6 months for most enrollees.

The DSS ACCESS portal at dss.sd.gov allows online renewal.

New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit. Primary care and preventive services remain free.

Children, pregnant women, nursing facility residents, and seniors are exempt.

South Dakota Medicaid and SNAP: Same Agency, Easier Access

Unlike South Carolina (which splits SNAP and Medicaid across two agencies), South Dakota DSS administers both SNAP and Medicaid through the same agency and the same ACCESS portal.

This means a single application can establish eligibility for both programs simultaneously.

Many South Dakota families qualify for both. SNAP in South Dakota uses the federal 130% FPL income limit with BBCE removing the asset test for most households.

Useful links:

• South Dakota SNAP benefits and eligibility
• How to apply for SNAP in South Dakota
• South Dakota WIC income guidelines
• Can seniors on Social Security get food stamps?

How to Apply for South Dakota Medicaid

Online: Apply through the ACCESS South Dakota portal at dss.sd.gov/benefits/medicaid.

The same portal handles Medicaid, SNAP, and other DSS benefits. South Dakota uses a single integrated application system.

By Phone: Call DSS at 1-800-305-3064 for Medicaid application assistance, or 1-877-999-5612 for long-term care or general DSS questions.

By Mail or In Person: Download the appropriate application from dss.sd.gov and submit to your nearest DSS office. South Dakota’s 66 counties are mostly rural or frontier — mobile DSS units serve remote areas.

Long-Term Care / HOPE Waiver: Call the DSS long-term care line at 1-866-890-0554 to initiate the NFLOC assessment.

A functional assessment must be completed before nursing home or HOPE Waiver eligibility is confirmed.

Tribal Applicants: Tribal-specific Medicaid outreach programs on Pine Ridge, Rosebud, and other reservations can assist with applications. Contact your local reservation’s health services office.

For the step-by-step application guide: how to apply for Medicaid in South Dakota.

Documents You’ll Need

• South Dakota residency proof (utility bill, lease, or official mail)
• U.S. citizenship or qualifying immigration status documentation
• Income proof: pay stubs, SSA award letters, pension statements
• SSNs for all household members
• For LTC / ABD: bank statements, property records, 60 months of financial history
• For disability: SSA disability documentation or physician letter
• For pregnancy: physician verification

Processing Times

• Standard applications: Up to 45 days
• Disability-based applications: Up to 90 days
• Expedited: Pregnant women and urgent cases may qualify for faster processing

Frequently Asked Questions

Did South Dakota expand Medicaid?

Yes — South Dakota expanded Medicaid through Constitutional Amendment D, approved by voters in November 2022 by a 56–44 margin.

Expansion took effect July 1, 2023, covering adults 19–64 earning up to 138% FPL (~$1,799/month for a single person) regardless of whether they have children or a disability. South Dakota was the seventh state to expand Medicaid via ballot initiative.

What is Amendment F and does it affect my coverage now?

Amendment F, approved by South Dakota voters in November 2024 by a 56–44 margin, authorizes the state legislature to impose work requirements on expansion adults.

Work requirements have not yet been implemented — they require a separate federal waiver approval. Until requirements take effect, expansion adults qualify based on income alone. Check dss.sd.gov for current status.

What is the HOPE Waiver in South Dakota?

The HOPE Waiver (Home and Community-Based Options and Person Centered Excellence) is South Dakota’s primary HCBS program for seniors and disabled adults who need nursing home-level care but prefer to remain at home.

It was formerly called the HCBS Waiver for the Elderly. Services include personal care assistance, homemaker services, adult day care, home modifications, private duty nursing, and emergency response systems. Slots are limited — contact DSS at 1-866-890-0554 early. Income limit: $2,901/month. Asset limit: $2,000 (single).

What is South Dakota’s Personal Needs Allowance and why is it so low?

South Dakota’s nursing home Personal Needs Allowance is $30/month — the amount a nursing home resident on Medicaid keeps for personal spending after their income goes toward care costs.

At $30/month, this is among the lowest in the country. Oregon protects $183.90/month; South Carolina $65/month; Pennsylvania $45/month; Rhode Island $50/month. The $30 figure reflects South Dakota’s historically conservative approach to Medicaid spending. Contact DSS or a Certified Medicaid Planner if you’re concerned about how this affects planning for a loved one’s care.

How does Medicaid interact with Indian Health Service (IHS) for tribal members?

South Dakota’s nine tribal nations are served by IHS facilities, but IHS has been historically underfunded.

Medicaid — including expansion — fills critical gaps: it pays for services IHS cannot provide and generates revenue for IHS facilities when they bill Medicaid for services rendered to enrolled members. American Indians and Alaska Natives make up about 30% of South Dakota’s uninsured population before expansion — a reflection of the limits of IHS coverage alone.

Tribal members can apply for Medicaid through DSS. Contact your reservation’s health services office for application assistance.

What is Amendment I on the 2026 ballot?

Amendment I, referred to the November 2026 ballot by the South Dakota legislature, would condition the Medicaid expansion on federal funding remaining at or above 90%.

Currently, federal funding covers 90% of expansion Medicaid costs. If federal match rates drop below that threshold — which could happen under certain federal budget scenarios — Amendment I would remove the constitutional obligation to maintain expansion.

Expansion enrollees should monitor this ballot measure at the South Dakota Secretary of State’s website.

Is the look-back period the same for the HOPE Waiver as for nursing homes?

Yes — the 60-month look-back applies equally to both Nursing Home Medicaid and the HOPE Waiver in South Dakota.

Asset transfers below fair market value within 5 years of applying for either program can trigger a penalty period. Plan any asset decisions with a Certified Medicaid Planner well in advance of when care may be needed.

Can I apply for both Medicaid and SNAP through the same portal in South Dakota?

Yes — South Dakota DSS administers both programs through the same ACCESS portal at dss.sd.gov.

A single application can establish eligibility for both Medicaid and SNAP simultaneously. This is simpler than in states like South Carolina where SNAP and Medicaid go through separate agencies. See South Dakota SNAP eligibility for SNAP-specific income limits.

Last updated: 2026 | Sources: South Dakota Department of Social Services (DSS), Ballotpedia (Amendment D, F, I), healthinsurance.org, USDA FPL guidelines, CMS.gov. South Dakota Medicaid expanded effective July 1, 2023, via voter-approved Amendment D. Verify current figures at dss.sd.gov or by calling DSS at 1-800-305-3064. This guide is for informational purposes only — eligibility is determined by South Dakota DSS.