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South Dakota MedicaidMedicaid · Administrative · Education · SDMedium impact

Fall Provider Newsletter

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jun 21, 2026

Summary

South Dakota Medicaid is implementing major federal changes including work requirements for expanded Medicaid, reduced retroactive coverage periods, and more frequent eligibility checks. Hospital reimbursement methodologies will also be updated in 2026, and the Health Home program is being renamed to Care Connect.

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What to do

by Jan 1, 2026 · 3 steps
01Update patient records and billing systems to reflect Health Home program name change to Care Connect.
02By January 1, 2027: Billing team must verify Medicaid expansion patients (ages 19-64) meet work requirements and understand retroactive coverage is limited to 1 month for expansion enrollees and 2 months for traditional enrollees.
03Update eligibility verification processes for 6-month redeterminations for expansion patients.

Original notice

Fall Provider Newsletter
dss.sd.gov · Always check the source before changing claims.
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Related changes

See all South Dakota Medicaid changes →
Fall Provider NewsletterHighEffective Jul 1, 2024 · EducationBrowse every South Dakota Medicaid change in the policy list

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South Dakota Medicaid policiesSD policy changes

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