South Dakota program
Help with a work-plan premium (Medicaid Premium Assistance)
Medicaid can help pay a private-plan premium after reviewing the available coverage and your child’s needs.
What it is
Medicaid can help pay a private-plan premium after reviewing the available coverage and your child’s needs.
Keeping a work plan can preserve access to your child’s treatment team. South Dakota’s review includes ongoing conditions such as cancer, a savings calculation, or an individual review. DSS decides whether the coverage qualifies.
Eligibility rules
- The person needs South Dakota Medicaid and private insurance available. The state’s methodology includes cancer among conditions considered cost-effective.
What you get
- Payment of a qualifying private-plan premium.
What the help includes
- The methodology effective October 1, 2022 includes ongoing cancer, anticipated annual savings of at least $1,000, and individual review as alternative routes. DSS reviews cost-effectiveness at least annually.
If you decide to apply
- Your hospital social worker can discuss keeping both plans and check the review process with Medicaid at 888-828-0059.
- Have the plan’s cost and coverage details ready, with help from the hospital financial counselor.
South Dakota Medicaid: 888-828-0059 · Official page ↗
After you ask
- The policy allows payment to the insurer, employer or recipient, with an initial payment immediately after approval and later payments on the first business day of the month. Your hospital social worker can help confirm the current intake form, decision timing and whether DSS can review available coverage before you enroll.
Good to know
Ongoing cancer is one way DSS can find a plan worth paying for. A $1,000 annual saving is a separate test, not a requirement for every cancer case.
Other details
- A financial counselor can compare the premium help with the value of keeping access to the current cancer team.
Federal background: Medicaid premium assistance.
Official sources
“Could Medicaid help pay a private-plan premium for our child? What are the benefits and drawbacks of keeping both plans, and could you help us request the calculation?”
Why I’m asking: I want to know whether keeping our child’s current coverage could cost us less.
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
Call, give the premium figure, and ask for the calculation if the answer is no.
Your social worker
The hospital financial counsellor can help you gather the premium paperwork.
The care team
Records and letters when the application asks for them.
- Who decides
- South Dakota Medicaid runs the cost-effectiveness calculation.
- Ask the agency
- “My child is on South Dakota Medicaid and we have a work plan. Can the Premium Assistance Program pay its premium, and can you run the cost-effectiveness calculation?”
How to apply
First step: Call 888-828-0059 before you drop a work plan.
- Call 888-828-0059 before you drop a work plan.
- Have the premium figure and the plan's summary of benefits to hand.
- Ask whether a family premium that cannot be split can be paid in full.
Official application / program page ↗
Where it starts: Call Premium Assistance on 888-828-0059. No application form was published.
What to gather
- Your premium amount
- The plan's summary of benefits
- Your child's Medicaid number
How long: No published decision clock. Ask for one when you call.
What a yes looks like
The premium paid on approval, then on the first business day of each month.
What a no looks like, and the next move
Ask to see the cost-effectiveness calculation and what figure it used for your child's expected claims.
Watch out
- DSS confirms the current intake form and review process.
- Ongoing cancer, the separate $1,000 savings test and individual case review are alternative routes; DSS decides whether the plan qualifies.
- DSS confirms whether available coverage can be reviewed before enrollment; the methodology does not establish enrollment first as a requirement.
Dates that change this
2026-09-11: The methodology effective October 1, 2022 describes cost-effectiveness routes and payments. DSS confirms the current intake form, decision timing and whether available coverage can be reviewed before enrollment. (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 can pay a private premium after its cost-effectiveness review.
- $1,000 — Annual savings under one alternative cost-effectiveness test, not a universal cancer requirement
Covers: The private premium paid by South Dakota Medicaid · Where a family premium cannot be split, the premium for family members who are not on Medicaid
Legal protection: Joining is voluntary
What it costs the family: Nothing, and it can save the premium you are paying now.
The eligibility facts, as published
- Coverage condition
- a South Dakota Medicaid recipient with private insurance available
- Cost test
- Ongoing cancer is one condition considered cost-effective; anticipated savings of at least $1,000 annually and individual case review are alternative methodology routes. DSS decides approval.
- Medical
- the methodology names cancer among the conditions considered cost-effective
Decisions this site cannot make: Cost-effectiveness calculation by South Dakota Medicaid
Expect friction on: No published form and no published decision clock; it moves by phone
The trap: Ongoing cancer is one condition considered cost-effective; anticipated savings of at least $1,000 annually and individual case review are alternative methodology routes. DSS decides approval.
Where I read this
- State plan Attachment 4.22-C — Cost Effectiveness Methodology — South Dakota Department of Social Services, read September 10, 2026
- South Dakota Medicaid phone list — South Dakota Department of Social Services, read September 10, 2026