The following individuals are eligible for medical assistance:

1. (1) A parent or other caretaker relative of a dependent child eligible for Medicaid under the provisions of chapter 67:46:12;
2. (2) A person who is a recipient of a money payment under the supplemental security income program;
3. (3) A person under age twenty-one who would be a recipient of a money payment under the supplemental security income program if not subject to subparagraphs (A) and (B) of 42 U.S.C. § 1382(c)(7);
4. (4) A person who is in a hospital or intermediate care facility and would be eligible for a money payment under the supplemental security income program upon leaving the facility;
5. (5) A person under age twenty-one who is in the custody of the department and who meets the income requirements of § 67:46:12:15;
6. (6) A person under age twenty-one who meets the income limits of § 67:46:12:15, is in foster care, and whose financial responsibility has been assumed in full or in part by the department;
7. (7) A person who is eligible under the provisions of chapters 67:46:02 to 67:46:06, inclusive;
8. (8) A person who is eligible for transitional medical benefits under the provisions of chapter 67:46:13;
9. (9) A child in a subsidized adoption;
10. (10) A person who is currently receiving social security, who was entitled to and received social security and supplemental security income concurrently after April 1977, who was terminated from supplemental security income, and who currently would be eligible for supplemental security income if the social security cost of living allowances back to the time of supplemental security income ineligibility are disregarded;
11. (11) A pregnant woman who meets the income requirements under the provisions of chapter 67:46:12;
12. (12) A woman who applied for Medicaid while pregnant and who was eligible for and received Medicaid on the date the pregnancy ended. Eligibility continues to the end of the month three hundred and sixty-five days after the pregnancy ends;
13. (13) A child under age nineteen whose family income meets the income requirements under the provisions of chapter 67:46:12;
14. (14) A child under age nineteen who is eligible for the non-Medicaid children's health insurance program covered under the provisions of chapter 67:46:14;
15. (15) A person determined to be a qualified Medicare beneficiary under the provisions of chapter 67:46:11, with benefits limited to the part A and B premium, deductible, co-payments, and coinsurance charges;
16. (16) A person determined to be a special low-income Medicare beneficiary under the provisions of chapter 67:46:11 whose income is at least one hundred percent, but less than one hundred and twenty percent of the federal poverty level. Benefits are limited to payment of part B Medicare premiums;
17. (17) A person determined to be a qualified Medicare beneficiary under the provisions of chapter 67:46:11 whose income is at least one hundred and twenty percent, but less than one hundred and thirty-five percent of the federal poverty level, and who is not otherwise eligible for Medicaid. Benefits are limited to payment of part B Medicare premiums. The department may discontinue services provided under the provisions of this chapter if the department exhausts its financial resources for providing the services;
18. (18) A person who is eligible for and is receiving services under the home and community-based services waiver program in chapter 67:44:03 or the home and community-based services program in chapter 67:54:04, 67:54:06 or 67:54:09;
19. (19) A disabled widow or a disabled widower who is at least age fifty but less than age sixty-five, who was terminated from supplemental security income due to receipt of social security benefits under Title II of the Social Security Act, as amended to January 1, 2016, who is not on Medicare part A, and who would continue to be eligible for supplemental security income if the Title II benefits are disregarded;
20. (20) A disabled adult who became disabled or blind before age twenty-two and was terminated from supplemental security income due to entitlement to social security benefits as an adult disabled child, but who would continue to be eligible for supplemental security income if the social security benefits are disregarded;
21. (21) A child born to a woman eligible for and receiving Medicaid on the date of the child's birth. Eligibility continues for up to one year as long as the child remains a resident of the state;
22. (22) A child under age twenty-one who is under the jurisdiction of the South Dakota Department of Corrections, is not an inmate of a public institution, does not reside with a parent, and meets the income requirements as established under the provisions of chapter 67:46:12;
23. (23) A child under age twenty-six who, on the child's eighteenth birthday, was in foster care under the responsibility of the state;
24. (24) A woman over age twenty-nine and under age sixty-five who was screened for breast and cervical cancer by the Department of Health's All Women Count Program and who is in need of treatment for breast or cervical cancer or a precancerous condition of the breast or cervix, is not covered under creditable coverage, and is not otherwise eligible for medical services;
25. (25) Coverage from conception to birth when the mother is not eligible for Medicaid under the requirements of § 67:46:01:16 and meets the income limits established in § 67:46:12:11;
26. (26) A working individual with a disability who has a net income below two hundred and fifty percent of the federal poverty level and who, except for earned income, meets all criteria for receiving benefits under the supplemental security income program; and

27. (27) A person over age eighteen and under age sixty-five who meets the income requirements in chapter 67:46:12.

    For purposes of this rule, a qualified alien who arrived in the United States after August 21, 1996, and who meets the eligibility requirements contained in this section must also meet the requirements of § 67:46:01:10.

    Cross-References:

    Federal poverty level, § 67:11:01:03.

    Subsidized adoption regulations, chapter 67:14:14.

    Declaration and documentation of citizenship required, § 67:46:01:16.

    Income limit -- Pregnant woman, § 67:46:12:11.

    Deemed newborn children, 42 C.F.R. § 435.117.

    Institutionalized individuals, 42 C.F.R. § 435.1009.

    Definitions relating to institutional status, 42 C.F.R. § 435.1010.

    Group care centers for minors, chapter 67:42:07.

    Residential treatment centers, chapter 67:42:08.

    State option of Medicaid coverage for adolescents leaving foster care, 113 Stat. 1829.

    John H. Chafee foster care independence program, 113 Stat. 1824.

    State option of Medicaid coverage for adolescents leaving foster care, 42 U.S.C. § 1396a(a)(10)(A)(ii)(XVII).

    State option of Medicaid coverage for certain breast or cervical cancer patients, 42 U.S.C. § 1396a(a)(10)(A)(ii)(XVIII).

    Prohibition of preexisting condition exclusions or other discrimination based on health status, 42 U.S.C. § 300gg-3(c).

    State option of working individuals with disabilities, 42 U.S.C. § 1396a(a)(10)(A)(ii)(XIII) (July 1, 2016).

Source: SL 1975, ch 16, § 1; 2 SDR 88, effective July 1, 1976; 4 SDR 35, effective December 22, 1977; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 8 SDR 170, effective June 21, 1982; 12 SDR 4, effective July 21, 1985; 12 SDR 112, effective January 16, 1986; 13 SDR 193, effective June 22, 1987; 14 SDR 140, effective May 1, 1988; 15 SDR 2, effective July 17, 1988; 15 SDR 171, effective May 15, 1989; 15 SDR 191, effective June 11, 1989; 17 SDR 8, effective July 23, 1990; 17 SDR 53, effective October 16, 1990; 17 SDR 187, effective June 3, 1991; 17 SDR 187, effective June 3, 1991; 17 SDR 200, effective July 1, 1991; transferred from § 67:16:01:02 , effective August 23, 1992; 19 SDR 141, effective March 25, 1993; 20 SDR 92, effective December 21, 1993; 21 SDR 67, effective October 13, 1994; 21 SDR 162, effective March 23, 1995; 22 SDR 32, effective September 11, 1995; 23 SDR 152, effective March 14, 1997; 24 SDR 24, effective August 31, 1997; 24 SDR 104, effective January 29, 1998; 25 SDR 13, effective August 9, 1998; 26 SDR 168, effective July 1, 2000; 29 SDR 84, effective November 22, 2002; 30 SDR 193, effective June 13, 2004; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014; 41 SDR 93, effective December 3, 2014 ; 43 SDR 31, effective September 12, 2016; 49 SDR 125, effective July 3, 2023 .

General Authority: SDCL 28-6-1 .

Law Implemented: SDCL 28-6-1 (6).

Prior versions effective: 2016-09-12, 2014-12-03, 2014-07-29, 2010-07-01.