Medicaid Costs and Coverage in South Dakota

Determining how much is Medicaid in South Dakota is dependent on the type of medical services and treatments received. South Dakota Medicaid coverage includes a wide range of medical treatments including physician services, mental health care, hospital stays, certain prescription drugs and more. For South Dakota Medicaid insurance participants, many treatments and services are free, while others require patients to provide a cost-sharing payment. With cost-sharing payments, recipients pay a small percentage of the cost of a medical treatment or service and the South Dakota Medicaid insurance program covers the remainder. Learn what services are covered by Medicaid in South Dakota by reviewing the topics below.

How South Dakota Medicaid Coverage Works

South Dakota Medicaid coverage pays for medical treatments and services for eligible low-income families and individuals. The South Dakota Department of Social Services (DSS) administers different types of Medicaid insurance plans according to guidelines established by the federal government. South Dakota Medicaid insurance is funded by the state and federal taxes.

The South Dakota Medicaid health insurance system encompasses several different programs designed for different categories of recipients including low-income families, pregnant women, disabled workers and the elderly. Medicaid covered services may vary depending on the type of Medicaid insurance, but all South Dakota Medicaid programs cover the same essential medical services. These essential medical services are federally mandated. Download our comprehensive Medicaid guide for more details about the mandatory coverage Medicaid must provide enrollees.

Select services covered by Medicaid require a small payment for a portion of your medical bill, also known as a “cost share” or “copayment.” Medicaid coverage and costs are influenced by your information on Medicaid application forms. The cost-sharing payment is provided to a health care professional at the time certain types of medical treatment or service are received.

What services are covered by Medicaid in South Dakota?

All South Dakota Medicaid coverage programs include the same types of fundamental medical treatments and services. However, Medicaid insurance patients should not presume Medicaid covers all medical services. Before receiving treatment, patients should talk to their health care provider to determine if their treatment is covered under Medicaid in South Dakota. The following are examples of Medicaid services that may be covered in South Dakota:

  • Medical and surgical services administered by a doctor, nurse practitioner or physician assistant
  • Dental checkups and two cleanings that do not exceed Medicaid coverage limits
  • Hospital inpatient and outpatient stays
  • Psychiatric and phycological evaluations, plus psychotherapy for certain mental health disorders and illnesses
  • Ground and air ambulance rides and emergency room visits

In South Dakota, Medicaid health insurance also covers many, though not all, prescription medications. Similarly, the South Dakota Non-Emergency Medical Travel (NEMT) Medicaid coverage program covers the cost of qualifying travel associated with medical treatments located a certain distance outside of a Medicaid participant’s area of residence. Beneficiaries should be aware that their Medicaid eligibility group will also influence which services are covered. For instance, children enrolled in Medicaid receive more comprehensive coverage than adults.

How much does Medicaid cost in South Dakota?

For many services covered by Medicaid, there is no cost to the patient. Medicaid services that do not require a cost-sharing payment or copayment include pregnancy services, family planning and emergency hospital treatments. In addition, there are no cost-sharing payments required for children, infants or participants in the breast or cervical cancer program. However, select South Dakota Medicaid covered services may require a small cost-sharing payment. You may be required to pay a small cost-share payment for the following services:

  • Dental procedures
  • Medical and mental health visits
  • Inpatient and outpatient hospital stays
  • Chiropractic treatments
  • Podiatry and vision services

Most Medicaid cost estimates do not exceed $3 per service or $4 for prescription medications. After completing the Medicaid application process in South Dakota, beneficiaries will receive information regarding copayments for prospective health care services.

What does Medicaid not Cover in South Dakota?

Although South Dakota Medicaid coverage includes many medical treatments, services and prescription medications, there are some that are not covered by Medicaid. For services not covered by Medicaid in South Dakota, patients are required to pay out of pocket. Most over-the-counter drugs and health products are not covered by Medicaid. Medicaid will also not cover cosmetic procedures that are not medically required. Likewise, the program will not cover medical treatments and equipment that are not considered necessary.

Some services covered by Medicaid typically may not be covered under certain conditions. Medicaid coverage has limits on certain services and treatments. For instance, Medicaid will stop covering mental health visits when the beneficiary has reached his or her coverage maximum. Similarly, Medicaid enrollees will need to cover the cost of hospital stays that exceed Medicaid maximums. Learn more about Medicaid-covered services by downloading our detailed national Medicaid guide here.

Services Covered by Different Types of Medicaid Insurance Programs

In South Dakota, there are different types of Medicaid insurance programs for different categories of recipients. In addition to standard medical services covered by Medicaid, South Dakota’s specialty Medicaid programs may include additional covered services and treatments. For example, Family Support Services Medicaid coverage, aimed at South Dakota patients with a developmental disability, like Down syndrome or autism, provides additional services to qualifying participants. In addition to usual Medicaid covered treatments, the South Dakota Family Support Services program includes respite care, companion care, certain nutritional supplements and other specialty services. Services and program eligibility are based on provided information on Medicaid applications, so it is important to note all medical needs on the forms.

Another example program is Medicaid health insurance for qualifying elderly individuals. In addition to basic services included in Medicaid, this South Dakota program covers private nursing, adult day care, emergency response devices and other elderly-specific services. Similarly, Pregnant Women Medicaid insurance programs may include special services for qualifying pregnant women. In addition to traditional services that Medicaid includes, Pregnant Women programs may include postpartum services.