SD Medicaid Reimbursement

SD Medicaid Reimbursement Enrollment

South Dakota is fortunate to be one of a handful of states that has fee-for-service Medicaid reimbursement for CHW services. To bill for CHW services to South Dakota Medicaid, an organization must become a CHW Agency with SD Medicaid. The following documents are shared below to help organizations become CHW agencies.

For questions regarding the CHW agency application process, please contact Ashley Lauing, Policy Strategy Manager, SD Department of Social Services, Division of Medical Services.

Frequently Asked Questions

Recommended Orientation

All sites interested in seeking Medicaid reimbursement for CHW services should email here to request a recommended orientation of the application process.

SD Medicaid Reimbursement

South Dakota is among a select few states that benefit from fee-for-service Medicaid reimbursement for Community Health Worker (CHW) services. Medicaid reimbursement allows organizations to bill for CHW services rendered to South Dakota Medicaid recipients. However, it is crucial for organizations to go through the process of becoming a CHW Agency with SD Medicaid to initiate billing for CHW services. Once approved as a CHW Agency, organizations can begin billing for CHW services. For a comprehensive understanding of SD Medicaid Onboarding, Implementation, and Billing for CHW services, please refer to the following pages, which provide detailed information on these topics.

Enrollment

To enroll as a Community Health Worker (CHW) Agency with South Dakota Medicaid, you will need to follow the specific procedures and requirements outlined by the South Dakota Department of Social Services (DSS). Learn more about how to enroll as a CHW Agency with South Dakota Medicaid.

SD Medicaid Reimbursement Enrollment

Implementation

Once you have been notified that your organization is an approved CHW Agency with South Dakota Medicaid, you can then begin the process of working with a provider to receive a referral and service plan for CHW services. Learn more about reviewing a patient’s Medicaid eligibility, what type of providers can refer, referrals, and service plans.
SD Medicaid Reimbursement Implementation

Billing

Understanding Medicaid billing for CHWs is crucial for program sustainability. While some CHW programs may have access to a billing team and/or billing department, other programs may need to learn to bill Medicaid and submit claims for payment. The following provides helpful information about billing SD Medicaid for CHW services.

SD Medicaid Reimbursement Billing

For questions regarding the CHW agency application process, please contact Ashley Lauing, Policy Strategy Manager, SD Department of Social Services, Division of Medical Services.