S.D. Admin. R. 67:12:01:23

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:12:01:23 - Medical-only coverage for certain children and pregnant women

The following individuals are eligible for Aid to Families With Dependent Children (AFDC) medical-only services provided under article 67:46:

(1) A pregnant woman who meets the AFDC income and resource requirements of an assistance unit composed of the pregnant woman, her unborn child, and, if living in the home, the pregnant woman's spouse and any other family member who is applying for or receiving medical-only assistance under this section. At the family's option, any other household member who could be included in an AFDC assistance unit may be included in the determination. The pregnancy must be verified by a licensed or certified physician, physician's assistant, nurse practitioner, nurse midwife, community health nurse, or family planning nurse. Eligibility continues throughout the pregnancy without regard to income changes;

(2) A woman who applied for medicaid while pregnant and who was eligible for and received medicaid on the date the pregnancy ended. Eligibility continues to the end of the month sixty days after the pregnancy ends if the AFDC resource limit is not exceeded. Coverage is limited to postpartum care and family planning services;

(3) A child under age seven, if the AFDC assistance unit meets the AFDC income and resource requirements. The AFDC assistance unit compromises the child, the child's parents living in the home, and any other family member who is applying for or receiving medical-only assistance under this section. At the family's option, any other household member who could be included in an AFDC assistance unit may be included in the determination;

(4) A dependent child of a minor parent who is ineligible for AFDC because of the deeming of the income of the minor parent's parent or the income of a sibling of the child;

(5) A child under age six, whose family income is up to one hundred thirty-three percent of the federal poverty level established in § 67:11:01:03. Eligibility continues up to age six as long as the family income remains below one hundred thirty-three percent of the federal poverty level. Persons considered in the determination are the child and any parents of the child living in the household as well as any other family member who is applying for or receiving medical-only assistance under this section. At the family's option, any other household member who could be included in an AFDC assistance unit may be included in the determination. Income is determined according to AFDC eligibility criteria;

(6) A pregnant woman whose family income is up to one hundred thirty-three percent of the federal poverty level established in § 67:11:01:03. Eligibility continues throughout the pregnancy and to the end of the month sixty days after the pregnancy ends without regard to income changes. Services payable are limited to those services that are related to pregnancy, postpartum care, or family planning. The pregnancy must be verified by a licensed or certified physician, physician's assistant, nurse practitioner, nurse midwife, community health nurse, or family planning nurse. Persons considered in the poverty level determination include the pregnant woman, her unborn child, and, if living in the home, the pregnant woman's spouse and any other family member who is applying for or receiving medical-only assistance under this section. At the family's option, any other household member who could be included in an AFDC assistance unit may be included in the income determination. Income is determined according to AFDC eligibility criteria;

(7) A child who is age six but not yet age nineteen, whose family income is up to one hundred percent of the federal poverty level established in § 67:11:01:03 Persons considered in the determination are the child and the child's parents living in the home and other family members in the household who are applying for or receiving medical-only assistance under this section. At the family's option, any other household member who could be included in the AFDC assistance unit may be included in the income determination. Income is determined according to AFDC eligibility criteria; and

(8) A child born to a woman eligible for and receiving medicaid on the date of the child's birth. Eligibility continues for up to one year as long as the child is in the mother's household and the mother remains a resident of the state.

S.D. Admin. R. 67:12:01:23

SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective 7/1/1981; repealed, 8 SDR 82, effective 1/13/1982; readopted, 8 SDR 174, effective 6/28/1982; 12 SDR 4, effective 7/21/1985; 12 SDR 112, effective 1/16/1986; 13 SDR 193, effective 6/22/1987; 15 SDR 2, effective 7/17/1988; 15 SDR 171, effective 5/15/1989; 17 SDR 8, effective 7/23/1990; 17 SDR 200, effective 7/1/1991; 19 SDR 68, effective 11/9/1992; 20 SDR 92, effective 12/21/1993; 21 SDR 67, effective 10/13/1994; 21 SDR 162, effective 3/23/1995; 22 SDR 32, effective 9/11/1995; 51 SDR 052, effective 11/11/2024

General Authority: SDCL 28-6-1

Law Implemented: SDCL 28-6-1

Medicaid coverage for children and pregnant women, Deficit Reduction Act of 1984, Pub. L. No. 98-369, § 2361, 98 Stat. 1104 (1984). Individuals who must be included in assistance unit, § 67:12:01:69. Consideration of income of parent of minor parent, § 67:12:05:52.01. Eligibility requirements, § 67:46:01:02.