SDAHO is sharing information from the South Dakota Medicaid Provider News – Summer 2026 to help members prepare for several upcoming changes to Medicaid and Children’s Health Insurance Program (CHIP) eligibility.
Medicaid Expansion Work Requirements Begin January 1, 2027
Currently, South Dakota Medicaid Expansion does not include community engagement or work requirements.
Beginning January 1, 2027, some adults enrolled in Medicaid Expansion will be required to demonstrate 80 hours per month of qualifying activities. These may include employment, job training, community service, educational enrollment or a combination of activities.
The requirements apply to certain individuals enrolled under Medicaid Expansion coverage codes 92, 93, 94 and 95. The South Dakota Medicaid Provider News includes additional information on individuals who may be excluded from these requirements.
Key Takeaways for SDAHO Members
Health care organizations should be aware of several additional changes and begin preparing staff and processes:
- Noncitizen eligibility changes — Oct. 1, 2026: Eligibility will narrow for certain noncitizens, including some asylees, refugees, parolees and trafficking or abuse victims. Most green card holders, Compact of Free Association (COFA) migrants and certain other eligible groups will remain covered.
- Prepare patient-facing staff: Front-desk, registration and financial counseling teams should be prepared for questions about eligibility, renewals, work-requirement exclusions and required documentation beginning in late 2026.
- Plan for potential coverage disruptions: More frequent eligibility reviews and new documentation requirements may result in some otherwise eligible patients losing coverage for administrative reasons, potentially increasing uncompensated care.
- Watch retroactive coverage: Shortened retroactive eligibility periods of one to two months make it increasingly important to verify Medicaid coverage earlier in the revenue cycle.
- New cost sharing — Oct. 1, 2028: Medicaid Expansion enrollees with income above 100% of the Federal Poverty Level will face copays on certain non-exempt services, capped at 5% of family income. Primary care, prenatal, pediatric, emergency, FQHC/RHC, mental health and substance use disorder services will remain exempt.
The Summer 2026 South Dakota Medicaid Provider News provides additional details on these changes, including exclusions from the new work requirements and information from the South Dakota Department of Health on the Rural Health Transformation Project.
SDAHO encourages members to review the full newsletter and begin considering how these changes may affect patients, eligibility processes, registration workflows and revenue cycle operations.
