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South Dakota Services Request Cover Sheet
Category:
State:
Multi-State
Control #:
US-143-AZ
Format:
Word;
PDF;
Rich Text
Instant download
Description
How to fill out Services Request Cover Sheet?
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FAQ
Medicaid Expansion Overview South Dakota voters approved Constitutional Amendment D, which provides for Medicaid Expansion in South Dakota. Under Constitutional Amendment D, starting July 1, 2023, adults ages 18 to 64 with incomes up to 138% of the federal poverty level will qualify for Medicaid.
Eligibility levels for parents are presented as a percentage of the 2023 FPL for a family of three, which is $24,860. Eligibility limits for single adults without dependent children are presented as a percentage of the 2023 FPL for an individual, which is $14,580.
Starting July 1, 2023, South Dakota's Medicaid expansion allows individuals to qualify for Medicaid by raising the income requirement to 138% of the Federal Poverty Level (FPL), up to $41,400 for a family of 4, and adding childless adults.
South Dakota Medicaid and CHIP Programs provide coverage to help pay for necessary medical expenses individuals need to stay healthy such as hospital stays, doctor visits, prescriptions, and other health care needs.
By using the SD DSS Online System you can apply at any time. The SD DSS Online System is one way for South Dakota residents to apply for benefits. Although an interview is still required to qualify for SNAP benefits, the application process begins the moment the application is submitted electronically.
Professional claims submitted on paper must be submitted using the original National Standard Form (CMS 1500) printed in red OCR ink to submit professional services claims to South Dakota Medicaid. The form is designed to permit a provider to bill up to six services for one recipient.
Am I Eligible for Assistance Family SizeAdjusted Monthly Income Based on 209% of Federal Poverty Level Effective March 1, 20232$3,4343$4,3304$5,2255$6,1202 more rows
Who is eligible for this program? Household Size*Maximum Income Level (Per Year)3$33,0644$39,9005$46,7376$53,5734 more rows
