| Group |
Income Eligibility |
| Children |
200% FPL |
| Pregnant Women |
133% FPL |
| Parents |
64% FPL |
| SSI Disabled (non-elderly) |
74% FPL |
High-Risk Pool
The South Dakota Risk Pool was created in 2003 to provide coverage to people who have lost coverage and have previous creditable coverage. However, unlike most high-risk pools, the program does not serve uninsured individuals who have a pre-existing condition or illness that causes them to be declined by private insurers unless the person recently lost creditable coverage. The program is financed by a combination of premiums paid by individual members, state general revenue, assessments on health insurance carriers, and an initial start-up grant from CMS' risk pool grant program. The premium cap is set at 150 percent of the average in force premium or payment rate for that classification charged by the three carriers with the largest number of individual health plan benefit plans in the state during the preceding calendar year. As of May 2006, 675 persons were enrolled in the pool.
Dependent Coverage
In 2005, the South Dakota Legislature passed HB 1045. It states that dependents shall have access to insurance up until their 19th birthday. If the young adult is enrolled in an educational institution, they are eligible for insurance until their 24th birthday.
Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile. |
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| 1 This overview provides a general description of state coverage levels under their Medicaid and SCHIP programs, including coverage through waivers, as of October 2006. Health Management Associates researched eligibility information from state web sites, data from state reports, and verified through contacts with state officials during the fall of 2006. This does not reflect the specific eligibility categories or requirements. This is not intended to be a substitute for eligibility information provided by each state. Individuals interested in applying for these programs should contact the state directly for specific eligibility requirements. |
2 Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey. |
| 3 Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. 2004 Medical Expenditure Panel Survey-Insurance Component. |
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