CHAPTER 67:46:12
MODIFIED ADJUSTED GROSS INCOME MEDICAID
ELIGIBILITY STANDARDS
Section
67:46:12:01 Definitions.
67:46:12:02 Medicaid eligibility -- Parent/caretaker relative.
67:46:12:03 Repealed.
67:46:12:04 Repealed.
67:46:12:05 Repealed.
67:46:12:06 Repealed.
67:46:12:07 Repealed.
67:46:12:08 Income limit -- Parent/caretaker relative.
67:46:12:09 Repealed.
67:46:12:10 Medicaid eligibility -- Pregnant woman.
67:46:12:11 Income limit -- Pregnant woman.
67:46:12:12 Medicaid eligibility -- Children.
67:46:12:13 Income limit -- Children.
67:46:12:14 Medicaid eligibility -- Other reasonable classifications of children.
67:46:12:15 Income limit -- Other reasonable classifications of children.
67:46:12:16 Medicaid eligibility -- Adult group.
67:46:12:17 Income limit -- Adult group.
67:46:12:01. Definitions. Terms\r\nused in this chapter mean:
\r\n\r\n\r\n\r\n
(1) "Caretaker relative," a\r\nrelative of a dependent child by blood, adoption, or marriage with whom the\r\nchild is living, who assumes primary responsibility for the child's care (as\r\nmay, but is not required to, be indicated by claiming the child as a tax\r\ndependent for Federal income tax purposes), and who is one of the following:
\r\n\r\n\r\n\r\n
(a) The child's father, mother,\r\ngrandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother,\r\nstepsister, uncle, aunt, first cousin, nephew, or niece;
\r\n\r\n(b) The spouse of such parent or\r\nrelative, even after the marriage is terminated by death or divorce.
\r\n\r\n\r\n\r\n
(2) "Dependent child," a\r\nchild who has not attained 18 years of age or has not attained 19 years of age\r\nand is a full-time student in a secondary school, and is expected to complete\r\nthe program before reaching the age of 19;
\r\n\r\n\r\n\r\n
(3) "Parent," a natural or\r\nbiological, adoptive or step parent;
\r\n\r\n\r\n\r\n
(4) "Pregnant woman," a woman\r\nduring pregnancy and the post-partum period, which begins on the date the\r\npregnancy ends, extends 60 days, and ends on the last day of the month in which\r\nthe 60-day period ends; and
\r\n\r\n\r\n\r\n
(5) "Family Size/Household,"\r\nan individual's family size has the same meaning as determined under the\r\nprovisions of 42 C.F.R. § 435.603 (July 15, 2013).
\r\n\r\n\r\n\r\n
Source: 24 SDR 24, effective August 31,\r\n1997; 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
Cross-References: Definitions and use of\r\nterms, 42 C.F.R. § 435.4 (March 23, 2012); Application of modified\r\nadjusted gross income (MAGI), 42 C.F.R. § 435.603 (July 15, 2013).
\r\n\r\n\r\n\r\n
67:46:12:02. Medicaid eligibility --\r\nParent/caretaker relative. If a dependent child is living with a\r\nparent/caretaker relative, the parent/caretaker relative may be eligible for\r\nMedicaid if the following criteria is met:
\r\n\r\n\r\n\r\n
(1) They meet the general eligibility\r\nrequirements of chapter 67:46:01;
\r\n\r\n(2) They meet the requirements\r\ncontained in this chapter.
\r\n\r\n\r\n\r\n
Source: 24 SDR 24, effective August 31,\r\n1997; 41 SDR 7, effective July 29, 2014; 41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral\r\nAuthority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
67:46:12:03. Determination of principal wage earner.Repealed.
\r\n\r\n\r\nSource:\r\n24 SDR 24, effective August 31, 1997; repealed, 31 SDR 107, effective February\r\n1, 2005.
\r\n\r\n\r\n67:46:12:04. Determining deprivation because of parents'\r\nunemployment.Repealed.
\r\n\r\n\r\nSource:\r\n24 SDR 24, effective August 31, 1997; repealed, 31 SDR 107, effective February\r\n1, 2005.
\r\n\r\n\r\n67:46:12:05. Circumstances under which parent not considered\r\nunemployed.Repealed.
\r\n\r\n\r\nSource:\r\n24 SDR 24, effective August 31, 1997; repealed, 31 SDR 107, effective February\r\n1, 2005.
\r\n\r\n\r\n67:46:12:06. Determining family\r\nsize. Repealed.
\r\n\r\n\r\n\r\n
Source: 24 SDR 24, effective August 31,\r\n1997; repealed, 41 SDR 7, effective July 29, 2014.
\r\n\r\n\r\n\r\n
67:46:12:07. Consideration of income\r\nand resources. Repealed.
\r\n\r\n\r\n\r\n
Source: 24 SDR 24, effective August 31,\r\n1997; repealed, 41 SDR 7, effective July 29, 2014.
\r\n\r\n\r\n\r\n
67:46:12:08. Income limit --\r\nParent/caretaker relative. To be eligible for assistance under this chapter\r\na parent/caretaker relative's income, based on family size determined under the\r\nprovisions of 42 C.F.R. § 435.603 (July 15, 2013), may not exceed the\r\nfollowing amounts plus five percent of the current year's federal poverty\r\nguidelines for that family size:
\r\n\r\n\r\n\r\n
| \r\n FAMILY SIZE \r\n | \r\n \r\n MONTHLY GROSS\r\n INCOME LIMIT \r\n | \r\n
| \r\n \r\n | \r\n \r\n \r\n | \r\n
| \r\n 1 \r\n | \r\n \r\n $ 563 \r\n | \r\n
| \r\n 2 \r\n | \r\n \r\n 703 \r\n | \r\n
| \r\n 3 \r\n | \r\n \r\n 796 \r\n | \r\n
| \r\n 4 \r\n | \r\n \r\n 885 \r\n | \r\n
| \r\n 5 \r\n | \r\n \r\n 977 \r\n | \r\n
| \r\n 6 \r\n | \r\n \r\n 1,070 \r\n | \r\n
| \r\n 7 \r\n | \r\n \r\n 1,160 \r\n | \r\n
| \r\n 8 \r\n | \r\n \r\n 1,249 \r\n | \r\n
| \r\n 9 \r\n | \r\n \r\n 1,340 \r\n | \r\n
| \r\n 10 \r\n | \r\n \r\n 1,431 \r\n | \r\n
\r\n\r\n
Source: 24 SDR 24, effective August 31,\r\n1997; 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
Cross-References: Definitions and use of\r\nterms, 42 C.F.R. § 435.4 (March 23, 2012); Application of modified\r\nadjusted gross income (MAGI), 42 C.F.R. § 435.603 (July 15, 2013).
\r\n\r\n\r\n\r\n
67:46:12:09. Resource limit.\r\nRepealed.
\r\n\r\n\r\n\r\n
Source: 24 SDR 24, effective August 31,\r\n1997; 31 SDR 107, effective February 1, 2005; repealed, 41 SDR 7, effective\r\nJuly 29, 2014.
\r\n\r\n\r\n\r\n
67:46:12:10. Medicaid eligibility --\r\nPregnant woman. A pregnant woman is eligible for Medicaid if the following\r\ncriteria is met:
\r\n\r\n\r\n\r\n
(1) She meets the general eligibility\r\nrequirements of chapter 67:46:01;
\r\n\r\n(2) She meets the requirements\r\ncontained in this chapter.
\r\n\r\n\r\n\r\n
Source: 41 SDR 7, effective July 29, 2014;\r\n41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
67:46:12:11. Income limit -- Pregnant woman. To be eligible for assistance under this chapter, a pregnant woman may not have income which exceeds one hundred and thirty-eight percent of the federal poverty guidelines based on family size, for the current year.
Source: 41 SDR 7, effective July 29, 2014; 49 SDR 125, effective July 3, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(4)(6).
Cross-Reference: Application of modified adjusted gross income (MAGI), 42 C.F.R. § 435.603, in effect on November 30, 2016.
67:46:12:12. Medicaid eligibility --\r\nChildren. A child is eligible for Medicaid if the following criteria is\r\nmet:
\r\n\r\n\r\n\r\n
(1) With the exception of\r\n§ 67:46:01:14, the child meets the general eligibility requirements of\r\nchapter 67:46:01;
\r\n\r\n(2) The child meets the requirements\r\ncontained in this chapter.
\r\n\r\n\r\n\r\n
Source: 41 SDR 7, effective July 29, 2014;\r\n41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
Cross-Reference: Application of modified\r\nadjusted gross income (MAGI), 42 C.F.R. § 435.603 (July 15, 2013).
\r\n\r\n\r\n\r\n
67:46:12:13. Income limit --\r\nChildren. To be eligible for assistance under this chapter a child's family\r\nincome, based on family size, may not exceed 182% of the current year's federal\r\npoverty guidelines for that family size.
\r\n\r\n\r\n\r\n
Source: 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
Cross-Reference: Application of modified\r\nadjusted gross income (MAGI), 42 C.F.R. § 435.603 (July 15, 2013).
\r\n\r\n\r\n\r\n
67:46:12:14. Medicaid eligibility --\r\nOther reasonable classifications of children. A child under age 21 is\r\neligible for Medicaid assistance if the child;
\r\n\r\n\r\n\r\n
(1) Is in an adoption that is\r\nsubsidized in full or part by a public agency;
\r\n\r\n\r\n\r\n
(2) Resides in a nursing or\r\nintermediate care facility;
\r\n\r\n\r\n\r\n
(3) Is under the custody of the\r\ndepartment;
\r\n\r\n\r\n\r\n
(4) Is in foster care and the\r\ndepartment is assuming full or partial financial responsibility;
\r\n\r\n\r\n\r\n
(5) Is under the jurisdiction of the\r\nDepartment of Corrections and is not an inmate of a public institution under\r\nthe provisions of 42 CFR 435.1008;
\r\n\r\n\r\n\r\n
(6) Is adjudicated under the\r\nguardianship of the South Dakota Human Services Center and is receiving\r\ninpatient psychiatric treatment for drug or alcohol dependency; or
\r\n\r\n\r\n\r\n
(7) Is adjudicated under the\r\nguardianship of the South Dakota Human Services Center and is receiving\r\ninpatient psychiatric treatment.
\r\n\r\n\r\n\r\n
The child must also meet the requirements in\r\nChapter 67:46:01 and have income within limits specified in § 67:46:12:15.
\r\n\r\n\r\n\r\n
Source: 41 SDR 7, effective July 29, 2014;\r\n41 SDR 93, effective December 3, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
Cross-Reference: Application of modified\r\nadjusted gross income (MAGI), 42 C.F.R. § 435.603 (July 15, 2013).
\r\n\r\n\r\n\r\n
67:46:12:15. Income limit -- Other\r\nreasonable classifications of children.
\r\n\r\n\r\n\r\n
| \r\n FAMILY SIZE \r\n | \r\n \r\n MONTHLY GROSS\r\n INCOME LIMIT \r\n | \r\n
| \r\n \r\n | \r\n \r\n \r\n | \r\n
| \r\n 1 \r\n | \r\n \r\n $ 382 \r\n | \r\n
| \r\n 2 \r\n | \r\n \r\n 484 \r\n | \r\n
| \r\n 3 \r\n | \r\n \r\n 561 \r\n | \r\n
| \r\n 4 \r\n | \r\n \r\n 636 \r\n | \r\n
| \r\n 5 \r\n | \r\n \r\n 713 \r\n | \r\n
| \r\n 6 \r\n | \r\n \r\n 790 \r\n | \r\n
| \r\n 7 \r\n | \r\n \r\n 865 \r\n | \r\n
| \r\n 8 \r\n | \r\n \r\n 940 \r\n | \r\n
| \r\n 9 \r\n | \r\n \r\n 1016 \r\n | \r\n
| \r\n 10 \r\n | \r\n \r\n 1092 \r\n | \r\n
\r\n\r\n
Source: 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
\r\n\r\n\r\n\r\n
Cross-Reference: Application of modified\r\nadjusted gross income (MAGI), 42 C.F.R. § 435.603 (July 15, 2013).
\r\n\r\n\r\n\r\n
67:46:12:16. Medicaid eligibility -- Adult group. An individual may be eligible for Medicaid if the individual:
(1) Is over age eighteen and under age sixty-five;
(2) Is not pregnant;
(3) Is not entitled to or enrolled to receive Medicare benefits;
(4) Is not otherwise eligible for and enrolled to receive mandatory coverage under the state Medicaid plan; and
(5) Has a household income that is at or below one hundred and thirty-three percent of the federal poverty level for the applicable family size.
Source: 49 SDR 125, effective July 3, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(4)(6).
67:46:12:17. Income limit -- Adult group. To be eligible for assistance under this chapter, an individual eligible for Medicaid under § 67:46:12:16, based on family size determined under the provisions of 42 C.F.R. § 435.603, may not exceed one hundred and thirty-three percent of the federal poverty level, plus five percent of the federal poverty guidelines based on family size for the current year.
Source: 49 SDR 125, effective July 3, 2023.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(4)(6).
Cross-References:
Application of modified adjusted gross income (MAGI), 42 C.F.R. § 435.603, in effect on November 30, 2016.
Definitions and use of terms, 42 C.F.R. §435.4, in effect on November 3, 2022.
Federal poverty level, § 67:11:01:03.