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Learn About Medicaid Costs and Coverage in South Dakota

Medicaid coverage in South Dakota helps eligible applicants get health care at an affordable cost. The types of Medicaid insurance available to potential beneficiaries extend across a wide range of medical services. The funding for Medicaid coverage comes from both the federal and state governments. SD Medicaid benefits cost the state more than $800 million, with just over half of that money coming from the federal level. Medicaid benefits cover a lot of medical procedures and services, but also exclude certain treatments and procedures, as well. Additionally, while the program attempts to keep Medicaid cost estimates low, in some cases, recipients will face costs in the form of copayments or other such charges. Understanding what Medicaid covers and the possible costs is vital information for petitioners seeking assistance. How much is Medicaid in South Dakota? Discover more about Medicaid cost estimates and what services are covered by Medicaid in the sections below.

What services are covered by Medicaid in South Dakota?

The government establishes the South Dakota Medicaid coverage regulations, including the procedures and services that the program handles. Individual states may change certain Medicaid benefits, depending on local needs. The cooperation between government officials, along with vital funding, helps make a system which can adjust to what the state requires.

A wide range of Medicaid benefits help families or individuals struggling with money who cannot otherwise get affordable medical care. Services covered by Medicaid fall under the administration of local officials who give petitioners detailed information about Medicaid cost estimates and the services provided. The combination of funds and coordination between state and federal governments allows state agents to manage the system in the best interest of potential beneficiaries. The flexibility of Medicaid coverage in South Dakota means that some guidelines are mandatory, while others are optional. For instance, the 2010 Affordable Care Act (ACA) allowed states to expand Medicaid to more recipients, such as adults struggling with income. South Dakota did not accept the ACA expansion, and therefore, does not cover more residents. Mandatory services Medicaid types of insurance cover include:

  • Primary physician visits.
  • Testing and treatment for specific diseases.
  • Transportation services.
  • Hospital services.
  • Nursing home services.
  • Home health care.
  • Health clinics.
  • Family planning services.
  • Pediatrician visits.
  • X-rays and other such tests.

To review the full list of services Medicaid covers, download our guide.

Medicaid coverage in South Dakota provides a lot of potential recipients throughout the state with aid. All who meet eligibility requirements can benefit from the assistance granted by the program. However, in addition to Medicaid coverage, certain providers add additional resources aimed at helping anyone under a specific age. Some of the coverage provided to minors includes:

  • Psychology and counseling.
  • Spine adjustment and other chiropractic services.
  • Private duty nurses in the home.
  • Vision, hearing and dental screenings.

In addition to Medicaid, children in South Dakota have the option of enrolling in CHIP. The CHIP program provides aid to children of families who earn too much income to qualify for regular Medicaid.

What services are not covered by Medicaid in South Dakota?

For potential beneficiaries seeking Medicaid coverage, it is important to learn the answer to, “What does Medicaid not cover in SD?” as well, as the program excludes certain types of medical procedures. Knowing the procedures and services not covered by Medicaid means that applicants will not spend time trying to gain aid that is otherwise unavailable. In most cases, medical services not considered medically necessary, otherwise known as “elective” procedures, are not covered by the program. Some of those services include:

  • Hearing and dental services for beneficiaries.
  • Occupational, speech or respiratory therapies.
  • Cosmetic procedures.
How much does Medicaid cost in South Dakota?

Medicaid cost estimates in South Dakota try to be as low as possible to help petitioners struggling with income get medical care. It is essential to understand that extra costs may be required of applicants. Prior to applying for Medicaid coverage, applicants want to know what expenses may be related to the program. For example, individuals or families getting certain procedures or requesting preventative services may face some costs. Furthermore, some Medicaid recipients may not have to pay any out-of-pocket costs due to particular exemptions.

Medicaid cost estimates for potential beneficiaries remain low, thanks to decent funding efforts. However, there are circumstances in which Medicaid costs are incurred by recipients. Additionally, in cases where payments are due, South Dakota Medicaid coverage caps the amount a provider may charge. Limits set by officials for Medicaid benefit costs are based on a range of factors. State agents will notify eligible applicants and give detailed information, such as the limits for costs. Keep in mind that providers are free to choose to charge any amount up to the maximum.

In certain situations the answer to, “How much does Medicaid cost in South Dakota?” is sometimes nothing at all. Some applicants receive exemptions from ever paying copayments or other expenses associated with Medicaid, altogether. For instance, the benefits of Medicaid are varied, and for applicants who are minors, living in nursing homes, pregnant or suffering from disabilities (blind, deaf, etc.) there are typically no out-of-pocket costs. Download our free guide to review more information about Medicaid costs and coverage.