South Dakota Medicaid Income Limits (2026)

South Dakota Medicaid joined the ranks of expansion states on July 1, 2023, after voters approved Constitutional Amendment D in November 2022 with 56% support. Before expansion, South Dakota Medicaid covered primarily children, pregnant women, and very low-income parents, leaving roughly 42,000 adults in a coverage gap. Under expansion, the Department of Social Services (DSS) now covers all adults ages 19 to 64 with household incomes at or below 138% of the Federal Poverty Level. The 2026 Federal Poverty Level stands at $15,960 for a single person and $33,000 for a family of four in the 48 contiguous states, making the 2026 South Dakota Medicaid expansion threshold $22,025 for an individual and $45,540 for a family of four.

South Dakota Medicaid eligibility in 2026 breaks into four main population groups. Adults ages 19 to 64 (the ACA expansion group) qualify up to 138% FPL with no asset test under the MAGI methodology. Children ages 0 to 18 qualify for South Dakota Medicaid up to 187% FPL, and for CHIP up to 209% FPL, giving most South Dakota families with children a meaningful safety net. Pregnant women qualify up to 138% FPL with postpartum coverage continuing for 12 months after delivery, a federal requirement that became permanent for South Dakota in 2023. Aged, blind, and disabled adults (the SSI-linked category) are assessed under a separate income and asset test: the 2026 SSI federal benefit rate is $994 per month for an individual, and the asset limit is $2,000 for a single person. Adults who qualify for both South Dakota Medicaid and Medicare are dual-eligible and may benefit from Medicare Savings Programs that help cover Medicare premiums and cost-sharing.

The household-size table below shows the 2026 South Dakota Medicaid income limits across all three MAGI-covered populations. Adults and pregnant women share the 138% FPL threshold under expansion. The children's column reflects the higher 187% FPL Medicaid threshold that predates expansion and remains the standard for South Dakota's child Medicaid program. South Dakota CHIP extends children's coverage to 209% FPL. If your family income falls above the relevant South Dakota Medicaid threshold but below 400% FPL, ACA marketplace plans with advance premium tax credits are available through Healthcare.gov. The 2026 ACA subsidy cliff returned as enhanced premium tax credits from the American Rescue Plan expired January 1, 2026, so families between 100% and 400% FPL receive standard subsidies while those between 400% and about 450% FPL may face full unsubsidized premiums.

South Dakota Medicaid income limits by household size (2026)

The 2026 South Dakota Medicaid income guidelines below are based on the 2026 Federal Poverty Level for the 48 contiguous states. Adult column = expansion-group South Dakota Medicaid (138% FPL, covers adults ages 19-64 with or without dependent children). Children column = South Dakota children's Medicaid (187% FPL for ages 0-18); CHIP extends coverage to 209% FPL. Pregnancy column = South Dakota Medicaid for pregnant women (138% FPL) with 12 months of postpartum coverage. Add $5,680 of annual income per additional household member at 138% FPL; add $10,622 per additional member at 187% FPL for the children's threshold.

South Dakota Medicaid eligibility requirements (non-income)

South Dakota Medicaid eligibility in 2026 requires meeting both income criteria and non-income criteria. Income is assessed using the federal MAGI (Modified Adjusted Gross Income) methodology for most groups. Non-income criteria include state residency, citizenship or qualifying immigration status, age, and household composition. The asset test has been eliminated for all MAGI-based categories (expansion adults, children, pregnant women, and parents), though it still applies to the aged/blind/disabled and long-term care categories.

• South Dakota residency: Applicants must live in South Dakota with the intent to remain. Temporary visitors and non-residents do not qualify. Proof of residency includes a utility bill, lease agreement, or official mail addressed to the applicant at a South Dakota address.
• U.S. citizenship or qualifying immigration status: U.S. citizens and certain lawful permanent residents qualify. Some immigrant categories face a 5-year waiting period before becoming eligible for federal Medicaid funding. South Dakota Medicaid does not cover undocumented adults or children beyond emergency-only services (unlike some states that use state-only funds for broader coverage).
• Social Security Number: Each person applying for Medicaid must provide a Social Security Number or proof that an SSN application is pending. SSNs are not required for undocumented household members who are not applying for coverage.
• Age and category: The ACA expansion group covers adults ages 19 to 64. Children ages 0 to 18 qualify under the children's Medicaid program up to 187% FPL. Pregnant women of any adult age qualify up to 138% FPL. Adults age 65 and older or adults who are blind or disabled qualify under a separate SSI-related category with income and asset tests.
• No asset test for MAGI categories: South Dakota Medicaid does not apply an asset (resource) test to the expansion adult, children, pregnant women, or parent categories. This means savings accounts, a vehicle, or home equity do not affect eligibility for these groups.
• No other minimum essential coverage disqualification: Having access to affordable employer-sponsored insurance does not automatically disqualify you from South Dakota Medicaid, though DSS may coordinate benefits if both coverages exist. Employees with access to employer coverage that costs more than about 8.39% of household income in 2026 may still qualify for Medicaid if their income falls within the Medicaid thresholds.

What income counts for South Dakota Medicaid

South Dakota Medicaid uses federal MAGI (Modified Adjusted Gross Income) rules to count income for adults, children, and pregnant women. MAGI is roughly equivalent to the income you report on your federal tax return, with a few differences specific to Medicaid. The 5% federal income disregard is built into the published thresholds, so you compare your gross income directly to the dollar figures in the household-size table. DSS references the South Dakota MAGI income manual and IRS modified AGI definition when determining countable income.

Income sources included

• Wages and salaries: All gross earned income from employment, including tips, bonuses, and overtime pay, is counted as MAGI income.
• Self-employment net earnings: Net profit from freelance, contract, or business income (after business expenses) is counted. South Dakota DSS may ask for 12 months of business records or a recent Schedule C.
• Social Security Disability Insurance (SSDI): SSDI benefits are counted as MAGI income (the taxable portion, per IRS rules). Note that SSI (Supplemental Security Income) is different and is excluded from MAGI.
• Social Security retirement and survivor benefits: The taxable portion of Social Security retirement and survivor benefit income is counted under MAGI.
• Unemployment compensation: State and federal unemployment benefits are counted in full as MAGI income.
• Pensions, annuities, and retirement distributions: Taxable distributions from 401(k), IRA, pension, and similar retirement accounts are counted as MAGI income.
• Interest, dividends, and capital gains: Investment income including bank interest, stock dividends, and proceeds from selling assets (net of cost basis) count as MAGI income.
• Rental and royalty income: Net income from rental properties (after allowable expenses) and royalties are counted as MAGI income.

Income sources excluded

• Supplemental Security Income (SSI): SSI cash payments from the Social Security Administration are excluded from MAGI. SSI recipients are automatically enrolled in South Dakota Medicaid under a separate category with its own income test based on the SSI federal benefit rate.
• Child support received: Child support payments received for a child in the household are excluded from MAGI income for Medicaid purposes.
• Veterans' benefits: VA disability compensation, pension, education benefits (GI Bill), and survivor benefits paid by the Department of Veterans Affairs are excluded from MAGI.
• Workers' compensation: Payments received from workers' compensation insurance for a work-related injury or illness are excluded from MAGI income.
• TANF and cash assistance: Temporary Assistance for Needy Families (TANF) grants and most other federal cash assistance payments are excluded from MAGI income.
• Gifts, inheritances, and loan proceeds: Lump-sum gifts, inherited money, and money borrowed through loans are not counted as income under MAGI methodology.

How to apply for South Dakota Medicaid in South Dakota

South Dakota Medicaid applications are submitted through the Department of Social Services (DSS) Economic Assistance Portal at eaportal.sd.gov. The same portal also handles SNAP (food stamps), TANF, and other assistance programs. South Dakota residents can apply online, by phone, by mail, or in person at any DSS county office. Applications are processed year-round with no open enrollment period for most Medicaid categories. Federal rules require DSS to process standard Medicaid applications within 45 days; pregnancy applications must be processed within 15 days under expedited-processing rules.

1. 1. Gather your documents before starting: photo ID, Social Security cards for everyone applying, proof of South Dakota residency, proof of citizenship or immigration status, and your most recent pay stubs or income statements for the past 30 days.
2. 2. Create an account at eaportal.sd.gov or call DSS at 1-605-773-3165 to begin a phone application. You can also download a paper application from dss.sd.gov/medicaid/generalinfo/apply.aspx and mail or fax it to your county DSS office.
3. 3. Complete the application by listing every household member, reporting all income sources, and uploading or attaching required documents. Provide information about any other health coverage your household currently has.
4. 4. Submit the application and save your confirmation number. DSS will send written notice of its eligibility determination by mail.
5. 5. Respond promptly to any DSS requests for additional information. DSS typically gives applicants 10 days to supply missing documents. Failure to respond within the deadline is the most common reason Medicaid applications are denied.
6. 6. Wait for the eligibility determination notice. Standard applications are decided within 45 days. Pregnancy applications are decided within 15 days. If approved, coverage may be retroactive up to 3 months before the application date if you had qualifying expenses during that period.

Official portal: eaportal.sd.gov

Documents needed

• Photo identification for the head of household (South Dakota driver's license, state ID card, or U.S. passport)
• Social Security Numbers for every household member who is applying for Medicaid coverage
• Proof of South Dakota residency (utility bill, lease or mortgage statement, or official mail showing the applicant's current South Dakota address)
• Proof of U.S. citizenship or qualifying immigration status (U.S. birth certificate, U.S. passport, Certificate of Naturalization, or Permanent Resident Card)
• Proof of income: last 30 days of pay stubs from all employers; if self-employed, the most recent 12 months of income records or a signed statement of expected annual earnings
• For pregnant women: documentation of pregnancy from a licensed medical provider (a signed statement from a doctor, midwife, or certified nurse-midwife stating the estimated due date)

Processing timeline: Standard South Dakota Medicaid applications are processed within 45 calendar days from the date the completed application is received. Pregnancy applications must be processed within 15 calendar days. Disability-related applications may take 60 to 90 days because they require a medical determination from DSS Disability Determination Services. If retroactive coverage is requested, DSS will review the prior 3 months of eligibility history.

Common reasons applications get denied

• Income above the population-specific threshold: The most common denial reason. An adult over 138% FPL does not qualify for expansion Medicaid. A child over 209% FPL does not qualify for Medicaid or CHIP.
• Failure to respond to a DSS request for additional information within the 10-day window. Applications are closed if DSS cannot verify required information within the processing period.
• Failure to verify South Dakota residency. Applicants who cannot provide a current utility bill, lease, or other address documentation in their name may be denied until proof is supplied.
• Immigration status: Adults who have not met the 5-year lawful permanent resident waiting period for federal Medicaid funding do not qualify for South Dakota Medicaid unless they are pregnant (in which case certain emergency and pregnancy categories apply).
• Age outside covered range for the category: Applicants ages 65 and older who apply under the expansion adult category will be directed to the aged/blind/disabled or Medicare Savings Program category instead.

If your child's income is over the South Dakota Medicaid limit for children

South Dakota CHIP covers uninsured children under age 19 in households earning between 187% and 209% of the Federal Poverty Level. For 2026, 209% FPL equals approximately $68,970 per year for a household of four. CHIP provides the same comprehensive benefit package as South Dakota Medicaid, including well-child visits, dental, vision, prescriptions, and mental health services. Children with private insurance coverage may qualify for CHIP up to 200% FPL. Apply for South Dakota CHIP through the same DSS portal at eaportal.sd.gov or call 1-605-773-3165. For a national comparison of CHIP and Medicaid income limits across all 50 states, see our state Medicaid income limits overview.

Compare Medicaid and CHIP income limits across all 50 states

If you are 65 or older with limited income: South Dakota Medicare Savings Programs

South Dakota runs four Medicare Savings Programs (MSPs) for residents who have Medicare Part A and Part B and limited income. The Qualified Medicare Beneficiary (QMB) program pays Medicare Part A and Part B premiums, deductibles, and coinsurance for individuals with income up to 100% FPL ($15,960 per year in 2026). The Specified Low-Income Medicare Beneficiary (SLMB) program pays Part B premiums for individuals with income between 100% and 120% FPL ($19,152 per year in 2026). The Qualifying Individual (QI) program pays Part B premiums for individuals between 120% and 135% FPL ($21,546 per year in 2026). South Dakota also offers the Qualified Disabled and Working Individuals (QDWI) program. Apply for Medicare Savings Programs through DSS at eaportal.sd.gov or call 1-605-773-3165. Dual-eligible individuals (those with both Medicare and Medicaid) may also qualify for Low-Income Subsidy (LIS/Extra Help) on Part D drug costs.

Read the Medicare eligibility guide

Frequently Asked Questions