Rights & Responsibilities for Medicaid

Fair Treatment

As a recipient of Federal financial assistance and a State or local governmental agency, the Department of Social Services does not exclude, deny benefits to, or otherwise discriminate against any person on the ground of race, color or national origin, or on the basis of disability or age in admission or access to, or treatment or employment in, its programs, activities or services, whether carried out by the Department of Social Services directly or through a contractor or any other entity with which the Department of Social Services arranges to carry out its programs and activities; or on the basis of actual or perceived race, color, religion, national origin, sex, gender identity, sexual orientation or disability in admission or access to, or treatment or employment in, its programs, activities, or services when carried out by the Department of Social Services directly or when carried out by sub-recipients of grants issued by the United States Department of Justice, Office on Violence against Women. For more information about this policy or to file a Discrimination Complaint you may contact: Discrimination Coordinator, Director of DSS Division of Legal Services, 700 Governors Drive, Pierre SD 57501, 605.773.3305.

To request a fair hearing if you disagree with any decision about your application. Hearing requests must be made within 30 days from the date the written notice was received. To request a hearing contact the Office of Administrative Hearings, Kneip Building, 700 Governors Drive, Pierre, SD 57501, by phone at 605.773.6851 or by fax 605.773.6873. The request must indicate what action is being appealed.

To have the information provided held in confidence and used solely for purposes of administration of the program.

Reporting Changes

Immediately report any changes to your Benefits Specialist. Examples of changes to report include changes in

• private health insurance (such as adding or removing individuals, starting or terminating a policy)
• address
• persons in the home (such as child leaving the home, marriage)
• income (such as increase in pay, changed jobs, part-time to full-time work)
• amount of money received from sources other than employment
• change in tax filing status

If your medical coverage is for pregnancy, you must also report the birth of a child, or if pregnancy otherwise ends.

Cooperation Requirements

By applying for Medical Assistance, you have agreed to cooperate with the Department of Social Services in identifying and providing information to help pursue any third party who may be responsible for paying for care and services for each person for whom medical coverage was requested. You may also be required to cooperate with the Division of Child Support.

Social Security Number (SSN)

The Division of Economic Assistance will use the SSN to verify your income and eligibility for Medical Assistance. It is possible the SSN will be used to determine another person’s right to Medical Assistance or to comply with Federal law requiring release of information from medical records. The information may be matched with the records in other agencies, such as the Social Security Administration or Internal Revenue Service. The matches may be done by computer or on an individual basis. This is required by section 1137(a)(I) of the Social Security Act and Medical Assistance regulations at 42CFR 435.910.

Fraud

There are state and federal penalties for fraud and false reporting in connection with your application for Medical Assistance. You may be required to repay any benefits that are paid to you as a result of incorrect or false information or failing to report changes. Willfully giving false statements, (misrepresentations, impersonations or other fraudulent means), can result in conviction for one or more felony criminal offenses which are punishable by fines and/or confinement in the South Dakota State Penitentiary.