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South Dakota MedicaidMedicaid · Coverage · Education · SDMedium impact

Summer Provider Newsletter

Effective date
Jan 1, 2027
Identified
Sep 12, 2026

Summary

Starting January 1, 2027, some adults enrolled in South Dakota Medicaid Expansion (coverage codes 92, 93, 94 and 95) must show 80 hours a month of work, job training, community service, educational enrollment, or a combination of these, and the source lists exclusions to this requirement. Those enrollees will renew every 6 months instead of every 12, and retroactive coverage for all Medicaid and CHIP applicants will be limited to 1 month for Expansion-only adults and 2 months for other groups, down from 3 months. Separately, inpatient hospital claims for recipients in a South Dakota Medicaid Care Management program must include the referring provider's NPI in locator 78 or 79 when the admission is urgent or elective.

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What to do

Action · 9 steps
01Before January 1, 2027: Billing team and front desk staff should verify eligibility at every visit at check-in, since renewal schedules are changing.
02Remind patients to keep their address and phone number current with the state Medicaid office so they do not miss renewal paperwork.
03Encourage uninsured patients to apply right away to avoid missing the new, shorter backdating windows.
04Check the DSS H.R.1 webpage for town hall recordings and frequently asked questions.
05The November 4, 2026 webinar on physician attestation forms for medically frail recipients is already past, so check the DSS H.R.1 webpage for its materials.
06Billing team: For inpatient hospital claims for recipients in a South Dakota Medicaid Care Management program, include the referring provider's NPI in locator 78 or 79 when the admission is urgent or elective.
07Prior approval of an out-of-state hospitalization does not replace this referral requirement.
08Claims pended for a missing referring NPI appear in the Claims Work Queue on the Medicaid Portal, where the portal user has 30 days to supply the referring NPI and any supporting referral documentation without resubmitting the claim.
09If no response is received within 30 days, the claim will complete processing and be denied for PCP/HH/NPI incorrect.

Original notice

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

See all South Dakota Medicaid changes →
Summer Provider NewsletterMediumEffective Jun 1, 2025 · EducationBrowse every South Dakota Medicaid change in the policy list

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