Cost and Coverage of Medicaid in South Dakota

What services are covered by Medicaid for South Dakota enrollees? How much is South Dakota Medicaid?

These, and other questions will be addressed below. In particular, the following are covered:

  • How much does Medicaid cost in South Dakota?

  • What services are covered by Medicaid in South Dakota?

  • What does Medicaid not cover in South Dakota?

  • Types of Medicaid insurance in South Dakota

How Much Does Medicaid Cost in South Dakota?

South Dakota Medicaid cost estimates are in line with the requirements of the federal government. According to federal guidelines, states have the option to establish cost sharing (out of pocket) spending requirements and charge premiums for Medicaid enrollees. SD Medicaid cost estimates for cost sharing expenses vary from member to member. The costs may include copayments, deductibles, coinsurance and other similar charges.

SD Medicaid cost estimates do not apply to pregnant women and children. These members are exempted from most coinsurance, copayments and out of pocket costs. Moreover, South Dakota estimate Medicaid costs do not apply to Native America receiving services through HIS or upon HIS referral or those eligible to receive or that have ever received care from Urban Indian Health, HIS or another Tribal facility.

So, how much is Medicaid in South Dakota? With these exemptions, it is clear very few members have to pay copayments. To promote efficient use of Medicaid, South Dakota imposes significant cost sharing requirements. Medicaid coverage copayments are charged for inpatient hospital ($50 per admission), non-emergency dental services ($3 co-pay, $1000 annual limit for adults), Durable Medical Equipment (5 percent), generic prescription drugs ($1), brand prescription drugs ($3.30) and non-emergency outpatient hospital services (5% of billed charges).

SD Medicaid services copayments do nto exceed $50.

What Services are Covered by Medicaid in South Dakota?

SD Medicaid services vary from provider to provider. However, not all providers cover the services outlined. Before you get a service, confirm with your provider whether it is covered. Check the Medicaid cost estimates for services not covered as you will have to pay for them from your pocket.

  • Ambulance. Covers air and ground ambulance trips, oxygen, attendant and loaded mileage (and other necessary expenses).

  • Chiropractic. Covers manual manipulation of the spine. Restricted to 30 manipulations in 12 months.

  • Clinics. Covers medical supplies and services provider under the direction of a health care provider.

  • Community Transportation (non-wheelchair) coverage. Covers emergency transportation to and from medically necessary appointments for the services covered under Medicaid.

  • Dental. Covers various dental services, some of which must be pre-approved. Adults over 21 years have a cover of up to $1000 per year for non-emergency services.

  • Diabetes Education. Covers up to 10 hours of education on how to manage diabetes when you are first diagnosed with the condition.

  • Home Health. Covers medical supplies, therapy and nursing care when offered in the recipient’s home.

  • Hospice. Provides end-of-life care for recipients that are terminally ill. The care should be provided by licensed hospice providers.

  • Family Planning. Covers counseling, procedures, devices, supplies, diagnostics and treatment, and drugs for people of childbearing age.

South Dakota Medicaid coverage also caters the following services: out-of-state coverage, personal care, physician (doctor), podiatry (foot doctor), prescriptions, rehabilitation hospital, vision, and wheelchair transportation.

More Medicaid services covered include: Durable Medical Equipment (reusable medically necessary equipment that comply with the set limits), hospital inpatient (lab, therapy, room and board, operating and delivery rooms, supplies and equipment and regular nursing services), outpatient (emergency room supplies and services, radiology services, X-rays, outpatient care, drugs and therapy care), mental health (psychological and psychiatric evaluations), nursing home (general medical supplies, meals, therapy care, room and board, and nursing care) and others.

What Does Medicaid Not Cover in South Dakota?

South Dakota Medicaid coverage is not inclusive of the following services and items:

  • Reports solely requested for legal or insurance purposes, unless if they are requested by the Department of Human Services or the Department of Health.

  • Nursing facility services for members between 21 years and 65 years in mental disease institutions

  • Personal comfort services, protective outwear, exercise equipment, self-help devices or environmental control equipment such as furnaces, heaters, dehumidifiers or air conditioners.

  • Gastroplasty, gastric stapling, gastric bypass and any other similar surgical procedures, or the associated conservative weight loss management. These services are only allowed through prior authorization.

  • Procedures for implanting an embryo

  • Biofeedback and acupuncture

  • Plastic or cosmetic surgery intended to improve a person’s appearance when they do not need any bodily repair or any cosmetic surgery that is more than is required for the improvement of the functioning of any part of the body.

  • Treatment or diagnosis given when the patient is not present

  • Services or items for which charges are imposed by members of the recipient’s household or immediate relatives, or which the recipient has no legal obligation to pay.

  • Services or items which have been determined by a medical consultant, the state dental board or through peer reviews to be not medically effective, safe or necessary

Types of Medicaid Insurance in South Dakota

Various types of Medicaid insurance in South Dakota are offered by two carriers; Sanford and Avera. The Medicaid types of insurance you can sign up for will depend on your financial situation and amount of cover you need. You can sign up with either of the two providers and then choose a participating provider for health care. The provider you may be eligible for will depend on where you live.

All providers offer the basic Medicaid services are provided for by the federal government. However, the providers also have optional services that may have to be paid for. Evaluate the types of SD Medicaid insurance before signing up with a provider.



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