South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:12 - Assistance payments › Chapter 67:12:01 - Assistance applications and eligibility › Section 67:12:01:23 - Medical-only coverage for certain children and pregnant women

Current through Register Vol. 51, page 10, July 15, 2024
The following individuals are eligible for AFDC medical-only services
	 provided under article 67:16:
(1) A
  pregnant woman who meets the AFDC income and resource requirements of an
  assistance unit composed of the pregnant woman, her unborn child, and, if
  living in the home, the pregnant woman's spouse and any other family member who
  is applying for or receiving medical-only assistance under this section. At the
  family's option, any other household member who could be included in an AFDC
  assistance unit may be included in the determination. The pregnancy must be
  verified by a licensed or certified physician, physician's assistant, nurse
  practitioner, nurse midwife, community health nurse, or family planning nurse.
  Eligibility continues throughout the pregnancy without regard to income
  changes;
(2) 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 60
  days after the pregnancy ends if the AFDC resource limit is not exceeded.
  Coverage is limited to postpartum care and family planning services;
(3) A child under age seven, if the unit
  meets the AFDC income and resource requirements. The unit includes the child,
  the child's parents living in the home, and any other family member who is
  applying for or receiving medical-only assistance under this section. At the
  family's option, any other household member who could be included in an AFDC
  assistance unit may be included in the determination;
(4) A dependent child of a minor parent who
  is ineligible for AFDC because of the deeming of the income of the minor
  parent's parent or the income of a sibling of the child;
(5) A child under age six, whose family
  income is up to 133 percent of the federal poverty level established in §
									67:11:01:03. Eligibility continues
  up to age six as long as the family income remains below the poverty level.
  Persons considered in the determination include the child and any parents of
  the child living in the household as well as any other family member who is
  applying for or receiving medical-only assistance under this section. At the
  family's option, any other household member who could be included in an AFDC
  assistance unit may be included in the determination. Income is determined
  according to AFDC eligibility criteria;
(6) A pregnant woman whose family income is
  up to 133 percent of the federal poverty level established in §
									67:11:01:03. Eligibility continues
  throughout the pregnancy and to the end of the month 60 days after the
  pregnancy ends without regard to income changes. Services payable are limited
  to those services that are related to pregnancy, postpartum care, or family
  planning. The pregnancy must be verified by a licensed or certified physician,
  physician's assistant, nurse practitioner, nurse midwife, community health
  nurse, or family planning nurse. Persons considered in the poverty level
  determination include the pregnant woman, her unborn child, and, if living in
  the home, the pregnant woman's spouse and any other family member who is
  applying for or receiving medical-only assistance under this section. At the
  family's option, any other household member who could be included in an AFDC
  assistance unit may be included in the income determination. Income is
  determined according to AFDC eligibility criteria;
(7) A child who is age 6 but not yet age 19,
  whose family income is up to 100 percent of the federal poverty level
  established in §
									67:11:01:03. Persons considered in
  the determination include the child and the child's parents living in the home
  and other family members in the household who are applying for or receiving
  medical-only assistance under this section. At the family's option, any other
  household member who could be included in the AFDC assistance unit may be
  included in the income determination. Income is determined according to AFDC
  eligibility criteria; and
(8) A
  child born after December 31, 1990, 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 is in the mother's household and the mother remains a
  resident of the state.
General Authority:
SDCL 28-7-2.
Law Implemented:
SDCL
		28-7-2.
Medicaid coverage for children and pregnant women, Pub.L. No. 98-369,
		§ 2361, 98 Stat. 1104.
Individuals who must be included in assistance unit, §
											67:12:01:69.
Consideration of income of parent of minor parent, §
											67:12:05:52.01.
Eligibility requirements, §
											67:46:01:02.