S.D. Admin. R. 67:46:10:04

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:46:10:04 - Eligibility requirements

An individual is eligible for benefits under this chapter if all of the following requirements are met:

(1) The individual is a resident of South Dakota;

(2) The individual is either a citizen of the United States or an alien eligible under the provisions of § 67:46:01:10;

(3) The individual is unable to pay the total cost of lifesaving care and treatment for the renal failure;

(4) The individual has not deprived himself or herself, directly or indirectly, of any property or assets for the purpose of qualifying for assistance;

(5) The individual does not have a third-party payer. For purposes of this rule, Medicare and Indian Health Services are not considered third-party payers. In addition, the department is not considered a third-party payer if the individual is determined to be a qualified Medicare beneficiary, a special low-income Medicare beneficiary, or a Medicare beneficiary who has income of at least 120 percent but less than 135 percent of the federal poverty level, and the individual's Medicaid benefits are limited to payment of the individual's part A or B premiums, deductibles, or coinsurance;

(6) The individual is a proper candidate for care and treatment as determined by §§ 67:46:10:02, 67:46:10:15, and 67:46:10:16 and is willing to receive it;

(7) The individual's income, considered according to § 67:46:10:05, is less than 150 percent of the federal poverty level established in § 67:11:01:03; and

(8) Excluding items listed in § 67:46:10:06, the equity value of resources is less than $4,000 for a single individual and $6,000 for an individual with a spouse.

S.D. Admin. R. 67:46:10:04

2 SDR 88, effective 7/1/1976; 7 SDR 66, 7 SDR 89, effective 7/1/1981; 7 SDR 121, effective 7/2/1981; transferred from

General Authority: SDCL 28-6A-12.

Law Implemented: SDCL 28-6A-2.

Qualified Medicare beneficiaries, ch 67:46:11.