South Dakota Medicaid Program Overview
Enrollment, funding, and managed care facts for South Dakota Medicaid.
Get South Dakota's Medicaid Fee Schedule →Enrollment
South Dakota Medicaid covered approximately 0.14M people. healthinsurance.org's state guide (citing state/CMS data) gives 136,919 (October 2025); KFF's total monthly Medicaid & CHIP enrollment tracker gives 138,641 (May 2026) -- both close. CMS's 2024 Medicaid Managed Care Enrollment report gives 144,864 (July 1, 2024), slightly higher, consistent with modest post-unwinding decline since mid-2024.
Funding & federal match
South Dakota has adopted ACA Medicaid expansion, effective 2023-07-01.
For FFY2026 (Oct 1, 2025 - Sep 30, 2026), South Dakota's Federal Medical Assistance Percentage (FMAP) is 51.01%.
Delivery system & managed care
A large share of South Dakota Medicaid is delivered through managed care organizations (MCOs) rather than fee-for-service — estimates range from 0% of Medicaid enrollees.
Waivers
South Dakota operates Medicaid managed care under the South Dakota 1915(c) Home and Community-Based Services waivers (CHOICES, Family Support 360, Assistive Daily Living Services (ADLS), HOPE), a Section 1915(c) demonstration waiver. South Dakota operates four active 1915(c) HCBS waivers, jointly run by the Departments of Social Services and Human Services: CHOICES (intellectual/developmental disabilities, ICF/IID level of care), Family Support 360 (intellectual/developmental disabilities), Assistive Daily Living Services / ADLS (elderly and physically disabled, nursing-facility level of care), and HOPE (elderly and working-age adults with disabilities, nursing-facility level of care). No active Section 1115 demonstration is in effect; a proposed 'SDCareerLink' 1115 work-requirement demonstration was not submitted to CMS.
Has South Dakota expanded Medicaid under the ACA?
Yes. South Dakota has adopted ACA Medicaid expansion. Effective 2023-07-01.
How many people are enrolled in South Dakota Medicaid?
Approximately 0.14M people.
What percentage of the federal Medicaid match does South Dakota receive?
51.01% for FFY2026 (Oct 1, 2025 - Sep 30, 2026) — meaning the federal government pays roughly 51 cents of every South Dakota Medicaid dollar, and the state pays the rest.
Is most of South Dakota Medicaid delivered through managed care?
Estimates range from 0% of Medicaid enrollees in managed care.
What Medicaid waivers does South Dakota operate under?
South Dakota 1915(c) Home and Community-Based Services waivers (CHOICES, Family Support 360, Assistive Daily Living Services (ADLS), HOPE), a Section 1915(c) demonstration waiver. South Dakota operates four active 1915(c) HCBS waivers, jointly run by the Departments of Social Services and Human Services: CHOICES (intellectual/developmental disabilities, ICF/IID level of care), Family Support 360 (intellectual/developmental disabilities), Assistive Daily Living Services / ADLS (elderly and physically disabled, nursing-facility level of care), and HOPE (elderly and working-age adults with disabilities, nursing-facility level of care). No active Section 1115 demonstration is in effect; a proposed 'SDCareerLink' 1115 work-requirement demonstration was not submitted to CMS.
Get South Dakota's Free Medicaid Fee Schedule
Request actual South Dakota Medicaid reimbursement rates by billing code — free, delivered as a CSV.
Sources
- KFF State Health Facts - Total Monthly Medicaid & CHIP Enrollment
- healthinsurance.org - Medicaid eligibility and enrollment in South Dakota
- CMS - Medicaid Managed Care Enrollment and Program Characteristics, 2024
- Federal Register / GovInfo - FY2026 FMAP Notice (89 FR 94742)
- Congressional Research Service - Medicaid's Federal Medical Assistance Percentage (FMAP), Report R43847 (Table, FY2021-FY2026)
- KFF State Health Facts - State Activity Around Expanding Medicaid Under the ACA
- KFF State Health Facts - Managed Care Penetration Rates by Eligibility Group
- Medicaid.gov - South Dakota Waiver Factsheet
- South Dakota DSS - Medicaid Home and Community Based Services
Data last verified 2026-09-17. Also see our free Medicaid Fee Schedule tool.