Medicaid agency: South Dakota Department of Social Services (DSS) / Division of Medical Services
South Dakota Medicaid is administered by the Department of Social Services (DSS), a multi-program agency whose Division of Medical Services runs the program. The Department of Human Services (DHS) is a separate cabinet agency that operates the state's HCBS waivers and other long-term services and supports on DSS's behalf. South Dakota runs Medicaid entirely fee-for-service, with no risk-based managed care organizations, one of the few remaining states with this structure; PRIME, its statewide primary care case management program, enrolled 106,872 people per CMS's most recent managed care enrollment data, report year 2024. Voters approved Medicaid expansion via constitutional Amendment D in November 2022, with coverage effective July 1, 2023; Amendment F, approved in November 2024 (56.12%-43.88%), authorized the legislature to impose work requirements on the expansion population. South Dakota drafted a state-specific work-requirements demonstration under that authority, SDCareerLink, but withdrew it before submitting it to CMS, choosing instead to implement Medicaid community engagement requirements under the federal reconciliation law (H.R. 1), effective January 1, 2027. A third constitutional measure, Amendment I, goes before voters November 3, 2026, and would let the state end the expansion mandate if the federal match for the expansion population falls below 90%. South Dakota's only active Section 1115 demonstration is the Former Foster Care Youth Demonstration, unrelated to expansion or work requirements, and its Attorney General has not joined the multistate lawsuit challenging the federal work-requirements rule.
CMS's most recent managed care enrollment dataset (report year 2024) shows no comprehensive managed care organizations operating in South Dakota, consistent with the state's fully fee-for-service structure. The one entity listed, PRIME, is a statewide primary care case management (PCCM) arrangement (the network of enrolled primary care providers most Medicaid recipients are assigned to) with 106,872 enrolled, none of them dual-eligible. Care Connect, DSS's separate chronic-condition care-coordination program, does not appear in this dataset; it runs as a state-plan arrangement with individually enrolled providers rather than a plan-based entity CMS's managed care enrollment reporting captures.
Long-term services and supports run entirely outside managed care through four Section 1915(c) home- and community-based waivers: HOPE (0189.R08.00), Assistive Daily Living Services (0264.R06.00), CHOICES (0044.R09.00), and Family Support 360 (0338.R05.00). DSS is the single state Medicaid agency of record for all four, but day-to-day operation sits with DHS: its Division of Long Term Services and Supports runs HOPE, its Division of Rehabilitation Services runs ADLS, and its Developmental Disabilities Division runs CHOICES and Family Support 360.
Not integrated into managed care
Behavioral health runs directly within DSS's own Division of Behavioral Health rather than through a separate carve-out vendor, following a 2011 transfer of behavioral health functions from DHS to DSS.
Carved in
Delta Dental of South Dakota administers the Medicaid dental benefit, including claims adjudication and the dental call center. That role is currently out for re-procurement, with a decision on award pending.
OptumRx processes South Dakota Medicaid's pharmacy claims and prior authorizations; member and eligibility questions are still handled directly by South Dakota Medicaid.
Non-emergency medical transportation is not brokered; members submit mileage, meal, and lodging claims directly for reimbursement, paid onto a Way2Go debit card that Conduent issues on the state's behalf.
South Dakota operates its own Medicaid claims-processing system rather than contracting that function out. CNSI built the current platform under a state-operated model, with a planned go-live of December 2019, after an earlier CNSI-built system was cancelled in 2010 following cost overruns. A separate eligibility system, BEES, built by RedMane Technology on the Cúram platform, launched in March 2024 and received full federal certification in September 2025.
37 agency updates tracked for South Dakota. Available with Pro.
See them with ProSouth Dakota Searchlight profiles Dan Ahlers, the Democratic nominee for governor, running against incumbent Republican Gov. Larry Rhoden. The piece covers Ahlers' background as a small business owner and former state legislator, and notes a companion podcast interview in which he addresses Medicaid alongside abortion, tribal relations, climate change, and taxes. No specific Medicaid policy position or proposal is detailed in this profile article itself. The race is notable because Democrats have not held the South Dakota governorship since 1979.
Backers and opponents of South Dakota's Amendment L traded accusations this week over campaign ads linking the measure to "out-of-state billionaires." Amendment L, on the Nov. 3 general election ballot, would require 60% voter approval for future constitutional amendments, though it would not change thresholds for citizen-initiated laws or referendums. Supporter Rep. John Hughes sent a cease-and-desist letter to media outlets airing opposition ads, calling them defamatory, while opponents say the ads illustrate how costly ballot campaigns would become under a higher threshold. The measure is the third such attempt in South Dakota since 2018, following past efforts that included constitutional ballot measures on Medicaid expansion and marijuana legalization.
CMS announced $7.2 million in federal funding to expand ambulance-based telemedicine and upgrade emergency communications infrastructure across South Dakota. The funding will support rural emergency medical services, including equipment for real-time video consultation between ambulance crews and physicians during transport. South Dakota officials and providers will implement the upgrades, which aim to improve emergency care access in rural and underserved areas of the state. The announcement did not specify an implementation timeline or the funding mechanism involved.
At an Oct. 1 debate co-hosted by South Dakota Public Broadcasting and South Dakota News Watch, Republican Marty Jackley and Democrat Nikki Gronli, candidates for South Dakota's U.S. House seat, sparred over tariffs, energy costs and the One Big Beautiful Bill Act's healthcare provisions. Jackley criticized Trump's push to import Argentine beef but otherwise backed Trump's tariff approach, while Gronli said tariffs and the Iran conflict have driven up costs for farmers and families. On Medicaid, Jackley defended the law's new work requirements as a fraud-prevention measure and praised sending rural health transformation dollars (South Dakota has received $189 million so far) to states to decide how to spend. Gronli argued the law's cuts to Medicaid and other programs would harm residents who depend on them. The general election is Nov. 3.
Opponents of South Dakota's Amendment I, on the Nov. 3 ballot, said Monday the measure would reduce health care access and shift costs to privately insured residents. Amendment I would automatically repeal Medicaid expansion if federal funding for the expansion population is reduced below current levels. South Dakota's Republican attorney general and other opponents oppose the measure, arguing it threatens coverage gained through expansion. The vote takes place November 3, and its outcome will determine whether the state's expansion population retains coverage if federal funding changes.
7 active waivers tracked for South Dakota. Available with Pro.
See them with Pro1 active solicitations tracked for South Dakota. Available with Pro.
See them with Pro4 managed care contracts tracked for South Dakota. Available with Pro.
See them with Pro3 bills tracked for South Dakota. Available with Pro.
See them with ProGet the daily briefing.