South Dakota Medicaid ends for several reasons in 2026, and the cause decides your next move. Some South Dakotans lose coverage because renewal paperwork came back late or a DSS letter went to an old address. Others lose it because household income rose above 138% of the Federal Poverty Level, which is $22,025 for one adult and $45,540 for a family of 4 in 2026. South Dakota expanded Medicaid to adults ages 19 to 64 on July 1, 2023, so most low-income adults who qualified then still qualify now if their income stayed low. Losing Medicaid is a qualifying life event, and it opens a 90-day Marketplace Special Enrollment Period (SEP) at healthcare.gov, the federal platform South Dakota uses. That window is longer than the standard 60-day window for most other life events. It exists so that you can sort out a possible Medicaid error and still land in a Marketplace plan if reinstatement fails. The Centers for Medicare & Medicaid Services (cms.gov) set the 90-day rule, and KFF (kff.org) tracks how it works in practice. This page walks through each decision in order, from reading your notice to comparing plans.
South Dakota adds one date to watch in 2026. Under federal H.R. 1, South Dakota Medicaid expansion adults face an 80-hour monthly work or community engagement requirement and six-month renewals starting January 1, 2027, according to the South Dakota Department of Social Services (dss.sd.gov). DSS estimated in April 2026 that 1,213 expansion adults could be disenrolled when the rules begin. Anyone who loses coverage now and is later reinstated will land in that new system, so keep every DSS letter and note your exemption category if you qualify for one. Exemptions include American Indian and Alaska Native members, caregivers of a child 13 or younger, medically frail adults, and pregnant or postpartum members. Your Marketplace SEP runs on its own clock, separate from any Medicaid hearing. Children in the home may qualify for South Dakota CHIP even when a parent does not. The rest of this page covers the exact steps, a 2026 income table, the documents DSS and healthcare.gov request, and the mistakes that cost South Dakotans coverage.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The costliest errors South Dakotans make after losing Medicaid in 2026:
- Waiting on a Medicaid decision while the 90-day Marketplace window runs out. File your appeal or reapplication and select a healthcare.gov plan in the same week.
- Ignoring DSS mail. Procedural terminations happen when renewal forms or address updates never reach the SD BEES portal, and a quick upload often restores coverage.
- Reporting last year's income to healthcare.gov. The Marketplace calculates 2026 subsidies from projected 2026 income, so a drop in pay should lower the number you enter.
- Skipping CHIP for children. South Dakota CHIP is open year-round, and children can qualify even when a parent has too much income for Medicaid.
- Choosing COBRA by default. COBRA costs 102% of the full premium, and a subsidized Silver plan on healthcare.gov usually costs far less in 2026.
Why South Dakota Medicaid Coverage Ends in 2026 and What Changes in 2027
South Dakota Medicaid terminations in 2026 fall into three groups, and each group has a different fix. Procedural terminations happen when DSS cannot verify eligibility because a renewal form, pay stub, or address change never arrived. Income-based terminations happen when DSS data from employers, the IRS, or the Social Security Administration shows household income above 138% FPL, which is $22,025 for one adult in 2026. Category changes happen when a member turns 65, ages out of children's coverage, or moves out of South Dakota. Procedural terminations are the most reversible: submit the missing document through the SD BEES portal at eaportal.sd.gov or call DSS at 605.773.3165, and request a fair hearing if the notice looks wrong. Medicaid.gov confirms that states must give written notice and hearing rights before ending coverage, so a termination without a clear notice is worth challenging. Keep every letter, because the notice is also your qualifying life event proof for the Marketplace SEP at healthcare.gov.
South Dakota Medicaid expansion adults face bigger changes on January 1, 2027. Federal H.R. 1 requires 80 hours of monthly work or community engagement for expansion adults ages 19 to 64, and DSS will check it at renewal, which moves to every 6 months. DSS estimated in April 2026 that 1,213 expansion adults, about 4% of the group, could be disenrolled, and another 6,066 could not yet be classified as exempt or compliant. Anyone reinstated in late 2026 should document an exemption early. American Indian and Alaska Native members, caregivers of a child 13 or younger, medically frail adults, and pregnant or postpartum members are exempt. South Dakota voters also see a constitutional amendment on the November 3, 2026 ballot that would condition Medicaid expansion on continued federal funding, per Ballotpedia. Marketplace coverage on healthcare.gov gives a backup if Medicaid eligibility changes again, and the 400% FPL subsidy cliff of $63,840 for one adult in 2026 sets the ceiling for premium tax credits.
South Dakota Medicaid Income Limits and ACA Subsidy Thresholds for 2026
South Dakota Medicaid income limits for adults follow the 138% FPL expansion line, and the 2026 Federal Poverty Level from HHS (aspe.hhs.gov) is $15,960 for one person plus $5,680 for each additional person. That math gives South Dakota Medicaid limits of $22,025 for one adult, $29,863 for two, and $45,540 for a family of 4 in 2026. Adults above that line move to the Marketplace, where premium tax credits apply from 100% FPL up to 400% FPL ($63,840 for one adult, $132,000 for a family of 4 in 2026). The cliff returned for 2026 because enhanced premium tax credits expired January 1, 2026, so a household one dollar over 400% FPL gets no subsidy. Between 138% and 250% FPL, South Dakota adults on a Silver plan also receive cost-sharing reductions that cut deductibles and copays. KFF (kff.org) reports that most Marketplace enrollees qualify for a premium tax credit, so check your 2026 projected income before assuming a plan is unaffordable. Use the screener on this site to test your household size against both thresholds.
Documents South Dakota Applicants Need and Why Each One Matters in 2026
South Dakota Medicaid and healthcare.gov request different proof, and each document answers a specific question. The DSS termination notice proves the qualifying life event and sets the start of your 90-day Special Enrollment Period, so healthcare.gov can confirm the loss. Pay stubs, an unemployment award letter, or self-employment records support the projected 2026 income that decides whether you land under 138% FPL for Medicaid or in the premium tax credit range. Social Security numbers and proof of citizenship or lawful status let both agencies run federal data matching, and a mismatch is a leading cause of delays. A current South Dakota address controls plan availability by ZIP code, and returned mail is the usual reason a renewal is missed. Birth certificates or school records support South Dakota CHIP applications for children. After you enroll, healthcare.gov issues Form 1095-A in early 2027, and you need it to file IRS Form 8962 with your 2026 return. Upload documents to the SD BEES portal or healthcare.gov account on the day you gather them, because both systems time out pending requests.
Frequently Asked Questions
What is the Special Enrollment Period after losing South Dakota Medicaid in 2026?
The Marketplace Special Enrollment Period after losing South Dakota Medicaid is 90 days from your coverage end date. If your Medicaid ends October 31, 2026, you can select a healthcare.gov plan from November 1, 2026 through January 29, 2027. You can also apply up to 60 days before the loss if you know the date from your DSS notice. Plans start the first day of the month after you select. Because the 2027 Open Enrollment Period also runs November 1, 2026 through January 15, 2027, anyone losing coverage this fall can use either route, but the SEP keeps the window open longer. Medicaid applications stay open year-round with no deadline, per medicaid.gov.
How do I document losing South Dakota Medicaid for a Marketplace application?
Upload or keep the Department of Social Services termination notice that shows your name, the coverage end date, and the reason. Healthcare.gov may ask for it after you report loss of Medicaid as your qualifying life event, usually within 30 days of your plan selection. If you never received a letter, ask DSS for a coverage verification letter by calling 605.773.3165 or through the SD BEES portal at eaportal.sd.gov. Also gather income proof for your projected 2026 earnings, such as pay stubs or an unemployment award letter, plus Social Security numbers and citizenship or immigration documents for every applicant. Keep copies of every upload for your records.
What if I miss the 90-day SEP after losing South Dakota Medicaid?
Missing the 90-day window means you usually wait for the next ACA Open Enrollment Period, which runs November 1, 2026 through January 15, 2027 for 2027 coverage, unless another qualifying life event applies, such as a job loss, a move, or a birth. In the meantime you carry no Marketplace protection against medical bills, and a gap can cost thousands after one emergency visit. South Dakota Medicaid and CHIP never close, so you can still apply for either any day of the year at eaportal.sd.gov if your income or your child's income qualifies. If DSS finds you eligible, coverage can reach back before your application month.
Can I get retroactive coverage after losing South Dakota Medicaid?
Retroactive coverage depends on the program. Federal Medicaid rules let eligible South Dakota applicants request up to 3 months of coverage before the month of application through December 31, 2026, and federal H.R. 1 shortens that to 1 month for expansion adults starting January 1, 2027, so confirm the current rule with DSS. A successful fair hearing can restore coverage back to the termination date. Marketplace plans never go backward: coverage starts the first day of the month after you select a plan under the loss-of-Medicaid SEP. Select your healthcare.gov plan early in the month to keep any gap short.
What is the difference between COBRA and Marketplace coverage after losing Medicaid?
COBRA applies only when you lose employer coverage, not Medicaid by itself, so most South Dakotans losing Medicaid have no COBRA right at all. If you also left a job, COBRA keeps your old plan at 102% of the full premium, often $400 to $900 per month for one person in 2026, with a 60-day election window. A healthcare.gov Marketplace plan with premium tax credits usually costs $10 to $150 per month for incomes under 250% FPL in 2026. COBRA fits mainly when a specialist is out of every Marketplace network or you already met a large deductible this year. Compare both quotes before the 90-day SEP closes.
What state-specific rules apply when I lose Medicaid in South Dakota?
South Dakota runs Medicaid and CHIP through the Department of Social Services and the SD BEES portal at eaportal.sd.gov, while Marketplace plans come through the federal site healthcare.gov. South Dakota expanded Medicaid on July 1, 2023, so adults ages 19 to 64 up to 138% FPL ($22,025 single in 2026) qualify. Starting January 1, 2027, expansion adults must show 80 hours per month of work or community engagement unless exempt, and renewals move to every 6 months. Fair hearing requests go in writing to the DSS Office of Administrative Hearings in Pierre, with the deadline printed on your notice.
Do I qualify for South Dakota Medicaid again after losing it?
You qualify again if your projected 2026 household income is at or below 138% FPL, which is $22,025 for one person, $29,863 for two, $37,702 for three, and $45,540 for four. DSS looks at current monthly income, so a recent pay cut or job loss can restore eligibility even if your annual income was higher. Adults ages 19 to 64 apply through eaportal.sd.gov. Adults above the line move to Marketplace subsidies, up to $63,840 for one person in 2026. People age 65 and older should check Medicare eligibility and South Dakota's aged, blind, and disabled Medicaid categories, which use different rules than expansion Medicaid.
What happens to my children's coverage if I lose South Dakota Medicaid?
Children keep separate eligibility, so a parent's loss does not automatically end a child's coverage. South Dakota CHIP covers children under 19 whose family income is above Medicaid limits but still modest, and CHIP enrollment is open year-round with no deadline. Apply through the SD BEES portal at eaportal.sd.gov and list every child in the household. If your children lose Medicaid or CHIP too, they get the same 90-day Marketplace SEP as you. A household can mix coverage, with parents on a healthcare.gov Silver plan in 2026 and children on CHIP, which often costs less than adding children to a Marketplace plan.
