How to Complete and Submit the South Dakota Medicaid Application (FSSA & EA240)

To apply for South Dakota Medicaid, complete one of two Department of Social Services forms — the general health coverage application (FSSA) for most applicants, or the long-term care application (DSS-EA-240) if you need nursing facility or waiver services — and submit it online through the DSS self-service portal, by mail, or in person at any of the roughly 30 local DSS offices across the state.¹ The state generally has 45 days to issue a decision, or 90 days if your application is based on disability.²

Pick the Right Form

South Dakota uses two separate Medicaid applications, and choosing the wrong one will slow you down.

Most people use the Application for Health Coverage and Help Paying Costs (form FSSA). That includes adults applying under Medicaid expansion, parents, pregnant women, and children. The FSSA is the shorter form and focuses on household composition, income, and tax-filing status.³

Use the DSS-EA-240 instead if you need coverage for nursing home care, assisted living, home and community-based waiver services, or if you’re a married couple requesting a resource assessment. The EA240 runs 49 sections and asks for detailed information on bank accounts, retirement funds, life insurance, real estate, trusts, and annuities, because long-term care programs apply a resource limit on top of income.⁴

Both forms are available as printable PDFs on the DSS website and at any local office.

Check Whether You Qualify

South Dakota expanded Medicaid on July 1, 2023, so adults aged 19 through 64 can now qualify if their household income is at or below 138 percent of the Federal Poverty Level.⁵ Under the 2026 poverty guidelines, that works out to a gross monthly income cap of $1,835 for one person, $2,488 for two, or $3,795 for a household of four.⁶

Other coverage groups use different thresholds for 2026:

Pregnant women: $1,835 per month for a household of one, same scale as expansion adults.
Children without private insurance (CHIP): $2,780 per month for a household of one, up to $5,748 for four.
Children with private insurance (CHIP): $2,487 per month for a household of one, up to $5,143 for four.
Low-income families: much lower, at $590 per month for a household of one and $941 for four.

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Long-term care programs, waiver services, and coverage for people with disabilities also carry a $2,000 resource limit for an individual, counting things like checking and savings accounts and certificates of deposit. The Medicare Savings Program uses higher resource limits of $9,950 for an individual and $14,910 for a couple.⁶

You must be a South Dakota resident. U.S. citizens and qualified immigrants are eligible, and the application asks for either a Social Security number or an immigration document number.³

Gather Your Documents First

Missing documents are the most common reason applications stall. Before you start the FSSA, pull together:

Social Security numbers (or immigration document numbers) for every person in your household.
Employer and income information: pay stubs, W-2 forms, or wage and tax statements showing current gross earnings.
Tax filing details, including whether you plan to file, whether you’ll file jointly, and anyone you plan to claim as a dependent. You do not need to file taxes to qualify for coverage.
Health insurance policy numbers for any current coverage a household member already carries.
Birth dates and relationships for every person in the household.

The EA240 asks for considerably more. Expect to attach bank statements, retirement and pension account records, life insurance policies, burial fund contracts, real estate tax assessments, trust documents, and details on any assets transferred within the past five years.⁴

Filling Out the FSSA

The general application walks you through your household in steps. Complete a Step 2 page for every person in your family and household, even if that person already has health coverage. The state uses all household members’ information to calculate whether you qualify and what level of help you can receive.³

Report income as gross monthly figures. That means the number before taxes, retirement contributions, and other deductions come out. If you’re paid biweekly, multiply your gross paycheck by 26 and divide by 12. Include wages, self-employment income, Social Security benefits, unemployment, pensions, and any other recurring payments.

The tax-filing questions matter more than most people expect. The form asks whether you plan to file a federal return, whether you’ll file jointly with a spouse, and which household members you’ll claim as dependents. Those answers decide which household members count in your eligibility group and whose income gets counted. Answer based on what you expect to do for the current tax year if that differs from last year.

Sign the certification page. An unsigned paper application is returned without processing.

Filling Out the EA240

The long-term care form is more involved because the program counts assets alongside income. Its 49 sections cover vehicles, mineral rights, promissory notes, life estates, and much more.⁴ Before you sign, the form’s completion checklist asks you to confirm that you have:

Attached all applicable supporting documents (bank statements, award letters, trust agreements, burial contracts, real estate tax assessments).
Reviewed the Statement of Understanding.
Completed the Authorization for Use or Disclosure of Protected Health Information.
Completed the Authorization to Release Information section if you want DSS to share case information with a third party, such as a family member or attorney.

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Married couples can use this same form to request a resource assessment without applying for Medicaid at the same time. A resource assessment establishes how assets will be divided between the applicant spouse and the community spouse (the one remaining at home), which is useful for planning before the institutionalized spouse actually needs benefits.

Submitting Your Application

DSS gives you three ways to file:

Online through the DSS self-service portal, accessible from the Department of Social Services website. This is the fastest route and lets you upload supporting documents electronically.
By mail or in person to your local DSS office. Print the appropriate form, complete it, sign it, and send or hand-deliver it. The EA240 specifically instructs you to send the completed, signed form to your local office.
With phone or in-person help from DSS staff at a local office, who can walk you through the application.

South Dakota has roughly 30 local DSS offices, from Aberdeen and Brookings to Rapid City, Sioux Falls, and Yankton. The DSS office locator on the department’s website lists mailing addresses for the office nearest you.⁷

If you don’t have every document ready, file anyway and provide the rest later. Submitting establishes your application date, which matters for retroactive coverage and processing deadlines.

What Happens After You File

Federal rules give the state up to 45 days to process a standard Medicaid application. Disability-based applications get 90 days because of the additional medical evidence required.² Expect DSS to contact you during that window if they need more documentation. Respond quickly. Delays on your end can push your case past the deadline or lead to denial based on incomplete information.

If you’re approved, coverage can be backdated up to three months before the month you applied, as long as you would have qualified during those months. That retroactive coverage can pick up medical bills you’ve already incurred.⁸ Starting January 1, 2027, South Dakota plans to limit retroactive coverage to one month for Medicaid expansion adults and two months for everyone else.⁹

If You Need Care Before Your Application Is Decided

Certain qualified hospitals in South Dakota can screen you for temporary Medicaid coverage on the spot through hospital presumptive eligibility. That provides short-term coverage while your full application is still working its way through the system.¹⁰ Ask the hospital’s financial counselor or admissions office whether they participate.

If You’re Denied

If DSS denies your application, the written notice must explain the reason, cite the specific regulations behind it, and tell you how to appeal.¹¹ You have the right to request a fair hearing in front of an independent hearing officer.

The deadline to request a hearing is stated on your denial notice. Federal rules require states to allow at least 30 days and some permit up to 90. Read the notice carefully and act within the stated timeframe, because missing it forfeits your appeal right.

One Thing to Know Before Applying for Long-Term Care

If your application is for nursing home or other long-term care coverage, be aware that South Dakota recovers Medicaid costs from the estates of deceased recipients in certain situations. Under SDCL 28-6-23, any Medicaid payment for someone in a nursing home or other medical institution is treated as a debt owed to the state. For recipients 55 or older, the state can also recover costs for home and community-based services, hospital care, and prescription drugs.¹²

The state cannot pursue recovery if the recipient is survived by a spouse, a child under 21, or a child who is blind or disabled. Once a surviving spouse later dies, the state may file a claim against that spouse’s estate for the original recipient’s Medicaid costs. A surviving spouse who wants to limit the amount available for reimbursement must file a petition with DSS within six months of the Medicaid recipient’s death.¹² Federal rules also require states to waive estate recovery when it would cause undue hardship.¹³

1
South Dakota Department of Social Services. Medical Assistance
2
eCFR. 42 CFR 435.912 – Timely Determination of Eligibility
3
South Dakota Department of Social Services. Application for Health Coverage and Help Paying Costs
4
South Dakota Department of Social Services. Application for Resource Assessment, Long-Term Care, or Other Related Medical Assistance
5
CMS. South Dakota Expands Medicaid Bringing Health Coverage to More Than 52,000 State Residents
6
South Dakota Department of Social Services. South Dakota Medicaid Coverage Groups
7
South Dakota Department of Social Services. Find Your Local Office
8
Social Security Administration. Social Security Act Section 1902
9
South Dakota Department of Social Services. South Dakota Medicaid – Impacts of the Federal Reconciliation Bill
10
South Dakota Department of Social Services. Presumptive Eligibility by Hospitals
11
Medicaid.gov. Understanding Medicaid Fair Hearings
12
South Dakota Department of Social Services. Estate Recovery
13
Medicaid.gov. Estate Recovery