South Dakota Medicaid Enrollment Stabilizes — But Thousands Are Still Uninsured
If you lost Medicaid coverage in South Dakota over the past two years, you are not alone — and you may still be eligible for coverage. South Dakota Medicaid enrollment dropped by thousands during the federally mandated "unwinding" process that began in April 2023, when states were required to resume annual eligibility redeterminations after a three-year pause during the COVID-19 public health emergency. According to recent reporting by South Dakota Searchlight, enrollment has now stabilized, but the gap left by disenrollments remains a serious concern for low-income households across the state.
This article explains who may be eligible to re-enroll in South Dakota Medicaid, what income thresholds apply, what documents you'll need, and where to get help — including options if Medicaid is not available to you.
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What Happened During the Medicaid Unwinding
From March 2020 through March 2023, the federal government required states to keep Medicaid enrollees continuously covered as a condition of receiving enhanced federal funding. When that requirement ended, states had up to 14 months to review their entire Medicaid caseload — a process called "unwinding."
Many enrollees were disenrolled not because they were ineligible, but due to procedural reasons: outdated addresses, missing paperwork, or administrative errors. The Kaiser Family Foundation and the Centers for Medicare & Medicaid Services (CMS) both documented that a significant share of people disenrolled during unwinding were likely still eligible for coverage.
South Dakota's situation was further complicated by the timing of its Medicaid expansion. Voters approved expansion under Amendment D in November 2022, and the state began covering newly eligible adults — those earning up to 138% of the Federal Poverty Level (FPL) — starting July 1, 2023. This means some residents who were disenrolled during unwinding may actually qualify under the expanded eligibility rules they didn't have access to before.
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Who May Be Eligible for South Dakota Medicaid
Adults Under the Expansion
South Dakota now covers non-elderly adults (ages 19–64) who earn at or below 138% FPL. Benefit amounts vary by household size and income. There is no asset test for this expansion population.
Children and Families
Children may be eligible through Medicaid or the Children's Health Insurance Program (CHIP), known in South Dakota as Healthy Kids. Children in households earning up to 200% FPL may qualify for CHIP, and those at lower income levels may qualify for full Medicaid.
Pregnant Individuals
Pregnancy-related Medicaid coverage is available at higher income thresholds. South Dakota covers pregnancy-related services for individuals earning up to 133% FPL under standard Medicaid rules, and postpartum coverage has been extended to 12 months under recent federal policy changes.
People Who Were Disenrolled
If you received a notice that your Medicaid coverage ended during 2023 or 2024, you have the right to reapply at any time. Medicaid has no open enrollment window — you can apply year-round.
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Required Documents for South Dakota Medicaid
When you apply or reapply, gather the following:
- Proof of identity: driver's license, state ID, or passport
- Proof of South Dakota residency: utility bill, lease agreement, or official mail
- Proof of income: recent pay stubs (last 30 days), employer letter, or tax returns if self-employed
- Social Security numbers for all household members applying
- Immigration documentation if applicable (lawful permanent residents and certain other immigration statuses may qualify)
- Current health insurance information, if any
If you don't have all documents, apply anyway. South Dakota's Department of Social Services (DSS) can often verify information electronically through federal data sources.
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How to Apply or Re-Enroll
- Online: Apply through the South Dakota Department of Social Services at dss.sd.gov or through HealthCare.gov, which screens for both Medicaid and Marketplace eligibility.
- By phone: Call SD DSS at 1-888-828-0059.
- In person: Visit your local DSS office. A directory is available on the DSS website.
- Through a Navigator or Certified Application Counselor: Free, trained assisters can help you complete your application. Find one at localhelp.healthcare.gov.
Note: If you request assistance through any online form, standard messaging rates may apply, and by submitting your contact information you consent to being contacted about your inquiry.
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If You Don't Qualify for Medicaid: ACA Marketplace Options
If your income is above 138% FPL, you may be eligible for subsidized coverage through the ACA Health Insurance Marketplace. Premium tax credits are currently available to households earning between 100% and 400% FPL, and enhanced subsidies enacted under the Inflation Reduction Act extend meaningful assistance to households above that threshold as well — though these provisions are subject to Congressional reauthorization.
South Dakota uses the federal Marketplace at HealthCare.gov. Open Enrollment typically runs from November 1 through January 15, but a Special Enrollment Period (SEP) may be available if you lost Medicaid coverage within the past 60 days. Loss of Medicaid is a qualifying life event that triggers a 60-day SEP window.
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Community Health Centers: Care Regardless of Coverage Status
If you are currently uninsured and waiting for coverage to begin, Federally Qualified Health Centers (FQHCs) provide primary care, dental, behavioral health, and pharmacy services on a sliding-fee scale based on income. No one is turned away for inability to pay.
Find the nearest FQHC in South Dakota using the Health Resources and Services Administration (HRSA) Find a Health Center tool at findahealthcenter.hrsa.gov.
FQHC staff can also help you apply for Medicaid or Marketplace coverage during your visit.
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Prescription Assistance If You're Uninsured
If you need medications while waiting for coverage, several programs may help:
- NeedyMeds (needymeds.org): A database of manufacturer patient assistance programs
- RxAssist (rxassist.org): Connects patients to free or low-cost medications
- 340B Drug Pricing Program: FQHCs and other safety-net providers can offer discounted medications to eligible patients
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People Also Ask
Q: Can I reapply for South Dakota Medicaid if I was disenrolled during the unwinding? Yes. Medicaid accepts applications year-round with no enrollment deadline. If you were disenrolled for procedural reasons — such as a missed renewal notice — you may still meet income and residency requirements. Apply through the SD Department of Social Services online, by phone, or in person. If your income is at or below 138% FPL, you may be eligible under the state's expanded coverage.
Q: What is the income limit for Medicaid in South Dakota? For adults under the ACA expansion, the income threshold is 138% of the Federal Poverty Level. For children, CHIP coverage (Healthy Kids) extends to 200% FPL. Pregnant individuals and people with disabilities may qualify under different thresholds. Benefit amounts vary by household size and income. Because FPL dollar amounts change annually, check current figures at HealthCare.gov or with SD DSS.
Q: Does losing Medicaid qualify me for a Special Enrollment Period on the ACA Marketplace? Yes. Losing Medicaid or CHIP coverage is a qualifying life event that opens a 60-day Special Enrollment Period on the ACA Marketplace. You can enroll in a Marketplace plan at HealthCare.gov during this window even outside the standard November–January Open Enrollment period. Premium tax credits may be available depending on your household income.
Q: Are there free helpers who can assist with Medicaid or Marketplace applications in South Dakota? Yes. Navigators and Certified Application Counselors provide free, unbiased help with Medicaid and Marketplace applications. Find local assisters at localhelp.healthcare.gov. Federally Qualified Health Centers (FQHCs) also offer enrollment assistance during patient visits. These helpers cannot make coverage decisions but can guide you through the application process.
Q: What if I don't have all my documents when I apply for Medicaid? Apply anyway. South Dakota DSS can often verify income, identity, and residency electronically through federal data systems. Submitting an incomplete application starts your eligibility date. You can provide missing documents after submission. Missing a deadline because you waited for paperwork could delay coverage, so submit what you have and follow up promptly.
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Program eligibility and availability vary by state. Not affiliated with any government agency.
Last reviewed: April 2026