The Medicaid program in South Dakota is administered by the South Dakota Department of Social Services’ Division of Economic Assistance. There are limitations to this program, including a need for approval before health care is provided.
Medicaid is a public, or government run, form of health insurance. It is designed to help people who are low-income to be able to have an affordable form of health insurance coverage. Medicaid is funded in part by the federal government, and is also funded by the government of an individual state.
In South Dakota, the Medicaid program is administered by the South Dakota Department of Social Services’ Division of Economic Assistance. This is the department that is in charge of Medicaid, CHIP, and all the other portions of the Medicaid program.
The only information that can be found on the South Dakota website about Medicaid is vague. It says the Medicaid program is “to help low income individuals, families, and children”. There is a Medical Assistance Program that can help pay for “the necessary medical expenses individuals need to stay healthy”. It notes that expenses may include hospital stays, doctor visits, prescriptions, nursing home care, and other health care needs.
A completely separate page within the website gives a little information about the federal poverty guidelines for 2011. A chart indicates the income limit for a single person, and on up through a family that includes 8 people.
It appears that if a person wants to find out more about the eligibility requirements for Medicaid they need to go through SD MEDX It is a payment processing system that helps South Dakota Medicaid be managed more efficiently. Here are a few examples of how South Dakota is managing the cost of their Medicaid program.
The Frequently Asked Questions section notes that people who receive Medicaid in South Dakota are required to have a Primary Care Provider (PCP). They are also required to participate in a Managed Care Program.
If a person receives care from a provider that is not enrolled with the South Dakota Medicaid Assistance Program, they may find themselves paying for that care out of their own pocket. There are also limitations about how much assistance a person can expect to get from Medicaid if they visit an Emergency Room.
“If you go to the ER for a non-referred, non-emergent service, you will be responsible for payment of these services”.
What if a person takes their child to an ER because their Primary Care Physician was closed? That parent can expect to pay for that care out of pocket, too. If that parent didn’t obtain a prior referral from their Primary Care Physician before going to the ER, and the emergency room staff didn’t consider the issue to be an emergency, then Medicaid will not provide coverage for the treatment that was received.
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