South Dakota Administrative Code

67:46:12:17. Income limit -- Adult group. To be eligible for assistance under this chapter, an individual eligible for Medicaid under § 67:46:12:16, based on family size determined under the provisions of 42 C.F.R. § 435.603, may not exceed one hundred and thirty-three percent of…

Rule 67:46:13:01 Definitions. 67:46:13:01. Definitions. Terms used in this chapter mean: (1) "Parent/caretaker relative," a Medicaid coverage group consisting of low income families eligible for Medicaid under the provisions of chapter 67:46:12; and (2) "TMB" or "transitional med…

Rule 67:46:13:02 Initial eligibility for transitional medical benefits. 67:46:13:02. Initial eligibility for transitional medical benefits. An individual that becomes ineligible for parent/caretaker relative Medicaid and any dependent child in the parent/caretaker relative's hous…

Rule 67:46:13:03 TMB limited to 12 consecutive months. 67:46:13:03. TMB limited to 12 consecutive months. Transitional medical benefits may begin the first month the parent/caretaker relative is ineligible for Medicaid under the provisions of chapter 67:46:12 and is limited to th…

Rule 67:46:13:04 Continuing eligibility for TMB. 67:46:13:04. Continuing eligibility for TMB. Eligibility for TMB continues for 12 consecutive months if the family continues to reside in the state and a dependent child who was a member of the family at the time the family was det…

Rule 67:46:13:05 Repealed. 67:46:13:05. TMB eligibility during second six months. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

Rule 67:46:13:06 Repealed. 67:46:13:06. Report forms required -- Ineligibility for delayed or incomplete reports. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

Rule 67:46:13:07 Repealed. 67:46:13:07. Good cause for filing late or incomplete report form. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

Rule 67:46:13:08 Repealed. 67:46:13:08. Determination of family's average monthly gross-earnings. -- TMB. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

Rule 67:46:13:09 Repealed. 67:46:13:09. Determining family's child care costs for TMB. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

Rule 67:46:13:10 Repealed. 67:46:13:10. Determining family size -- TMB. Repealed. Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

Rule 67:46:13:11 Ineligibility for fraud. 67:46:13:11. Ineligibility for fraud. If a court of law finds that a member of a Medicaid household committed fraud resulting in mistaken eligibility for Medicaid for one of the six months preceding the current period of Medicaid ineligib…

67:46:14:01. Definitions. Terms used in this chapter mean; (1) "Caretaker," the adult who lives with and provides care and control of a child eligible for services under this chapter. The caretaker may include the child's parent or parents; (2) "Child," an individual under age ni…

67:46:14:02. Eligibility requirements for nonmedicaid children's health insurance program. A child is eligible for the nonmedicaid children's health insurance program (CHIP-NM) if the child: (1) Does not meet the financial eligibility criteria for the state's medicaid program; (2…

Rule 67:46:14:03 Insurance -- Exceptions. 67:46:14:03. Insurance -- Exceptions. The provisions of subdivisions 67:46:14:02(3) and (4) do not apply if any of the following circumstances exist: (1) The child had coverage under a group health plan and the coverage was dropped for go…

67:46:14:04. Good cause for dropping insurance under a group health plan. Good cause for dropping insurance under a group health plan exists if the insurance is dropped for reasons beyond the caretaker's control. Reasons for dropping the insurance include: (1) The cost of the ins…

67:46:14:05. Determining size of nonmedicaid children's health insurance program family. A nonmedicaid children's health insurance program family size or household is defined in 42 C.F.R. § 435.603 (November 30, 2016). Source: 26 SDR 168, effective July 1, 2000; 41 SDR 7, effecti…

Rule 67:46:14:06 Repealed. 67:46:14:06. Consideration of income. Repealed. Source: 26 SDR 168, effective July 1, 2000; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:14:07 Repealed. 67:46:14:07. Unit members to take advantage of all income. Repealed. Source: 26 SDR 168, effective July 1, 2000; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:14:08 Repealed. 67:46:14:08. Income exempt from consideration. Repealed. Source: 26 SDR 168, effective July 1, 2000; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:14:09 Repealed. 67:46:14:09. Consideration of unearned income. Repealed. Source: 26 SDR 168, effective July 1, 2000; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:14:10 Repealed. 67:46:14:10. Earned income from self-employment. Repealed. Source: 26 SDR 168, effective July 1, 2000; 30 SDR 193, effective June 13, 2004; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:14:11 Repealed. 67:46:14:11. Deductions from self-employment. Repealed. Source: 26 SDR 168, effective July 1, 2000; repealed, 41 SDR 7, effective July 29, 2014.

Rule 67:46:14:12 Repealed. 67:46:14:12. Deductions for employment-related child care expenses. Repealed. Source: 26 SDR 168, effective July 1, 2000; repealed, 41 SDR 7, effective July 29, 2014.

67:46:14:13. Members of nonmedicaid children's health insurance program family must cooperate with department. The department may request information from any member of a children's health insurance program (CHIP-NM) family concerning the existence of actual or potential third-pa…

Rule 67:46:14:14 Discontinuance of services. 67:46:14:14. Discontinuance of services. The department may discontinue services provided under the provisions of this chapter if the department exhausts its financial resources for providing the services. Source: 26 SDR 168, effective…

67:46:15:01. Qualifications for refugee assistance. Pursuant to the Refugee Act of 1980, Pub. L. No. 96-212 (March 17, 1980), assistance may be provided to individuals who have been granted asylum or have been admitted as refugees. United States citizens and their dependents who …

67:46:15:02. Documentation required. A refugee applying for assistance under this chapter must meet immigration status and identification requirements pursuant to 45 C.F.R. § 400.100(a)(2) (March 22, 2000). Source: 43 SDR 31, effective September 12, 2016; 49 SDR 46, effective Nov…

67:46:15:03. Eligibility factors relating to refugees with children. Assistance may be provided to any child or any other member of the household who would be eligible for assistance under chapters 67:12:01 to 67:12:06, inclusive, but is not required to meet the requirements of §…

67:46:15:04. Earned income exemption not applied. When determining eligibility and computing the amount of assistance for a refugee under this chapter, the earned income exemption may not be applied. Source: 43 SDR 31, effective September 12, 2016; 49 SDR 46, effective November 2…

67:46:15:05. Eligibility factors relating to adult refugees. Assistance may be provided to adult refugees who have no children and would be eligible under the income and resource limitations according to chapters 67:12:04 to 67:12:06, inclusive. Source: 43 SDR 31, effective Septe…

67:46:15:06. Children of refugees who are U.S. citizens. If the child of a refugee is a United States citizen because the child was born in this country, that child is considered a part of the refugee family for purposes of eligibility for medical care. Source: 43 SDR 31, effecti…

67:46:15:07. Exempted income and resources. Resources or income of the sponsor and resources not currently available to the refugee must be exempted in the determination of initial or continuing eligibility for the program. Source: 43 SDR 31, effective September 12, 2016; 49 SDR …

67:46:15:08. Medical services. If a refugee is eligible for services under this chapter, medical assistance may be provided for a period of twelve months from the date the refugee entered the United States. Source: 43 SDR 31, effective September 12, 2016; 49 SDR 46, effective Nov…

67:46:15:09. Fair hearings. An applicant or a recipient is entitled to a fair hearing in accordance with chapter 67:17:02. Source: 43 SDR 31, effective September 12, 2016; 49 SDR 46, effective November 21, 2022. General Authority: SDCL 28-1-50, 28-6-1. Law Implemented: SDCL 28-6-…

67:47:01:01. Definitions. As used in this chapter: (1) "Adult exercising parental control" means an individual who: (a) Is 18 years of age or older; (b) Is neither the child's parent nor guardian; (c) Does not reside with the child's parent or guardian; and (d) Has permission fro…

Rule 67:47:01:02 Application for child care services. 67:47:01:02. Application for child care services. A recipient desiring direct child care assistance must submit a completed, written, and signed application for assistance to the department. An application may not be submitted…

Rule 67:47:01:03 Child care services available for certain children. 67:47:01:03. Child care services available for certain children. A parent or guardian may be eligible for direct child care services if the parent or guardian has a child who meets one of the following requireme…

Rule 67:47:01:03.01 Time requirements for work and education -- Exceptions. 67:47:01:03.01. Time requirements for work and education -- Exceptions. If employed, the recipient shall be employed a minimum of 80 hours a month and must receive a salary which is equivalent to the hour…

Rule 67:47:01:03.02 Child care assistance for recipient working at night. 67:47:01:03.02. Child care assistance for recipient working at night. A recipient who works a graveyard shift and sleeps during the day is eligible for child care assistance while the recipient sleeps. Chil…

Rule 67:47:01:03.03 Determination of incapacity and inability to provide child care. 67:47:01:03.03. Determination of incapacity and inability to provide child care. A recipient who is unable to work and provide child care because of an incapacity that has caused a break in ongoi…

67:47:01:04. Required documentation. If a child is considered to be a child with special needs because of a physical or mental incapacity, the client shall supply, from a physician, physician's assistant, nurse practitioner, psychologist, psychiatric social worker, special educat…

67:47:01:05. Income eligibility. Eligibility for child care services is based on annual income. Income is considered prospectively, based on the verification required in this section. As proof of income, a recipient shall provide either copies of the last two pay stubs or employe…

Rule 67:47:01:05.01 Adjustment to gross earned income. 67:47:01:05.01. Adjustment to gross earned income. After determining the recipient's annual gross earned income, the department shall reduce that amount by four percent before computing the recipient's share of child care cos…

Rule 67:47:01:06 Deadline for determining eligibility -- Beginning date of eligibility. 67:47:01:06. Deadline for determining eligibility -- Beginning date of eligibility. The department shall determine eligibility for child care services within ten working days after receiving t…

Rule 67:47:01:07 Notice to household -- Issuance of child care certificate. 67:47:01:07. Notice to household -- Issuance of child care certificate. If a recipient is eligible for child care benefits, the department shall send a written notice to the recipient of the amount of chi…

Rule 67:47:01:08 Household required to participate in child care costs. 67:47:01:08. Household required to participate in child care costs. Household contribution rates if applicable, are available on the department's website at: http://dss.sd.gov/childcare/childcareassistance/el…

Rule 67:47:01:08.01 Repealed. 67:47:01:08.01. Family pays cost when lump sum income exceeds federal poverty level. Repealed. Source: 22 SDR 188, effective July 8, 1996; 24 SDR 30, effective September 14, 1997; 33 SDR 152, effective April 4, 2007; 37 SDR 236, effective June 28, 20…

Rule 67:47:01:09 Repealed. 67:47:01:09. Ineligibility when household fails to make copayments. Repealed. Source: 18 SDR 112, effective January 9, 1992; 45 SDR 82, effective December 10, 2018. Rule 67:47:01:09.01 Cooperation with Division of Child Support as condition of eligibili…

Rule 67:47:01:09.01 Cooperation with Division of Child Support as condition of eligibility. 67:47:01:09.01. Cooperation with Division of Child Support as condition of eligibility. Recipients of child care assistance must cooperate with the department in identifying and locating t…