South Dakota

Federal FAP only

No statewide income floor. Medicaid expanded in 2023. Homestead protection is strong.

I.R.C. § 501(r) · compiled September 2026

Rule	This state
Free-care floor	—
Discount / eligibility floor	—
Covers insured patients	Yes, if they otherwise qualify
Which hospitals	Nonprofit / 501(c)(3) hospitals via federal 501(r)
Medicaid expansion	Yes — adults to 138% FPL
Screen before collections	Not required by state law
Credit reports	No state ban
Debt sales	Not banned
Home liens	Not banned
Wage garnishment	Federal CCPA cap (typically 25%)
Interest on medical debt	No special cap located
Collection hold	No extra state waiting period
Lawsuit clock	6 years · SDCL § 15-2-13

2026 poverty line here

Alaska and Hawaii use their own HHS tables. Everyone else uses the 48-state and D.C. figures, effective January 2026.

Household	100%	Free floor	Discount floor
1	$15,960	—	—
2	$21,640	—	—
3	$27,320	—	—
4	$33,000	—	—
5	$38,680	—	—
6	$44,360	—	—

01 Send an itemized-bill request (UB-04 / CPT ledger) and ask for a 30-day collections hold.
02 Apply for the hospital’s Financial Assistance Policy even though South Dakota has no income floor. Attach 2026 FPL math.
03 If uninsured, reject chargemaster and ask for the self-pay or Medicare-comparable rate.
04 If a collector is involved, send an FDCPA validation letter. Do not make a “good-faith” partial payment on old debt — it can restart the lawsuit clock.

Federal No Surprises Act.

Insurance: South Dakota Division of Insurance — external review

Medicaid: DSS fair hearing.

Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.

I request a FAP determination under Internal Revenue Code section 501(r).

Put a South Dakota bill in the machine.

The estimate will use this state’s floors. The letters will cite I.R.C. § 501(r).

501(r)
501(c)(3) hospital organizations must publish a Financial Assistance Policy, a plain-language summary, and generally may not take extraordinary collection actions (selling the debt, reporting it, liens, lawsuits) until they have made reasonable efforts to determine FAP eligibility.
No Surprises Act
Emergency services, air ambulance, and many out-of-network clinicians at in-network facilities cannot balance-bill beyond in-network cost-sharing. Independent dispute resolution is between the plan and the provider — not a reason to pay the sticker rate.
FDCPA
15 U.S.C. § 1692g. Within 30 days of first collector contact, demand validation. Until validated, collection and credit reporting should stop. Partial payment can restart a state’s statute of limitations.
EMTALA
Emergency departments must screen and stabilize regardless of ability to pay. An ER bill is not an agreement that chargemaster rates are the cash price.
Medicare appeals
Five levels: redetermination (MAC, 120 days), reconsideration (QIC), ALJ at OMHA, Medicare Appeals Council, then federal district court. A remaining patient balance is often a claim the provider still needs to work.
Credit bureaus
The CFPB’s 2025 medical-debt reporting rule was vacated in July 2025. Industry practice still generally omits paid medical collections and unpaid balances under $500. Unpaid medical debt over $500 can appear after a delay unless a state ban applies. FCRA-preemption fights over those state bans are ongoing.