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• South Dakota submitted a third amendment on September 1, 2000, to establish a separate child health program called CHIP-NM (Children’s Health Insurance Program, Non-Medicaid) effective July 1, 2000. CHIP-NM covers uninsured children from birth to age 19 with family incomes above 140 percent of the FPL and not exceeding 200 percent of the FPL.

• South Dakota submitted its fourth amendment on July 1, 2002. This amendment updates and amends the SCHIP state plan to indicate the State’s compliance with the final SCHIP regulations.

Children Covered Under the Program

• The State reported that 14,584 SCHIP children and 11,254 M-CHIP children were ever enrolled during Federal fiscal year 2006.

Administration

• The Department of Social Services (DSS) is responsible for administering CHIP-NM as well as Medicaid and M-CHIP. Only DSS staff makes eligibility determinations.

Health Care Delivery System

• Most individuals enrolled in Medicaid participate in PRIME, a primary care case management system operated under a section 1915(b) waiver that has been in effect since 1993. Each participating individual must choose a primary care provider who, in turn, ensures 24-hour access, gives referrals for specialty services, and provides case management. Rural health clinics, Federally Qualified Health Centers (FQHCs) and Indian Health Service (IHS) clinics participate as primary care providers. Certain services (including emergency room, family planning, dental, vision, chiropractic, nursing facility and other specialized services) are covered on a fee-for-service basis.

• Health care services for CHIP-NM are delivered using the existing Medicaid program delivery and payment systems.

Benefit Package

• Medicaid PRIME waiver services include, but are not limited to the following: EPSDT, physician services, inpatient and outpatient hospital services, prescription drugs, mental health and other medical services. Other covered services, provided on a fee-for-service basis, include emergency room, family planning, dental, vision, chiropractic, nursing facility and other specialized services.

• The benefit package under CHIP-NM is the same as the SCHIP Medicaid expansion program package.

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