Nursing Home Medicaid Application in South Dakota
Before You Apply: Two Tracks Running in Parallel
The Medicaid application in South Dakota involves two separate agencies working simultaneously. The Department of Human Services handles the clinical side — confirming the applicant needs nursing-home-level care. The Department of Social Services handles the financial side — verifying income and assets qualify. Both must approve before benefits start.
Start the clinical track first by calling Dakota at Home at 1-833-663-9673 to request an intake. An LTSS Case Management Specialist will schedule a clinical assessment, and a DHS nurse will make the final level-of-care determination. For nursing facility applicants, a Level I PASRR screening is also required within 30 days of admission to check for serious mental illness or developmental disabilities.
The Financial Application: Form DSS-EA-240
The core application is Form DSS-EA-240, titled "Application for Resource Assessment, Long-Term Care, or Related Medical Assistance." It can be submitted online through the Economic Assistance Portal at eaportal.sd.gov, by mail to your local DSS office, or in person.
The online portal lets you upload supporting documents, check application status, and respond to verification requests — all of which help avoid processing delays.
Documents You'll Need
DSS requires extensive financial documentation going back 60 months. Gather these before starting the application:
- Bank statements for every account (checking, savings, money market, CDs) covering the full 60-month lookback period
- Investment account statements — brokerage accounts, mutual funds, stocks, bonds
- Retirement account statements — IRAs, 401(k)s, pensions (South Dakota counts these as assets regardless of payout status)
- Life insurance policies showing both face value and cash surrender value
- Property deeds and tax assessments for all real estate
- Vehicle titles and registration documents
- Prepaid burial contracts — must be irrevocable to qualify as exempt
- Tax returns for the most recent two years
- Proof of income — Social Security award letter, pension statements, VA benefit letters
- Marriage certificate (if applying for spousal protections)
- Form DSS-EA-208 — a signed release authorization allowing DSS to verify bank and medical records
If a Miller Trust has been established because the applicant's gross income exceeds $2,982, include a copy of the executed trust document and the dedicated trust bank account statement.
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Processing Timelines
DSS has 45 days to process a standard long-term care Medicaid application and 90 days for applications requiring a disability determination. The clock starts on the date DSS receives the application, not the date the applicant enters a nursing facility.
During processing, DSS will likely request additional verifications. Respond to every request within the stated deadline — failure to provide requested documentation by the due date is a common reason for procedural denials.
Retroactive Coverage
Currently, South Dakota Medicaid provides retroactive coverage for up to three months before the application month, provided the applicant met all eligibility criteria during that period. This can cover unpaid nursing home bills incurred during the initial crisis.
However, starting January 1, 2027, new federal rules under the Budget Reconciliation Act of 2025 will cap retroactive coverage for aged, blind, and disabled long-term care applicants at two months. Families who delay filing while gathering documents will lose coverage for any care incurred beyond that window.
What Happens During "Medicaid Pending"
While the application is under review, the applicant is in "Medicaid pending" status. During this period, the resident must pay their patient liability — gross income minus the $100 personal needs allowance (plus up to the first $75 of gross earned income), health insurance premiums, and any permitted spousal income diversion — directly to the facility. Nursing homes cannot legally demand that family members pay private-pay rates out of pocket while an application is pending.
The South Dakota Medicaid Long-Term Care & Asset Protection Guide includes a pre-application document checklist organized by account type, a timeline planner for coordinating the clinical and financial tracks, and a Miller Trust setup sequence to complete before filing.
Get Your Free South Dakota — Medicaid Long-Term Care Eligibility Checklist
Download the South Dakota — Medicaid Long-Term Care Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.