Guide for 2022 Medicaid Eligibility for Adults Aged 19 - 64 in South Dakota
Please note that there may be other pathways for medical assistance offered by your state not listed here. This information was collected from government resources but is not official and may be incomplete or outdated. This website has no government affiliation.
Medicaid is a public government-run health insurance program that provides health insurance to low income Americans. Over 75 million adults and children are enrolled in Medicaid. On this page, we'll cover the main Medicaid eligibility pathways for adults aged 19 to 64 that do not have a disability (in other words, are not Medicare eligible).
The Affordable Care Act expanded Medicaid to allow adults age 19 - 64 with household incomes below 138% of the Federal Poverty Level to be eligible for Medicaid. However, 12 states did not choose to expand their Medicaid programs, resulting in no Medicaid options for most adults without dependents in those states. South Dakota did not expand their Medicaid program.
The Affordable Care Act also offers discounts on health insurance premiums on plans purchased through healthcare.gov through the Premium Tax Credit. In states that did not expand Medicaid, individuals in households below 100% of the Federal Poverty Level are often not eligible for Premium Tax Credits or Medicaid. This is often called the "coverage gap." The reason the coverage gap exists is that when the Affordable Care Act was passed, it was not expected that states would be able to opt-out of the Medicaid expansion.Even though Medicaid was not expanded in South Dakota, Medicaid pathways are available for people who are either parents to children 18 or younger or are pregnant.
How Eligiblity Is Determined
Eligibility for Medicaid for adults aged 19 to 64 requires meeting an income limit that is based on your household size. There is no asset test.
Your household size for Medicaid is typically the same as your tax filing household size: you + your spouse + your dependents. If you're claimed as a dependent by someone else, or if your pregnant, your household size may vary from your tax household size. If either of those situations apply to you, try using our Medicaid Eligibility Calculator for assistance calculating your household size.
A household's Modified Adjusted Gross Income (MAGI) is used for eligibility decisions for many medical assistance programs. It's similar to Adjusted Gross Income (AGI) which is on your tax return, however some uncommon deductions are added back. For most people it shouldn't be too much different than your total household income, so when reading the charts below use the combined income from all household members from jobs and other sources, except for child support, Supplemental Security Income, and childrens' non-taxable income (like disability payments).
Some pathways for Medicaid eligibilty may only be available if you're a parent to a child 18 or younger or are pregnant or were pregnant in the last 60 days.
Medicaid Income Limits for Adults 19-64
South Dakota is one of the states that did not roll out the Medicaid expansion, so Medicaid for most adults aged 19 - 64 with no dependents is not available in South Dakota
Medicaid Income Limits for Parents
1 person household$645 / month
2 person household$869 / month
3 person household$1,093 / month
4 person household$1,318 / month
5 person household$1,542 / month
6 person household$1,766 / month
7 person household$1,990 / month
Each additional person in household+$224 / month
Medicaid Income Limits for Pregnant Women
1 person household$1,562 / month
2 person household$2,105 / month
3 person household$2,648 / month
4 person household$3,191 / month
5 person household$3,734 / month
6 person household$4,276 / month
7 person household$4,819 / month
Each additional person in household+$542 / month
CHIP Income Limits for Pregnant Women
South Dakota does not offer a CHIP program for pregnant women separately from Medicaid.
Premium Tax Credit Income Limits (minimum income limits)
The Premium Tax Credit is a tax credit on health insurance plans purchased through the Health
Insurance Marketplace. Households can take this tax credit in advance,
using it to lower the monthly premium on their health insurance plan.
Credit amounts are based on household income and are available to households with income
above 100% of the Federal Poverty Level. Therefore, the income limits below are the minimum
income limits: only households with more than the monthly amount are eligible.
Typically, the credits phase out above 400% of the Federal Poverty Level (4 times the amount of monthly income in the chart below), however for 2022 marketplace plans credits may be offered for households with higher incomes. If you are eligible for health insurance through your employer, in most cases you are not eligible for the Premium Tax Credit.
One exception to the 100% Federal Poverty Level minimum income requirement for the Premium Tax Credit applies if an individual is a lawfully present immigrant who would be eligible for Medicaid if it weren't for their immigration status. For these individuals, the Premium Tax Credit becomes available even if the household has $0 in income.
1 person household$1,132 / month
2 person household$1,525 / month
3 person household$1,919 / month
4 person household$2,312 / month
5 person household$2,705 / month
6 person household$3,099 / month
7 person household$3,492 / month
Each additional person in household+$393 / month
Want a more detailed eligibility estimate?
See if you might be eligible using our Medicaid eligibility calculator.