Dss.sd.govmedicaidrecipientsDepartment of Social Services - South Dakota 2026

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The document is a Medicaid Transportation Exception Verification form used by the County Department of Social Services to request transportation assistance for Medicaid beneficiaries. It includes sections for identifying information, beneficiary consent to release information, justification for exceptions to standard transportation regulations, and an attestation by the medical provider. The form is necessary when transportation needs exceed normal service area limits or require special accommodations.

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Click ‘Get Form’ to open it in the editor.
Begin with Section 1, where you will find fields for identifying information. Fill in the County Department of Social Services, date, beneficiary name, address, date of birth, Medicaid ID, phone number, caseworker name, and caseworker phone.
Proceed to Section 2 for the Medicaid Beneficiary Consent to Release Information. Enter your name and authorize a medical provider to release necessary information by filling in their details. Sign and date this section.
In Section 3, specify the exception requested and justification. Indicate if transportation is needed to a provider at a greater distance or if special accommodations are required. Provide detailed explanations as needed.
Complete Section 4 by having the provider print their name, phone number, sign, and date the form. Ensure all sections are filled accurately to avoid delays.

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Versions	Form popularity	Fillable & printable
2022	4.6 Satisfied (22 Votes)
2018	4.7 Satisfied (41 Votes)
2015	4.8 Satisfied (56 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How long does it take to get approved for Medicaid in South Dakota?

Applications for coverage which require a disability determination to be made will be processed within 90 days. All other applications will be processed within 45 days. The South Dakota Medicaid Identification Card is issued by the Department of Social Services on behalf of eligible South Dakota Medicaid recipients.

What is the maximum income for Medicaid in South Dakota?

Individuals who are eligible are entitled to full South Dakota Medicaid coverage. A person must be age 18 or older and have quadriplegia. The income limit can be up to $2,901 in 2025 a month. The resource limit is $2,000 for an individual.

Who is eligible for Medicaid expansion in South Dakota?

Individuals could be eligible if they are: at least age 19 but not yet 65, and not entitled to Medicare, and have income up to 138% of the Federal Poverty Limit. What does 138% FPL look like?

What is the income limit for Medicaid in South Dakota?

The application for Medicaid expansion is the same as the current application process. Its easy to apply at dss.sd.gov/applyonline! Interviews are not required. The entire process can be completed online.

How do I apply for Medicaid expansion in South Dakota?

South Dakota Medicaid covers most medical services that are necessary to keep you and your family healthy. These include physical and behavioral health, dental, vision and transportation services.

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What salary is too high for Medicaid?

The income limits for Medicaid applicants can change depending on the state where they live, their marital status and the Medicaid program. In general, however, the income limits are low. In most states in 2025, the income limit for receiving long-term care at home or in a nursing home through Medicaid is $2,901/month.

How do you expand Medicaid?

The Affordable Care Act (ACA) permits states to expand Medicaid coverage to adults with incomes up to 138 percent of the poverty level (about $20,780 annually for an individual or $35,630 for a family of three). States that have adopted the expansion have dramatically lowered their uninsured rates.