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CHAPTER 28-13

COUNTY POOR RELIEF

28-13-1      County duty to relieve poor persons--Taxation--Determination of eligibility.
28-13-1.1      "Indigent or poor person" defined--Eligibility standards.
28-13-1.2      Considerations in establishing eligibility standards.
28-13-1.3      Medically indigent person defined.
28-13-1.4      Appeal regarding medical indigence.
28-13-2      Residency acquired for poor relief purposes.
28-13-3      Residency required for assistance--Establishment.
28-13-4      Repealed.
28-13-5      Children's residency.
28-13-6, 28-13-7.      Repealed.
28-13-8      Residency continued until lost by new residency.
28-13-9 to 28-13-11.      Repealed.
28-13-12      Residency not established by state acceptance of application.
28-13-13      Repealed.
28-13-14      Residency not established by residence in health care facility.
28-13-15      Repealed.
28-13-16      County commissioners to have responsibility for care and relief of poor persons.
28-13-16.1      Waiting period imposed at board's discretion while residency investigated.
28-13-16.2      Intentional fraud or deceit to receive assistance.
28-13-17      Proceedings by and against commissioners in name of county.
28-13-18      Record of poor relief payments available in investigation of residency.
28-13-19      Establishment of special emergency county welfare account--Purpose--Deposit and withdrawal of fund--Source of fund.
28-13-20      Services required of applicant--Contract for repayment of assistance.
28-13-20.1      Regular county employees not replaced by poor relief applicants--Maximum hours of work.
28-13-20.2      Refusal to work without just cause--Eligibility for assistance terminated.
28-13-21      County funds expended on federal work relief projects--Agreements with federal agencies--Construction of public buildings not authorized.
28-13-22      Employment of welfare workers to distribute funds and supplies to poor.
28-13-23      Annual allowances to competent poor persons.
28-13-24      Repealed.
28-13-25      Repealed.
28-13-26      Employment of physician to attend poor persons in county--Annual salary--Monthly report by physician.
28-13-27      Hospitalization of poor persons--Definition of terms.
28-13-27.1      Medically necessary hospital services.
28-13-27.2      Cost guidelines for medical and remedial services.
28-13-28      Statement of costs required of hospital caring for indigent persons--Frequency of statements.
28-13-29      Cost governed by statement or amendment--Claim against county not to exceed usual hospital rates.
28-13-30      Approval of statement by secretary--Modification of items in statement.
28-13-31      Continuation of statement in effect until withdrawn or amended--Effective date of amendments--Statements available for inspection.
28-13-32      County commissioners' objections to statements.


28-13-32.1, 28-13-32.2. Repealed.
28-13-32.3      Medical indigency required for poor relief assistance in the event of hospitalization--Application required--Time--Limitation.
28-13-32.4      Submission of application by hospital within one year of discharge--Contents--Additional information not to be required.
28-13-32.5      Determining medical indigence--Annual income guideline.
28-13-32.6      Housing indexes by county.
28-13-32.7      Determining household income--Sources.
28-13-32.8      Household resources.
28-13-32.9      Determination of person's ability to pay--Factors.
28-13-32.10      Indigency by design.
28-13-32.11      Determination of household's ability to purchase health insurance.
28-13-33      County liability for emergency and nonemergency hospitalization of indigent persons--Remedies for recovery of expense by county.
28-13-33.1      Experimental procedures and treatment for medically indigent patient.
28-13-33.2      Billing for care of medically indigent patients.
28-13-34      Repealed.
28-13-34.1      Notice to county where hospitalization is furnished to indigent person--Time for notice of emergency and nonemergency admissions--Contents of notice.
28-13-34.2      Release of information.
28-13-35      Substitute arrangements for hospitalized indigent patient--County not liable to hospital after failure to cooperate.
28-13-36      Contractual arrangements between county and hospital not impaired.
28-13-37      County duty to relieve nonresidents in distress.
28-13-37.1      Medical review by county or Department of Social Services.
28-13-38      Temporary relief to nonresident--Reimbursement by home county.
28-13-38.1      When hospitals outside state are eligible for reimbursement by county.
28-13-39      Repealed.
28-13-40      Appeal to circuit court from county commissioners--Direction for assistance.
28-13-41      Repealed.
28-13-42      Names of recipients not released for publication.
28-13-43      Assignment or transfer of property to qualify for assistance as misdemeanor.
28-13-44      Bankruptcy not admissible in making determination of indigency.


     28-13-1.   County duty to relieve poor persons--Taxation--Determination of eligibility. Every county shall relieve and support all poor and indigent persons who have established residency therein, as that term is defined in §§ 28-13-2 to 28-13-16.2, inclusive, and who have made application to the county, whenever they shall stand in need. Each board of county commissioners may raise money by taxation for the support and employment of the poor. If a person is receiving benefits from the Department of Social Services, the board of county commissioners may determine if he is eligible for county relief.

Source: SDC 1939, § 50.0101; SL 1939, ch 200, § 1; SL 1941, ch 211, § 1; SL 1976, ch 173, § 1; SL 1980, ch 202, § 1.


     28-13-1.1.   "Indigent or poor person" defined--Eligibility standards. For the purposes of this chapter, an indigent or poor person is any person who does not have sufficient money, credit, or property to be self-supporting; who has no one to look to who is legally required to provide support; or who is unable to be self-supporting through work because of illness or injury. In applying this definition, each county shall establish reasonable eligibility standards for county poor relief.

Source: SL 1984, ch 203, § 1; SL 1997, ch 170, § 1.


     28-13-1.2.   Considerations in establishing eligibility standards. A county in establishing eligibility standards for county poor relief shall take into consideration an applicant's total economic resources including current assets and income, sources of financial support to which the applicant is legally entitled and total economic needs. In a case involving support among family members the county shall take into consideration family size, total family economic resources, and total family economic needs.

Source: SL 1984, ch 203, § 2.


     28-13-1.3.   Medically indigent person defined. A medically indigent person is one who meets the following criteria:
             (1)      Requires medically necessary hospital services for which no public or private third-party coverage, such as insurance, veterans' assistance, medicaid, or medicare, is available which covers the actual cost of hospitalization;
             (2)      Has no ability or only limited ability, as determined under the provisions of this chapter, to pay a debt for hospitalization;
             (3)      Has not voluntarily reduced or eliminated ownership or control of an asset for the purpose of establishing eligibility;
             (4)      Is not indigent by design; and
             (5)      Is not a veteran or a member of a Native American tribe who is eligible or would have been eligible for services through the veterans administration or the Indian Health Service if the services had been applied for within seventy-two hours of the person's admission.

Source: SL 1997, ch 170, § 4.


     28-13-1.4.   Appeal regarding medical indigence. Notwithstanding § 7-8-30, in any appeal regarding medical indigence, the circuit court may affirm or remand for further proceedings, or the court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the county's findings, inferences, conclusions, or decisions are:
             (1)      In violation of constitutional or statutory provisions;
             (2)      In excess of the statutory authority of the county;
             (3)      Made upon unlawful procedure;
             (4)      Affected by other error of law;
             (5)      Clearly erroneous in light of the entire evidence in the record; or
             (6)      Clearly unwarranted exercise of discretion.

Source: SL 1997, ch 170, § 29.


     28-13-2.   Residency acquired for poor relief purposes. A person may establish a residency in any county so as to oblige such county to relieve and support him, in case he is poor and stands in need of relief, as provided by §§ 28-13-3 to 28-13-16.2, inclusive.

Source: SDC 1939, § 50.0102; SL 1976, ch 173, § 2.


     28-13-3.   Residency required for assistance--Establishment. Except as otherwise provided in this chapter, any person, in order to be entitled to assistance, shall have an established residency in the state, and in the county where the application is made. The residency shall be established by his personal presence, in a fixed and permanent abode and his intention to remain there. In determining the residency of an applicant the county commissioners may consider the establishment of a local bank account by the applicant, the applicant's driver's license address, an automobile registration, the enrollment of applicant's children in a local school, and the applicant's voter registration; however, the absence of any of the above considerations shall not be a positive determination of nonresidency.

Source: SDC 1939, § 50.0102 (4); SL 1976, ch 173, § 3; SL 1980, ch 202, § 2.


     28-13-4.   Repealed by SL 1976, ch 173, § 35


     28-13-5.   Children's residency. For the purposes of this chapter, children shall have the same residency as their parents, the party granted their legal custody pursuant to court order or decree, or as fixed by their guardian.

Source: SDC 1939, § 50.0102 (2); SL 1976, ch 173, § 6.


     28-13-6, 28-13-7.   Repealed by SL 1976, ch 173, § 35


     28-13-8.   Residency continued until lost by new residency. For the purposes of this chapter a person's residency, when once legally established, shall continue until it is lost by establishing residency in another state or county.

Source: SDC 1939, § 50.0102 (6); SL 1941, ch 211, § 2; SL 1957, ch 263; SL 1961, ch 261; SL 1976, ch 173, § 7.


     28-13-9 to 28-13-11.   Repealed by SL 1972, ch 158, § 1


     28-13-12.   Residency not established by state acceptance of application. The acceptance of an applicant for any type of public assistance administered by the Department of Social Services, in a county where the applicant has not established residency in accordance with § 28-13-3, shall not operate to establish a residency for the purposes of this chapter in that county.

Source: SL 1951, ch 254, § 1; SDC Supp 1960, § 50.0102-1; SL 1976, ch 173, § 8.


     28-13-13.   Repealed by SL 1976, ch 173, § 35


     28-13-14.   Residency not established by residence in health care facility. An occupant or patient of any health care facility, licensed pursuant to the provisions of chapter 34-12, who has not otherwise established residency in accordance with § 28-13-3 in the county where such facility is situated, shall not establish residency in such county solely by virtue of becoming and remaining an occupant or patient of such facility.

Source: SL 1951, ch 254, § 2; SDC Supp 1960, § 50.0102-1; SL 1972, ch 158, § 2; SL 1976, ch 173, § 9.


     28-13-15.   Repealed by SL 1976, ch 173, § 35


     28-13-16.   County commissioners to have responsibility for care and relief of poor persons. The county commissioners in each county are responsible for the care and relief of all poor persons in the county as provided by this chapter as long as those persons remain eligible. The commissioners may designate a county official to assist in the coordination of poor relief information with other counties.

Source: SDC 1939, § 50.0201; SL 1980, ch 202, § 3; SL 1986, ch 234; SL 1997, ch 170, § 2.


     28-13-16.1.   Waiting period imposed at board's discretion while residency investigated. The board of county commissioners may, except for their obligations under §§ 28-13-37 and 28-13-38, impose upon applicants for assistance such a reasonable waiting period as they may determine to be necessary in order to adequately investigate and consider all factors relevant to determining whether an applicant has established residency in good faith in the state, and in the county where the application is made.

Source: SL 1976, ch 173, § 4.


     28-13-16.2.   Intentional fraud or deceit to receive assistance. Any applicant for assistance who knowingly makes any false statement, with intent to defraud, as to his financial status or other required information, or in any way intentionally deceives any county commissioner, or any welfare worker employed pursuant to § 28-13-22, in order to receive assistance, shall be guilty of a Class 1 misdemeanor.

Source: SL 1976, ch 173, § 5.


     28-13-17.   Proceedings by and against commissioners in name of county. In all actions or proceedings in favor of or against any such commissioners, pertaining to or connected with the poor of their respective counties, the same shall be conducted in favor of or against such county in its corporate name.

Source: SDC 1939, § 50.0206.


     28-13-18.   Record of poor relief payments available in investigation of residency. For the purpose of aiding the investigation of an applicant's residency conducted pursuant to § 28-13-3, each county auditor shall make the information recorded pursuant to § 28-14-7 available upon request to any county commissioner, county auditor, or welfare worker employed pursuant to § 28-13-22.

Source: SL 1976, ch 173, § 10.


     28-13-19.   Establishment of special emergency county welfare account--Purpose--Deposit and withdrawal of fund--Source of fund. The board of county commissioners may establish a special emergency county welfare account upon which the county welfare departments may make immediate, direct cash withdrawals up to one hundred dollars a month to meet special emergency requirements of said county welfare departments.
     The special account shall be deposited with a local bank and subject to withdrawals upon the signatures of county officials designated and authorized to do the same by the board of county commissioners. The board shall from time to time appropriate money from the general fund to this special account.

Source: SL 1966, ch 32; SL 1985, ch 77, § 16.


     28-13-20.   Services required of applicant--Contract for repayment of assistance. Whenever financial assistance is requested under the provisions of this chapter, the board of county commissioners may require the applicant to perform labor or other services of a public nature commensurate with the amount of aid desired or granted. In addition, the board may require the recipient of assistance to enter into a contract for the repayment of all or part of the assistance he receives.

Source: SDC 1939, § 50.0202; SL 1976, ch 173, § 11; SL 1982, ch 213, § 1.


     28-13-20.1.   Regular county employees not replaced by poor relief applicants--Maximum hours of work. No person required to perform labor or other services under § 28-13-20 shall be used to replace any regular employee of the county. No such person shall be required to work more than eight hours in a day nor more than forty hours in a week.

Source: SL 1976, ch 173, § 12.


     28-13-20.2.   Refusal to work without just cause--Eligibility for assistance terminated. Any person who without just cause refuses to report for work to which he has been assigned by the board of county commissioners, or by a welfare worker employed pursuant to § 28-13-22, shall thereupon become ineligible for further assistance under this chapter until such work is commenced.

Source: SL 1976, ch 173, § 13.


     28-13-21.   County funds expended on federal work relief projects--Agreements with federal agencies--Construction of public buildings not authorized. Every county may expend moneys raised by taxation for the support and employment of the poor for the purpose of sponsoring federal work projects now, or hereafter, established by work relief agencies of the United States, whether now existing or hereafter established by the United States, for the purpose of providing support and employment for poor and indigent persons and may enter into agreements therefor with such federal agencies. The provisions of this section shall not authorize the construction of public buildings or additions thereto in conjunction with federal agencies.

Source: SDC 1939, § 50.0101 as added by SL 1939, ch 200, § 1; SL 1939, ch 200, § 2; SL 1941, ch 211, § 1.


     28-13-22.   Employment of welfare workers to distribute funds and supplies to poor. Whenever the board of county commissioners, in any county having within its borders a municipal corporation of the first class, deems it necessary and advisable for the best interests of the county, for the protection of health or the promotion of morals and order within the county, to employ one or more persons to act as welfare workers in the distribution of funds or supplies to needy poor within the county, derived from any source, such board of county commissioners shall be empowered to employ such welfare workers.

Source: SDC 1939, § 12.1602.


     28-13-23.   Annual allowances to competent poor persons. The board of county commissioners may in its discretion allow and pay to poor persons who may become county charges and who are of mature years and sound mind, and who from their general character will probably be benefited thereby, and also to the parents of children with intellectual disabilities and children otherwise helpless and requiring the attention of their parents, and who are unable to provide for such children themselves, such annual allowance as will not exceed the charge of their maintenance in the ordinary mode, such board taking the usual amount of charges in like cases as the rule for making such allowance.

Source: SDC 1939, § 50.0205; SL 2013, ch 125, § 15.


     28-13-24.   Repealed by SL 1972, ch 43, § 5


     28-13-25.   Repealed by SL 1976, ch 173, § 35


     28-13-26.   Employment of physician to attend poor persons in county--Annual salary--Monthly report by physician. Each board of county commissioners may annually employ a duly qualified physician and surgeon registered and licensed in the healing arts, as the term "healing arts" is defined by chapter 36-2, as county physician, whose duty it shall be to attend and render his services as physician and surgeon to poor persons of the county. The board of county commissioners shall fix the annual salary to be paid and which shall be paid monthly with warrants of the county auditor upon proper verified vouchers approved by the county commissioners. It shall be the duty of such physician and surgeon to file with the county auditor not later than the first day of each month a report disclosing the patients treated by him, the value and kind of services rendered and the name and address of the person so treated within the previous thirty days.

Source: SL 1953, ch 31; SDC Supp 1960, § 50.0204-1; SL 1976, ch 173, § 14.


     28-13-27.   Hospitalization of poor persons--Definition of terms. Terms used in this chapter mean:
             (1)      "Actual cost of hospitalization," the actual cost to a hospital of providing hospital services to a medically indigent person, determined by applying the ratios of costs to charges appearing on the statement of costs required in § 28-13-28 to charges at the hospital in effect at the time the hospital services are provided;
             (2)      "Emergency hospital services," treatment in the most appropriate hospital available to meet the emergency need. The physician, physician assistant, or certified nurse practitioner on duty or on call at the hospital must determine whether the individual requires emergency hospital care. The need for emergency hospital care is established if the absence of emergency care is expected to result in death, additional serious jeopardy to the individual's health, serious impairment to the individual's bodily functions, or serious dysfunction of any bodily organ or part. The term does not include care for which treatment is available and routinely provided in a clinic or physician's office;
             (3)      "Hospital," any hospital licensed as such by the state in which it is located;
             (4)      "Household," the patient, minor children of the patient living with the patient, and anyone else living with the patient to whom the patient has the legal right to look for support;
             (5)      "Nonemergency care," hospitalization which is medically necessary and recommended by a physician licensed under chapter 36-4 but does not require immediate care or attention;
             (6)      "Indigent by design," an individual who meets any one of the following criteria:
             (a)      Is able to work but has chosen not to work;
             (b)      Is a student at a postsecondary institution who has chosen not to purchase health insurance;
             (c)      Has failed to purchase or elect major medical health insurance or health benefits made available through an employer-based health benefit plan although the person was financially able, pursuant to § 28-13-32.11, to purchase or elect the insurance or health benefits;
             (d)      Has failed to purchase available major medical health insurance although the individual was insurable and was financially able, pursuant to § 28-13-32.11, to purchase the insurance. For purposes of this subdivision, an individual is presumed insurable unless the individual can produce sufficient evidence to show that the individual was declined major medical insurance by an insurance company and the individual did not qualify for any guarantees of major medical insurance available through any legal or contractual right that was not exercised; or
             (e)      Has transferred resources for purposes of establishing eligibility for medical assistance available under the provisions of this chapter. The lookback period for making this determination includes the thirty-six month period immediately prior to the onset of the individual's illness and continues through the period of time for which the individual is requesting services.

Source: SL 1953, ch 131, § 1; SDC Supp 1960, § 27.12B01; SL 1980, ch 202, § 4; SL 1984, ch 203, § 3; SL 1988, ch 225, § 1; SL 1991, ch 227, § 1; SL 1997, ch 170, § 3; SL 2000, ch 134, § 1; SL 2017, ch 171, § 50.


     28-13-27.1.   Medically necessary hospital services. Medically necessary hospital services are services provided in a hospital which meet the following criteria:
             (1)      Are consistent with the person's symptoms, diagnosis, condition, or injury;
             (2)      Are recognized as the prevailing standard and are consistent with generally accepted professional medical standards of the provider's peer group;
             (3)      Are provided in response to a life-threatening condition; to treat pain, injury, illness, or infection; to treat a condition which would result in physical or mental disability; or to achieve a level of physical or mental function consistent with prevailing standards for the diagnosis or condition;
             (4)      Are not furnished primarily for the convenience of the person or the provider; and
             (5)      There is no other equally effective course of treatment available or suitable for the person needing the services which is more conservative or substantially less costly.
     A county shall rely on the attending physician's determination as to medical necessity of hospital services unless evidence exists to the contrary.

Source: SL 1997, ch 170, § 5.


     28-13-27.2.   Cost guidelines for medical and remedial services. Except for the costs of emergency hospital services, a county may adopt guidelines which define the amount, scope, and duration of medical and remedial services available to eligible persons and the basis for and extent of payments made to providers by counties on behalf of eligible persons.

Source: SL 1997, ch 170, § 6.


     28-13-28.   Statement of costs required of hospital caring for indigent persons--Frequency of statements. A hospital may avail itself of the provisions of this chapter for purposes of determining payment for hospitalization of a medically indigent person only if the hospital has filed a detailed statement of costs with the secretary of social services in the form prescribed by the secretary. The statement of costs shall compute and set forth the ratios of costs to charges for the hospital's fiscal year covered by the statement of costs. The statement of costs shall be filed with the secretary at least annually, unless such period is extended or otherwise provided by the secretary, but a hospital may file a detailed statement of costs or amendments to such a statement once every six months.

Source: SL 1953, ch 131, § 2; SDC Supp 1960, § 27.12B02; SL 1976, ch 173, § 15; SL 1991, ch 227, § 2; SL 1997, ch 170, § 7.


     28-13-29.   Cost governed by statement or amendment--Claim against county not to exceed usual hospital rates. The amount of reimbursement for hospital services is the amount calculated pursuant to § 28-13-32.9. It may not exceed the actual cost of hospitalization as defined in subdivision 28-13-27(1) or an amount established by the secretary of the Department of Social Services, whichever is less. The amount established by the secretary shall be based on medicaid payment methodology. A hospital may not maintain a claim against a county for any amount which exceeds the usual ordinary and reasonable charge for any hospital service, even if the charge is less than the hospital's actual cost of hospitalization. If the hospital furnishes hospital services to medically indigent persons residing in the county in which the hospital is located at rates less than the rates provided for in this section, the hospital shall furnish such hospital services to all medically indigent persons at the same rates.

Source: SL 1953, ch 131, § 2; SDC Supp 1960, § 27.12B02; SL 1991, ch 227, § 3; SL 1997, ch 170, § 8.


     28-13-30.   Approval of statement by secretary--Modification of items in statement. The secretary of social services shall make such investigation as necessary, and shall approve the statement of costs only if the statement is accurate, complete, and reliable as could reasonably be expected, and that it discloses, as nearly as may be reasonably determined, the ratios of costs to charges for the hospital's fiscal year covered by the statement of costs. In granting approval, the secretary may modify any items in the statement which require such modification and shall provide written notice of any such modification to the respective hospital.

Source: SL 1953, ch 131, § 2; SDC Supp 1960, § 27.12B02; SL 1976, ch 173, § 16; SL 1991, ch 227, § 4; SL 1997, ch 170, § 23.


     28-13-31.   Continuation of statement in effect until withdrawn or amended--Effective date of amendments--Statements available for inspection. No statement of costs, or amendment thereto, may take effect until approved by the secretary of social services and the expiration of thirty days from the filing thereof, and thereafter, for purposes of this chapter, shall remain in full force and effect until the next statement of costs, or amendment thereto, filed by the hospital pursuant to § 28-13-28 is approved by the secretary. Any such statement of costs, or amendments thereto, shall be a public record and be available for inspection at any time in behalf of any board of county commissioners.

Source: SL 1953, ch 131, § 2; SDC Supp 1960, § 27.12B02; SL 1976, ch 173, § 17; SL 1991, ch 227, § 5; SL 1997, ch 170, § 24.


     28-13-32.   County commissioners' objections to statements. Any board of county commissioners may at any time file, with the secretary of social services and the hospital concerned, objections in writing to any such statement of costs, any items therein, or amended thereto, which objections shall be passed upon by the secretary.

Source: SL 1953, ch 131, § 2; SDC Supp 1960, § 27.12B02; SL 1976, ch 173, § 18; SL 1991, ch 227, § 6; SL 1997, ch 170, § 25.


     28-13-32.1, 28-13-32.2.   Repealed by SL 1988, ch 226, §§ 5, 6


     28-13-32.3.   Medical indigency required for poor relief assistance in the event of hospitalization--Application required--Time--Limitation. To receive assistance under this chapter for the costs of hospitalization, a person must be medically indigent as defined in § 28-13-1.3. The person or someone acting on behalf of the person shall apply to the person's county of residence for assistance within two years of the date of the hospital's discharge of the person.

Source: SL 1988, ch 226, § 3; SL 1997, ch 170, § 9; SL 2002, ch 137, § 1.


     28-13-32.4.   Submission of application by hospital within one year of discharge--Contents--Additional information not to be required. An application made by a hospital on behalf of a medically indigent person pursuant to § 28-13-32.3 shall be submitted to the county auditor within one year of the discharge of the indigent. The application shall include:
             (1)      The notice of hospitalization as provided in § 28-13-34.1;
             (2)      The dates of hospitalization;
             (3)      The final diagnosis;
             (4)      The cost of hospital services; and
             (5)      Any financial information in the possession of the hospital concerning the patient or the responsible party, including the availability of insurance coverage.
     The county may not require the hospital to provide more information concerning such a medically indigent person than is contained in the application provided for in this section and the release of information provided for in § 28-13-34.2.

Source: SL 1988, ch 226, § 4; SL 1997, ch 170, § 10.


     28-13-32.5.   Determining medical indigence--Annual income guideline. For purposes of determining medical indigence, the county shall establish an annual income guideline for the person which is derived as follows:
             (1)      Using the housing index established in § 28-13-32.6, determine the housing index for the person's county of residence. Multiply the county index by three hundred six dollars, the median gross rent of residences in South Dakota in 1996;
             (2)      Using the federal poverty guidelines adopted in rules promulgated by the Department of Social Services pursuant to chapter 1-26, determine the federal poverty level for the household size and multiply that figure by one hundred seventy-five percent; and
             (3)      Add the results of subdivisions (1) and (2) of this section and multiply by twelve.

Source: SL 1997, ch 170, § 12; SL 1998, ch 165, § 1.


     28-13-32.6.   Housing indexes by county. The housing index for each county is as follows:

COUNTY
 
HOUSING INDEX  
    Aurora   0.65  
    Beadle   0.91  
    Bennett   0.86  
    Bon Homme   0.71  
    Brookings   0.96  
    Brown   0.95  
    Brule   0.80  
    Buffalo   0.77  
    Butte   0.91  
    Campbell   0.74  
    Charles Mix   0.65  
    Clark   0.72  
    Clay   0.95  
    Codington   0.92  
    Corson   0.47  
    Custer   1.03  
    Davison   0.90  
    Day   0.78  
    Deuel   0.79  
    Dewey   0.89  
    Douglas   0.69  
    Edmunds   0.71  
    Fall River   0.89  
    Faulk   0.66  
    Grant   0.81  
    Gregory   0.68  
    Haakon   0.80  
    Hamlin   0.70  
    Hand   0.70  
    Hanson   0.96  
    Harding   0.70  
    Hughes   1.03  
    Hutchinson   0.72  
    Hyde   0.75  
    Jackson   0.84  
    Jerauld   0.61  
    Jones   0.76  
    Kingsbury   0.67  
    Lake   0.78  
    Lawrence   1.00  
    Lincoln   0.93  
    Lyman   0.77  
    Marshall   0.72  
    McCook   0.73  
    McPherson   0.58  
    Meade   1.03  
    Mellette   0.74  
    Miner   0.65  
    Minnehaha   1.23  
    Moody   0.79  
    Oglala Lakota   0.81  
    Pennington   1.26  
    Perkins   0.65  
    Potter   0.86  
    Roberts   0.70  
    Sanborn   0.67  
    Spink   0.82  
    Stanley   1.06  
    Sully   0.82  
    Todd   0.79  
    Tripp   0.83  
    Turner   0.78  
    Union   0.87  
    Walworth   0.97  
    Yankton   0.93  
    Ziebach   0.82  

Source: SL 1997, ch 170, § 13; SL 2015, ch 56 (HJR 1005), eff. May 1, 2015.


     28-13-32.7.   Determining household income--Sources. For the purpose of determining a household's income, the county shall consider all sources of income, including the following:
             (1)      Compensation paid to household members for personal services, whether designated as gross salary, wages, commissions, bonus, or otherwise;
             (2)      Net income from self-employment, including profit or loss from a business, farm, or profession;
             (3)      Income from seasonal employment;
             (4)      Periodic payments from pensions or retirement programs, including social security, veterans' benefits, disability payments, and insurance contracts;
             (5)      Income from annuities or trusts, except for a trust held by a third party for the benefit of the minor children of the household;
             (6)      Interest, dividends, rents, royalties, or other gain derived from investments or capital assets;
             (7)      Gain or loss from the sale, trade, or conversion of capital assets;
             (8)      Unemployment insurance benefits and strike benefits;
             (9)      Workers' compensation benefits and settlements;
             (10)      Alimony and child support payments received; and
             (11)      School grants and stipends which are used for food, clothing, and housing but not for books and tuition.
     A federal income tax return is the preferred source for determining earnings. If a federal income tax return is not representative of current earnings, the county may also require pay stubs which include gross and net earnings.

Source: SL 1997, ch 170, § 14.


     28-13-32.8.   Household resources. For the purpose of determining a household's resources, the county shall consider all resources, including:
             (1)      Equity value of the household's primary residence, excluding the homestead exemption provided for in subdivision 43-45-3(2);
             (2)      Equity value of other real property;
             (3)      Equity value of major recreational and other leisure equipment including watercraft, campers, recreational vehicles, all-terrain vehicles, and snowmobiles;
             (4)      Equity value, in excess of five thousand dollars, of all motor vehicles;
             (5)      Personal assets, including cash in excess of one-half month's income, stocks, securities, accounts and notes due the person or the person's household, cash values of life insurance policies, collectible judicial judgments in favor of the person or the person's household, and monetary gifts;
             (6)      Equity value of business property, including real estate, equipment, and inventory; and
             (7)      Equity value of household goods and personal property beyond that which is reasonably essential for everyday living and self-support.
     Equity value is determined by subtracting an asset's outstanding indebtedness from its fair market value.
     The county shall subtract five thousand dollars from the total of the household's countable resources to determine the household's adjusted resources.

Source: SL 1997, ch 170, § 15.


     28-13-32.9.   Determination of person's ability to pay--Factors. A county is financially responsible only for the hospitalization expense which is beyond the person's ability to pay. A person's ability to pay is determined according to the following:
             (1)      Determine the household's contributions for taxes, social security, medicare, and payments to other standard retirement programs. A household's contribution for taxes is limited to the amount of taxes payable for the actual number of dependents in the household;
             (2)      Determine the household's expenses, including actual rent paid or scheduled principal and interest payments for a personal residence plus property taxes and homeowner's insurance costs; all utilities; child care expenses related to work schedules; grocery expenses up to the maximum allowed under the Food Stamp Program's Thrifty Food Plan as specified in rules promulgated by the Department of Social Services pursuant to chapter 1-26, plus household supplies and toiletries; basic auto expenses, gasoline, and upkeep; employee-paid health, life, and auto insurance payments; installment payments for medical bills; recurring expenses for medicine and medical care; court-ordered child support and alimony paid; automobile installment payments for one vehicle; clothing, reasonable in relation to the household's income; and installment payments, limited to necessary household items required by the household to maintain the needs of everyday living and reasonable in relation to the household's income;
             (3)      Determine the amount of a household's discretionary income by subtracting the sum of the household's contributions and expenses from the household's income determined according to § 28-13-32.7. Divide the amount of the household's discretionary income in half and multiply the resulting amount by forty-four dollars and ninety-six cents. The result added to the household's adjusted resources determined according to § 28-13-32.8 equals the household's ability to pay the debt and constitutes the household's share of the hospital bill. The amount of forty-four dollars and ninety-six cents represents the amount of medical or hospital expenses which can be amortized over sixty months at twelve percent annual interest per dollar of payment.
     The amount of the county's obligation is determined by subtracting the amount of the household's ability to pay from the hospital charges computed according to § 28-13-29. If the household defaults on the payment of its share of the hospital bill, a hospital may not pursue a collection action against the county for the defaulted payment.

Source: SL 1997, ch 170, § 16; SL 1998, ch 165, § 2.


     28-13-32.10.   Indigency by design. If an individual is indigent by design, the individual is ineligible for medical assistance under the provisions of this chapter and there may be no other criteria used to determine eligibility.

Source: SL 1997, ch 170, § 22.


     28-13-32.11.   Determination of household's ability to purchase health insurance. For purposes of subsections 28-13-27(6)(c) and (d), when determining whether the household was financially able to purchase health insurance which would have covered the medical costs the county is being requested to pay, the county shall use the following methodology:
             (1)      Determine the household's income and resources according to §§  28-13-32.7 and 28-13-32.8;
             (2)      Determine the household's contributions for taxes, social security, medicare, and payments to other standard retirement programs according to subdivision 28-13-32.9(1);
             (3)      Except for the medical expenses for which the household is requesting assistance, determine the household's expenses according to subdivision 28-13-32.9(2);
             (4)      Determine the amount of the household's discretionary income by subtracting the sum of the household's contributions and expenses from the household's income. Divide the amount of the household's discretionary income in half. The result added to the household's adjusted resources determined according to § 28-13-32.8 equals the household's discretionary income that was available to purchase health insurance;
             (5)      Subtract the amount of the monthly health insurance premium that was available to the household if known or, if unknown, an estimate of the premium the household could be expected to incur. For purposes of this subdivision, the county shall establish such estimate either by obtaining premium estimates from two major medical insurance carriers doing business in the state or by using an estimate based on the rate data provided to the county by the Division of Insurance of the Department of Labor and Regulation. The policy used shall have a benefit design that equals or exceeds the benefit design of the basic benefit plan as developed by the Health Benefit Plan Committee pursuant to § 58-18B-32. If the result is a negative number, the health insurance was not affordable. If the result is a positive number, health insurance was affordable and the individual is considered to be indigent by design.

Source: SL 2000, ch 134, § 2; SL 2004, ch 17, § 36; SL 2011, ch 1 (Ex. Ord. 11-1), § 162, eff. Apr. 12, 2011.


     28-13-33.   County liability for emergency and nonemergency hospitalization of indigent persons--Remedies for recovery of expense by county. Subject to the provisions of this chapter and except as expressly provided, if a hospital furnishes emergency hospital services to a medically indigent person, the county where the medically indigent person has established residency is liable to the hospital for the reimbursement of the hospitalization. In the case of nonemergency care, the county of residence is liable only to the extent that the board of county commissioners, in good faith, approves an application for assistance. If a county provides payment for nonemergency services, the services shall be approved by the county before the services are provided. To the extent that the county provides payment to a hospital, the county has the same remedies for the recovery of the expense as are provided by chapter 28-14 for the recovery of money expended for the relief and support of poor and indigent persons.

Source: SL 1953, ch 131, § 3; SDC Supp 1960, § 27.12B03; SL 1976, ch 173, § 19; SL 1988, ch 226, § 2; SL 1997, ch 170, § 11.


     28-13-33.1.   Experimental procedures and treatment for medically indigent patient. No county is liable for the payment of any experimental procedures or experimental modes of treatment provided on behalf of a medically indigent person.

Source: SL 1997, ch 170, § 28.


     28-13-33.2.   Billing for care of medically indigent patients. If submitting a bill to a county for medically necessary hospital services provided on behalf of a person who is medically indigent, the hospital must first demonstrate that it has exhausted all avenues of payment including accepting reasonable monthly payments from the person who does not have the ability to pay the hospital in one lump sum at the time of discharge.

Source: SL 1997, ch 170, § 30.


     28-13-34.   Repealed by SL 1988, ch 226, § 7


     28-13-34.1.   Notice to county where hospitalization is furnished to indigent person--Time for notice of emergency and nonemergency admissions--Contents of notice. If hospitalization is furnished to a medically indigent person, the county is not liable for the cost of the hospitalization unless, within fifteen days in the case of an emergency admission, notice of the hospitalization is mailed to the auditor of the county. The notice shall contain:
             (1)      The name and last known address of the patient or the patient's guardian;
             (2)      The name and address of the responsible party, if known;
             (3)      The name of the attending physician;
             (4)      The nature and degree of severity of the illness;
             (5)      The anticipated diagnostic or therapeutic services required;
             (6)      The location at which the services are to be provided;
             (7)      The estimated reimbursement for the services; and
             (8)      A statement that the hospital has asked the patient or the responsible party, if known, whether the patient has served in any branch of the military, is potentially eligible for Indian Health Service benefits, or is a member of a Native American tribe and a statement of the information received in response to the inquiry.

Source: SL 1988, ch 226, § 1; SL 1989, ch 245; SL 1997, ch 170, § 17.


     28-13-34.2.   Release of information. If submitting a notice under the provisions of § 28-13-34.1, the hospital shall make every reasonable effort to secure from the patient, and to include with the notice, a release of information form which has been signed by the patient or the patient's authorized representative. The form shall authorize persons, agencies, or institutions to release, to the county, the patient's social security number, the social security number of other household members, medical information concerning the patient, and financial information concerning the patient or members of the patient's household.

Source: SL 1997, ch 170, § 26.


     28-13-35.   Substitute arrangements for hospitalized indigent patient--County not liable to hospital after failure to cooperate. In any case of hospitalization of a medically indigent person, the county, through any elected officer or through an employee, may arrange for adequate and suitable care of the person elsewhere. If the county notifies the hospital in writing of its arrangement for the removal of the medically indigent person and the hospital unreasonably fails or refuses to cooperate in effecting the change, the county is not liable for any hospitalization subsequent to the hospital's failure or refusal to cooperate.

Source: SL 1953, ch 131, § 4; SDC Supp 1960, § 27.12B04; SL 1997, ch 170, § 18.


     28-13-36.   Contractual arrangements between county and hospital not impaired. Nothing in this chapter precludes a hospital and a county from entering into a reasonable and suitable arrangement, contract, or agreement for hospitalization of medically indigent persons at other rates than provided under this chapter, or abrogates or impairs any rights or remedies of either the county or the hospital under any such arrangement, contract, or agreement.

Source: SL 1953, ch 131, § 5; SDC Supp 1960, § 27.12B05; SL 1997, ch 170, § 19.


     28-13-37.   County duty to relieve nonresidents in distress. It shall be the duty of the county commissioners, on complaint made to them that any person not an inhabitant of their county is lying sick therein or in distress, without friends or money, so that he is likely to suffer, to examine into the case of such person and grant such temporary relief as the nature of the case may require.

Source: SDC 1939, § 50.0105.


     28-13-37.1.   Medical review by county or Department of Social Services. A county may review the need for emergency room treatment, an admission, a transfer, a continued stay, or inpatient surgical services. At its option, a county may request the Department of Social Services to provide the needed reviews on the county's behalf. In either case, the review shall be conducted by or under the supervision of a physician licensed under chapter 36-4, and shall be consistent with generally accepted medical practice guidelines.

Source: SL 1997, ch 170, § 27.


     28-13-38.   Temporary relief to nonresident--Reimbursement by home county. Whenever any person entitled to temporary relief as a poor person shall be in any county in which he has not established residency, the commissioners thereof may, if the same is deemed advisable, grant such relief by providing the same relief as is customary in cases where persons have established residency in the state and county. The county furnishing relief shall be entitled to reimbursements from the county in which said poor person has established residency.

Source: SDC 1939, § 50.0104; SL 1941, ch 211, § 4; SL 1976, ch 173, § 20.


     28-13-38.1.   When hospitals outside state are eligible for reimbursement by county. Hospitals located outside South Dakota are eligible for reimbursement from the county where the medically indigent person has established residency only if the hospital provides services which are not available in South Dakota or the hospital is approved by the county of residence of the medically indigent person as providing a reasonable or cost-effective service.

Source: SL 1988, ch 225, § 2; SL 1997, ch 170, § 20.


     28-13-39.   Repealed by SL 1976, ch 173, § 35


     28-13-40.   Appeal to circuit court from county commissioners--Direction for assistance. If any person shall suppose that he is entitled to the benefit of the laws for the relief of the poor, and the commissioners of the county in which he applies for assistance shall refuse to give such person the benefit thereof, upon application of such person a judge of the circuit court having jurisdiction over such county may, if he shall think proper, direct such commissioners to provide assistance pursuant to this chapter to such person.

Source: SDC 1939, § 50.0208; SL 1976, ch 173, § 21.


     28-13-41.   Repealed by SL 2013, ch 127, § 1.


     28-13-42.   Names of recipients not released for publication. The county auditor or any other county official shall not release the name of any poor relief recipient for official publication.

Source: SL 1975, ch 79, § 1.


     28-13-43.   Assignment or transfer of property to qualify for assistance as misdemeanor. At any time before or after making an application for poor relief, an applicant may not assign or transfer any property for the purpose of becoming eligible for assistance under this chapter. Violation of this section is a Class 1 misdemeanor.

Source: SL 1980, ch 202, § 7.


     28-13-44.   Bankruptcy not admissible in making determination of indigency. The fact that an individual has filed a petition in bankruptcy or has received a discharge in bankruptcy under Title 11 of the United States Code is not admissible evidence in a proceeding under this chapter and may not be considered in making a determination of indigency.

Source: SL 1995, ch 166; SL 1997, ch 170, § 21.


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