South Dakota program
Coverage for care in another state (Medicaid)
South Dakota Medicaid can cover care in another state. The approval rules depend on the service and where it is given.
What it is
South Dakota Medicaid can cover care in another state. The approval rules depend on the service and where it is given.
A referral to another state can involve separate medical and travel reviews. Your referring team checks whether medical approval is needed for the service and clinic. The Medicaid travel office checks travel approval separately.
Eligibility rules
- Your child needs South Dakota Medicaid. The referring doctor supplies records supporting the need for care elsewhere and describing care already given in state.
What you get
- Medicaid payment for approved care outside South Dakota.
- Travel help when the separate travel request is approved.
What the help includes
- Emergency care and qualifying border clinics within 50 miles of South Dakota, plus Bismarck, North Dakota, have exceptions to advance out-of-state medical approval, subject to the manual’s limits. Service-specific approval can still apply. Travel approval is separate. For planned transplant or cell therapy, Medicaid and the treating hospital confirm approval, enrollment, any single-case agreement, its signer and the decision time in writing.
If you decide to apply
- If out-of-state treatment is being considered, ask the referring doctor who will send the medical request.
- Ask the social worker to check the travel request with the Medicaid travel line.
- Keep the written decisions with your appointment details.
South Dakota Medicaid, Division of Medical Services: 866-403-1433 · Official page ↗
After you ask
- The Division of Medical Services decides the medical request. Travel assistance needs a separate decision before travel.
Good to know
An appointment or referral is not Medicaid approval. A later approval may not cover care that already happened.
Other details
- The parent does not submit the clinical request in place of the referring doctor. The social worker can track both requests.
Official sources
- Out-of-State Providers billing manual, January 2024
- PA-105 out-of-state prior authorization request form
- Non-Emergency Medical Travel
- Official guidance supporting Out-of-state exceptions, transplant/cell therapy and single-case agreements
- Official guidance supporting Out-of-state exceptions, transplant/cell therapy and single-case agreements
- Official guidance supporting Out-of-state exceptions, transplant/cell therapy and single-case agreements
“If our child needs care in another state, what are the coverage benefits and drawbacks? Would you help us arrange the medical and travel reviews before we make plans?”
Why I’m asking: I want to understand both approvals before relying on Medicaid for care away from home.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask who is sending each of the two approvals and on what date, and keep the answer in writing.
Your social worker
The oncology social worker chases both.
The care team
The referring doctor sends the medical request with the records and the in-state care already given.
- Who decides
- South Dakota Medicaid, Division of Medical Services
- Ask your social worker
- “My child may be treated out of state. Who is sending the out-of-state prior authorisation, and is the travel approval being sent too?”
How to apply
First step: Ask the oncologist who is sending the out-of-state request and on what date.
- Ask your oncologist today who is sending the out-of-state request and on what date.
- Ask separately about the travel approval, which is not the same request.
- Get the date the approval was sent in writing before your child travels.
Official application / program page ↗
Where it starts: Your referring doctor sends the out-of-state prior authorisation request. You call 866-403-1433 about travel.
What to gather
- The name and address of the out-of-state hospital
- A note of the care already given in South Dakota
How long: For covered non-drug requests, the federal rule effective January 1, 2026 generally requires seven calendar days or 72 hours when expedited. Drug and transplant-specific criteria need a separate written check.
What a yes looks like
A written approval naming the hospital and the dates before your child travels.
What a no looks like, and the next move
Ask what in-state option the state thinks exists, and appeal by the date on the notice.
Watch out
- Two separate approvals, sent by two different people.
- The medical one is sent by your referring doctor, not by you.
- An approval that arrives after the admission does not fix the bill.
Dates that change this
2026-09-11: South Dakota publishes the general out-of-state route but no transplant or cell therapy criteria, and no named signer for a single-case agreement. Ask your Medicaid worker who signs and how long it takes. (not yet confirmed against the final rule)
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Medicaid pays for care and travel in another state, once it has approved both in advance.
Covers: Treatment at an out-of-state hospital · Travel help for an out-of-state trip, once the travel approval is in
Legal protection: A South Dakota child is not stuck with in-state options when the care is not available here
What it costs the family: Nothing, if the approvals are in place before the care.
The eligibility facts, as published
- Coverage condition
- South Dakota Medicaid
- Procedure
- the referring provider sends a prior authorisation request with medical records supporting the need for out-of-state care and documentation of care already provided in state; travel assistance needs a separate approval from the Division of Medical Services before travel
Decisions this site cannot make: Division of Medical Services approval for travel; a separate medical prior authorisation for the care itself
Expect friction on: Two different approvals are needed and they are sent by different people: the doctor sends the medical one, the state travel side handles the travel one
The trap: The travel approval and the medical approval are not the same thing, and the medical one is sent by the referring provider, not by you. Ask by name who is sending which, and on what date.
Where I read this
- Out-of-State Providers billing manual, January 2024 — South Dakota Department of Social Services, read September 10, 2026
- PA-105 out-of-state prior authorisation request form — South Dakota Department of Social Services, read September 10, 2026
- Non-Emergency Medical Travel — South Dakota Department of Social Services, read September 10, 2026