How to Apply for Medicaid in South Dakota

You can apply for Medicaid online by clicking here.  You can also submit a paper application, which you can find on the state website (here), or get assistance applying via an attorney.

Medicaid Eligibility Program Overview

Medicaid pays for the cost of Nursing Home care in South Dakota that meets certain financial and health criteria.  The average cost of Skilled Nursing Care in South Dakota is $88,332 per year, so securing Medicaid coverage is essential.  There are 100 nursing homes in South Dakota, most of which accept Medicaid insurance as a form of payment.  Nursing homes in South Dakota are currently 86.0% occupied, with an average of 4,638 patients currently using the 5,393 available beds.

South Dakota Medicaid Asset Limitations for 2023

Individuals in South Dakota can keep $2,000 when they apply to Medicaid for long-term care.  If they are over this amount, they must spend down on care.  It’s important to note that individuals are not allowed to give gifts of any amount for a period of 5 years (60 months) before applying for Medicaid.  If an individual’s assets are more than $2,000, they should learn about Medicaid Planning strategies.  This asset limit only applies to assets that are considered countable.  Countable assets include; savings accounts, checking accounts, retirement accounts and a second home.  If you have multiple assets and are looking to access Medicaid, it may make sense to speak with a Medicaid Planner or Elder Law attorney in South Dakota.

Couples requiring Medicaid for long-term care in South Dakota are allowed to keep $3,000 in assets.  If one spouse requires care and one does not, the spouse that does not receive care is known as the Community Spouse.  The Community Spouse is allowed to keep 50% of their assets up to $123,600 in countable assets, which is known as the Community Spouse Resource Allowance.  The Community Spouse is allowed to keep 100% of their marital assets up to $24,720.

The maximum amount of home equity allowed when applying to Medicaid is $572,000.  Despite the fact that the home is not a countable asset, Medicaid can look for repayment in probate court from the sale proceeds after it stops paying for care.  It is important to understand if your home may be subject to the Medicaid repayment process.

Income Limits in South Dakota For Medicaid

In South Dakota, the individual receiving Medicaid cannot earn over $2,250.  If their income exceeds that amount, they will need to do some Medicaid planning to create eligibility.  One strategy that works well is a Miller Trust, also known as a Qualified Income Trust.  If an individual is married, the spouse’s income does not typically count towards the income cap, but it is important to maximize income protection via the Monthly Needs Allowance rules.  The maximum amount of income the Medicaid office allows a community spouse to keep in South Dakota is $3,090.  All of an individual’s monthly income must go towards their cost of care, which can include medical bills, prescriptions and other health care costs.  $60 can be set aside for the personal needs allowance.  The income limits are based on a percentage of the Supplemental Security Income defined by the Social Security Administration’s Federal Poverty Levels (FPL) and change annually.

Penalty Information in South Dakota For Medicaid

If a gift of any amount is given in South Dakota during a period of 5 years before applying to Medicaid, a penalty period will be initiated. This penalty period in South Dakota is called a look-back period, which can make an individual not eligible for Medicaid.   Medicaid will not pay for care until the penalty period is over.  The penalty is calculated by taking the total amount of any gifts given and dividing it by $6,215, which creates a several-month period before Medicaid coverage begins.

The average cost of Nursing home care (private room) in South Dakota is $7,604, so penalties can become very costly for a family that has not planned appropriately for Medicaid.