How to Apply for SD Medicaid 2026: DSS ePortal Guide

South Dakota Medicaid for long-term care uses an income cap of $2,982 per month, and applicants over that limit must set up a Medicaid Income Trust before the state can begin paying benefits. If your income exceeds $2,982/month, you must first set up a Medicaid Income Trust before applying.

For current program details, visit the South Dakota Department of Social Services.

How to Apply for South Dakota Medicaid

The South Dakota Department of Social Services (DSS) handles Medicaid applications through two main channels.

Online at eaportal.sd.gov

Go to eaportal.sd.gov to submit your application through the DSS Economic Assistance Portal. The portal lets you upload supporting documents and track your application status online after submission.

Create an account first if you want to save progress and return to the application later. If your situation is straightforward and you have all your documents ready, you can complete and submit in one session.

By Phone

Call DSS at 1-605-773-3165. A DSS representative can assist with the application over the phone and tell you what documents to gather and where to send them.

Before You Apply for South Dakota Medicaid: The Income Test

South Dakota is an income-cap state for long-term care Medicaid. The income limit for nursing-facility and home- and community-based services (HCBS) waiver coverage is $2,982/month (300% of the 2026 SSI Federal Benefit Rate).

Unlike medically needy states such as Montana, South Dakota does not allow applicants to spend excess income down on medical bills to qualify. If your gross monthly income exceeds $2,982, you are not eligible unless you first establish a Medicaid Income Trust.

The Medicaid Income Trust (Miller Trust)

A Medicaid Income Trust, also called a Qualified Income Trust or Miller Trust, is a legal tool that lets an income-over-limit applicant redirect excess income into a dedicated account to meet the income cap. Each month, income above $2,982 is deposited into the trust. DSS then counts only what is outside the trust when determining eligibility. Funds in the trust are used to pay for nursing care costs not covered by other sources, and any remaining balance at death goes to the state as reimbursement for Medicaid benefits paid.

Setting up a trust before you apply:

1. Retain an elder law attorney to draft the trust document. DSS will not accept DIY documents for this purpose.
2. Open a separate bank account in the name of the trust.
3. Set up a monthly transfer of the excess income amount into the trust account.
4. Provide DSS with a copy of the trust document and account information as part of your application package.

An elder law attorney familiar with South Dakota Medicaid rules is the right resource here. The trust must meet specific requirements under federal law, and errors in the drafting or operation of the trust can result in an eligibility denial.

If your income is under $2,982, no trust is needed. Proceed directly to applying.

Before You Apply for South Dakota Medicaid: Asset Check

DSS will also review your countable assets. The single-applicant limit is $2,000 ($3,000 for a married couple with both spouses applying).

Exempt assets (not counted):

• The primary home, subject to an equity cap of $752,000
• One vehicle
• Household goods and personal effects
• Prepaid burial plans

Countable assets (do count):

• Checking and savings accounts
• Certificates of deposit
• Stocks, bonds, and non-retirement investments
• Accessible retirement accounts
• Cash value of life insurance above any exempt threshold

If your countable assets exceed $2,000, you must spend them down before DSS will approve the application.

The 60-month look-back. DSS reviews the prior 60 months of financial transactions for any gifts or transfers made for less than fair market value. Transfers intended to reduce assets for Medicaid eligibility create a penalty period during which Medicaid will not cover nursing facility or waiver services. An elder law attorney can help you assess whether any past transfers will trigger a penalty and how to document legitimate transactions.

For married couples, the community spouse (the one remaining at home) may keep up to $162,660 in countable assets (minimum $32,532) under the Community Spouse Resource Allowance. The community spouse may also receive up to $2,643.75 to $4,066.50 per month from the institutionalized spouse's income under the Minimum Monthly Maintenance Needs Allowance.

South Dakota's $100 Personal Needs Allowance

Once a nursing-facility resident is approved, they keep a Personal Needs Allowance of $100/month from their income. The rest of their income is contributed toward the cost of care, with Medicaid covering the remainder. The $100 PNA is notably higher than in many states (Montana, for comparison, sets it at $50), which gives South Dakota residents slightly more discretionary money for personal items while in care.

What Documents You'll Need

Gather these before you start. Incomplete submissions slow processing.

Identity and citizenship:

• Social Security card or SSA statement
• Birth certificate, U.S. passport, or Certificate of Naturalization
• South Dakota driver's license or state ID

Income:

• Social Security award letter or SSA-1099
• Pension and retirement income statements
• Documentation of any other monthly income

Assets and financial accounts:

• Bank statements for all accounts (at minimum the past 3 months; for nursing home applications, prepare up to 60 months)
• Statements for retirement accounts, CDs, stocks, and bonds
• Life insurance policy documentation (face value and cash surrender value)
• Prepaid burial or funeral contract

Property:

• Property deed and recent tax assessment
• Vehicle title or registration

Medicaid Income Trust (if applicable):

• Trust agreement
• Bank account statement for the trust account

For nursing-facility or HCBS-waiver applications, be prepared to provide five years of bank statements. DSS reviews the full 60-month window for these applications.

What Happens After You Apply for South Dakota Medicaid

After submission, DSS reviews your application and may request additional documents or a phone interview. Federal rules require a timely decision.

• If approved, you will receive a Medicaid card and an eligibility notice. Coverage may be backdated to the first day of the application month, depending on the program.
• If DSS requests more documents, respond by the deadline stated in the request. Missing the deadline is a common reason applications stall or are denied.
• If denied, you have the right to a fair hearing.

Track your application status at eaportal.sd.gov or call 1-605-773-3165.

Can Someone Else Apply on Your Behalf?

Yes. A family member, friend, or authorized representative can apply on behalf of the applicant.

• A close family member with knowledge of the applicant's finances can typically sign the application.
• A non-family representative must be authorized by the applicant in writing.
• A person holding legal authority (power of attorney, legal guardian, or court-appointed conservator) can act as the applicant's representative by providing documentation of that authority.

An authorized representative can submit the application, provide documents, communicate with DSS, and receive eligibility notices.

If You're Denied: How to Appeal

The denial notice will state the reason and the deadline to request a fair hearing. South Dakota allows applicants to appeal eligibility decisions through DSS's hearing process.

To request a hearing:

• Call 1-605-773-3165 and ask for a fair hearing.
• Submit a written request to DSS.

A hearing officer will review the case independently. You can present documents and explain your situation. For applicants navigating income-trust issues or look-back penalties, an elder law attorney or legal aid representative can make a meaningful difference.

East River Legal Services serves eligible residents in eastern South Dakota. Dakota Plains Legal Services serves western South Dakota and Native American communities. Contact information is available on the South Dakota State Bar website at statebarofsd.org.

Learn More

• South Dakota Medicaid Eligibility and Income Limits
• Medicaid Planning Strategies
• Medicaid Estate Recovery Explained

Find personalized help applying for South Dakota Medicaid at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.