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.
Frequently Asked Questions
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.