South Dakota Medicaid and CHIP for Grandparents Raising a Child

You Can Get Health Coverage Without Having Custody

If you're a grandparent or relative raising a child in South Dakota, you can apply for Medicaid or CHIP on the child's behalf — even without legal custody or guardianship. The Department of Social Services doesn't require a court order to process a child's health insurance application.

That said, health coverage and medical consent are two different things. Getting a Medicaid card for a child solves the insurance question. It doesn't solve the question of who can authorize the doctor to treat the child.

Medicaid and CHIP Through Access SD

South Dakota's Medicaid and Children's Health Insurance Program (CHIP) provide comprehensive health coverage for eligible children. A relative caregiver can start an application through the Access SD portal.

Eligibility for children is based on MAGI (Modified Adjusted Gross Income) household rules, which use tax-filing relationships. Key points for kinship caregivers:

• The child's household composition is determined by who claims the child on their tax return, not necessarily who the child lives with
• Children qualifying through MAGI-based Medicaid or CHIP are not subject to an asset test
• If you're a grandparent who claims the child as a tax dependent, your income is counted; if you don't claim the child, the household may be calculated differently

The application asks about the child's income and the household's income, but the rules can work in favor of kinship families. A child with little or no income of their own and a caregiver whose income falls within the guidelines will typically qualify.

TANF Child-Only Grants

Temporary Assistance for Needy Families (TANF) offers a "child-only" grant for children living with non-parent caretaker relatives when no parent is present in the home.

What makes child-only TANF different from regular TANF:

• Only the child's financial resources are evaluated — not the caregiver's full household income
• The child's unearned income (Social Security benefits, child support) is counted, but the caregiver's earnings are handled separately
• Child-only grants don't count toward the 60-month lifetime limit that applies to adult TANF recipients
• The caretaker relative is exempt from TANF work activity requirements
• The caregiver must meet the relationship criteria under ARSD 67:10:01:06

TANF requires a paper application in South Dakota — you can't complete it through the online portal. Contact the Department of Social Services to get the form.

Informal relative placements arranged privately between families receive standard child-only TANF rates. The higher agency-placed rate is reserved for children in DSS out-of-home placements under court-ordered custody.

SNAP and School Meals

SNAP (food assistance): A child living in your home can be included in your SNAP household. Eligibility is based on total household income and the number of people who purchase and prepare meals together.

Free or reduced-price school meals: If your household receives SNAP or TANF, the child is directly certified for free meals — no separate application needed. Otherwise, you can submit a standard meal application listing the child as a household member.

Neither benefit requires a court order or legal custody determination.

What Benefits Don't Do

All of these programs address financial needs: health insurance, cash assistance, food. None of them address legal authority. Specifically:

• Having a Medicaid card doesn't give you permission to consent to medical treatment
• Receiving TANF child-only payments doesn't grant custody or guardianship
• Being the authorized representative for benefit applications doesn't give you parental decision-making rights

For medical consent, you still need either a parent-signed consent letter (for routine care accepted at provider discretion) or court-ordered guardianship under SDCL 29A-5. For school enrollment, you need a school board residency petition under SDCL 13-28-10.

Applying for Benefits While Sorting Out Legal Authority

The practical advice: start the benefit applications immediately. Don't wait until you have legal custody or guardianship to apply for Medicaid, CHIP, or TANF. The child needs health coverage now, and you can work on consent authority in parallel.

At the same time, get the consent pieces in motion — a parent-signed medical consent letter if the parent is available, or a consultation with legal aid if they're not.

East River Legal Services (1-800-952-3015) and Dakota Plains Legal Services (1-800-658-2297) can help with both benefits appeals and guardianship questions. The South Dakota School and Medical Consent guide includes a benefits checklist alongside the consent tools, so you can track both tracks at once.

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