NASHP

South Dakota CHIP Fact Sheet

For more than two decades, the Children’s Health Insurance Program (CHIP) has provided health coverage to children in families with low to moderate incomes. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options.

CHIP is currently funded through federal fiscal year (FFY) 2027 (Sept. 30, 2027) by the HEALTHY KIDS and ACCESS Acts. The Acts also extended the maintenance of effort (MOE) provision, which requires states to maintain eligibility standards that were in place in 2010 through FFY 2027. However, beginning in FFY 2020 MOE only applies to children in families with incomes at or below 300 percent of the federal poverty level (FPL).

Eligibility

Modified adjusted gross income (MAGI) eligibility levels for CHIP/Title XXI in South Dakota (by age)

  Ages 0 – 1  Ages 1 – 5 Ages 6 – 18
Medicaid expansion 147 – 182% FPL 147 – 182% FPL 111 – 182% FPL
Separate CHIP 183 – 204% FPL 183 – 204% FPL 183 – 204% FPL

Source: Medicaid and CHIP Payment and Access Commission (MACPAC), MACStats: Medicaid and CHIP Data Book, December 2018, Exhibit 35: “Medicaid and CHIP Income Eligibility Levels as a Percentage of the Federal Poverty Level for Children and Pregnant Women by State, April 2018.” Note: Eligibility levels do not include the mandatory 5% income disregard.

Coverage for Pregnant Women

Using CHIP funding, states can opt to provide coverage for pregnant women and/or services through the “unborn child” coverage option. South Dakota provides coverage up to 133% FPL through the CHIP unborn child option.

Benefit Package

States that operate Medicaid expansion CHIP programs must follow Medicaid rules, providing all Medicaid-covered benefits to enrolled children, including the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services benefit. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines.

Delivery System

South Dakota’s CHIP program uses a fee-for-service primary care case management model.

Premiums and Cost Sharing

Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed 5 percent of family income annually.

South Dakota’s CHIP program has no premiums or cost sharing.

Key Highlights:

Program type: South Dakota operates a combination CHIP program called South Dakota CHIP.

Number of children covered: In FFY 2018, 20,129 children were covered by South Dakota CHIP. (Data from CHIP Annual Report Template System)

State’s enhanced federal match rate*: For FFY 2020, the federal match is 81.83 percent.

Participation rate: In 2017, 88.8 percent of eligible children in South Dakota participated in either Medicaid or South Dakota CHIP.  (Urban Institute)

*The Affordable Care Act increased the federal CHIP match rate by 23 percentage points. The HEALTHY KIDS and ACCESS Acts maintained this increase through FFY 2019, and reduced it to 11.5 percentage points in FFY 2020. The federal CHIP match rate returns to states’ regular enhanced match rate in FFY 2021 and beyond.

Strategies to Simplify Enrollment and Renewals in South Dakota

Strategy Used
Use of presumptive eligibility No
Use of 12-month continuous eligibility No
Use of express lane eligibility No[1]
Premium assistance No

For definitions of strategies in this chart, see the Centers for Medicare & Medicaid Services December 2009 State Health Official letter here.

Other Characteristics of South Dakota’s CHIP Program

Does South Dakota…
Require a waiting period?[2] Yes, 90 days
Offer a buy-in option?[3] No
Cover dependents of public employees? No
Cover lawfully residing children without a five-year waiting period? No

Source: Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey. Kaiser Family Foundation and Georgetown University Center for Children and Families.

Health Services Initiatives

States can develop Health Services Initiatives (HSIs) to improve the health of low-income children and youth by using a portion of their existing CHIP administrative dollars. After covering regular CHIP program administrative costs, states can use any remaining funds – within the 10 percent cap – for an HSI project. The federal share of the HSI project cost is funded at the state’s CHIP match rate. States have used HSIs to support poison control centers, school health services, lead abatement efforts, and other unique prevention and intervention projects. South Dakota currently does not have an HSI.

Quality Measures

States may report on a core set of quality measures for children. South Dakota reported on 11 measures for federal fiscal year 2018. Among the measures is preventive dental services, listed below.

Percentage of eligibles ages 1 20 receiving preventive dental services (FFY 2018)

Ages 1 – 20 who receive preventive dental services
South Dakota 48.4%

Source: Department of Health and Human Services, 2019 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP, September 2019.

[1] ELE is only used in the state’s Medicaid expansion CHIP program.

[2] States may implement waiting periods up to 90 days in CHIP. A waiting period is the length of time a child must be uninsured before enrollment in CHIP.

[3] States can allow families with incomes above the upper income eligibility limit to pay the full cost to purchase coverage for their uninsured children through CHIP.

Copyright © 2019, by The National Academy for State Health Policy. All rights reserved. May not be published or otherwise distributed without explicit permission | Privacy Policy | Terms Of Use