South Dakota Administrative Rules › Title 67 - Department of Social Services › Article 67:46 - Eligibility for medical services › Chapter 67:46:01 - General provisions › Section 67:46:01:02 - Eligibility requirements

Current through Register Vol. 51, page 10, July 15, 2024
The following individuals are eligible for medical assistance:
(1) A parent/caretaker relative eligible for
  Medicaid under the provisions of chapter 67:46:12;
(2) A person who is a recipient of a money
  payment under the supplemental security income program;
(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 paragraphs (A) and (B) of
  42 U.S.C.
  1382(c)(7);
(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) A person under the age of twenty-one who
  is in the custody of the department and who meets the income requirements of
  §
									67:46:12:15;
(6) A person under the age of twenty-one who
  meets the income requirements 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) A person who is
  eligible under the provisions of chapters 67:46:02 to 67:46:06,
  inclusive;
(8) A person who is
  eligible for transitional medical benefits under the provisions of chapter
  67:46:13;
(9) A child in a
  subsidized adoption;
(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) A pregnant woman who meets the income
  requirements under the provisions of chapter 67:46:12;
(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 sixty days after
  the pregnancy ends;
(13) A child
  under age nineteen whose family income meets the income requirements under the
  provisions of chapter 67:46:12;
(14) A child under age nineteen who is
  eligible for the nonmedicaid children's health insurance program covered under
  the provisions of chapter 67:46:14;
(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) 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 twenty percent of the federal poverty level. Benefits are limited to
  payment of part B Medicare premiums;
(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 twenty percent, but less than one hundred 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) 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) 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) 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) 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) 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) A child under age
  twenty-six who, on the child's eighteenth birthday, was in foster care under
  the responsibility of the state;
(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) 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) A working
  individual with a disability who has a net income below two hundred 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) A person age
  nineteen or older 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.
General Authority:
SDCL 28-6-1.
Law Implemented:
SDCL
		28-6-1(6).
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.
Medicaid entitlement for certain newborns,
		42 C.F.R. §
												435.117.
Institutionalized individuals,
		42 C.F.R. §
												435.1009.
Definition of "public institution,"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, Pub. L. No. 106-169, § 121, (113 Stat. 1829).
John H. Chafee foster care independence program, Pub. L. No. 106-109, § 477(a)(5), (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).
Definition of "creditable coverage,"42 U.S.C. §
												300gg-3(c).
State option of working individuals with disabilities,
		42 USC §
												1396a(a)(10)(A)(ii) (XIII)
		(July 1, 2016).