Down Syndrome Benefits in South Dakota

• To qualify for Supplemental Security Income (SSI), you must have limited income and resources, and meet Social Security’s definition of disability. For children, this means a condition that causes marked and severe functional limitations. For adults, it means a condition that prevents substantial work and is expected to last at least a year or result in death.
• Social Security Disability Insurance (SSDI) requires a work history and enough Social Security credits. Family members may also qualify based on a parent’s or spouse’s work record.
• Both programs require medical evidence showing the disability meets Social Security’s standards.
• SSI is needs-based, while SSDI is based on work history and contributions to Social Security.

Source: SSA.gov, 2025-11-06

• For SSI, the federal income limit in 2025 is $943 per month for an individual, but some income is not counted.
• SSDI eligibility depends on age and work credits, generally needing 40 credits, with 20 in the last 10 years.

Source: National Disability Institute, 2025-11-06

• In South Dakota, individuals with Down Syndrome may qualify for SSI if they meet federal income and resource limits.
• Children with Down Syndrome may also qualify for Medicaid through the Disabled Children’s Program.
• South Dakota Medicaid for Workers with Disabilities allows people with disabilities to work and keep Medicaid coverage, even if their income is above the SSI limit.
• The state offers Medicaid waivers for home and community-based services, which can provide extra support for people with Down Syndrome.
• South Dakota also has special rules for continued Medicaid coverage under Section 1619(b) if SSI cash payments stop due to work, but income is below the state threshold ($53,022 in 2025).

Source: South Dakota Benefits Specialist Network, 2025-11-06

• The state’s Medicaid program covers services for children and adults with disabilities, including those with Down Syndrome.
• South Dakota’s Medicaid for Workers with Disabilities program is for those who are employed and have a significant disability.

• Gather medical records and proof of income.
• Contact the Social Security Administration to apply for SSI or SSDI.
• Apply for Medicaid through the South Dakota Department of Social Services.
• Ask about Medicaid waivers and ABLE accounts for extra support.
• Report any changes in income or living situation to avoid overpayments.

• Step 1: Collect all medical records and documentation showing the diagnosis of Down Syndrome and how it affects daily life.
• Step 2: Gather proof of income, resources, and living expenses.
• Step 3: Contact the Social Security Administration (SSA) by phone (1-800-772-1213) or visit a local office to apply for SSI or SSDI. You can also apply online at SSA.gov.
• Step 4: Apply for Medicaid through the South Dakota Department of Social Services. You can apply online, by phone, or in person.
• Step 5: Ask about Medicaid waivers for home and community-based services if extra support is needed.
• Step 6: Consider opening an ABLE account to save for disability-related expenses without losing benefits.
• Step 7: Report any changes in income, resources, or living situation to SSA and the state to avoid overpayments.
• Step 8: If denied, you can appeal the decision within 60 days.

Source: SSA.gov, 2025-11-06

• For children, parents or guardians can apply for SSI and Medicaid on their behalf.
• For adults, the individual or a representative can apply.
• The application process may take several weeks to months.
• Keep copies of all documents and correspondence.

Source: South Dakota Department of Social Services, 2025-11-06

• Supplemental Security Income (SSI): Monthly cash payments for people with limited income and resources who are disabled, blind, or age 65 and older.
• Social Security Disability Insurance (SSDI): Monthly payments for people who have worked and paid Social Security taxes, and are unable to work due to disability.
• Medicaid: Health coverage for people with disabilities, including children and adults with Down Syndrome.
• Medicare: Health coverage for people who receive SSDI after a 24-month waiting period.
• Work Incentives: Programs that help people with disabilities keep benefits while working, such as Impairment Related Work Expenses and Plan for Achieving Self-Support.

Source: SSA.gov, 2025-11-06

• Expedited Reinstatement: Allows people who lose benefits due to work to get them back quickly if they become unable to work again.
• Continued Medicaid Coverage (1619b): Allows people to keep Medicaid even if their income is above the SSI limit, as long as it is below the state threshold.

Source: South Dakota Benefits Specialist Network, 2025-11-06

• South Dakota Medicaid for Workers with Disabilities: Allows people with disabilities to work and keep Medicaid coverage, even if their income is above the SSI limit.
• Disabled Children’s Program: Provides Medicaid for certain disabled children in South Dakota.
• Medicaid Waivers (HCBS): Provide extra support for home and community-based services for people with disabilities.
• Former Foster Care Medical Program: Extended medical coverage for youth aged 18 to 26 leaving foster care.
• Adult Foster Care Homes: Medicaid for adults in foster care homes who meet eligibility criteria.
• South Dakota Medicaid for Individuals Currently and Formerly Receiving SSI: Automatic Medicaid eligibility for those receiving SSI.

• ABLE accounts allow people with disabilities to save money for disability-related expenses without losing SSI or Medicaid benefits.
• In South Dakota, you can open an ABLE account through the state’s ABLE program.
• The account can be used for expenses like education, housing, transportation, and personal support.
• There are annual and lifetime contribution limits.

Source: National Disability Institute, 2025-11-06

• For SSI in 2025, the federal income limit is $943 per month for an individual.
• Some income is not counted, such as the first $20 of most income, the first $65 of earned income, and half of earned income above $65.
• For SSDI, there is no income limit, but you cannot earn more than Substantial Gainful Activity (SGA) to qualify, which is $1,620 per month in 2025 (or $2,700 if blind).
• South Dakota’s Medicaid for Workers with Disabilities program allows income above the SSI limit, up to $53,022 per year in 2025, while keeping Medicaid coverage.

Source: South Dakota Benefits Specialist Network, 2025-11-06 Source: National Disability Institute, 2025-11-06

• It is important to report any changes in income, resources, or living situation to SSA and the state to avoid overpayments.
• Overpayments can happen if you do not report changes or if there is a mistake in your benefits.
• If you receive an overpayment, you may be able to request a waiver or set up a repayment plan.
• Always keep copies of all documents and correspondence.

Source: SSA.gov, 2025-11-06 Source: South Dakota Benefits Specialist Network, 2025-11-06

• South Dakota Department of Social Services
  Phone: 1-800-597-1603

  Email: [email protected]

  Hours: 8:00 AM - 5:00 PM, Monday-Friday

  Website

  For Medicaid and other state benefits.
• Social Security Administration
  Phone: 1-800-772-1213

  TTY: 1-800-325-0778

  Hours: 8:00 AM - 7:00 PM, Monday-Friday

  Website

  For SSI and SSDI applications and questions.
• South Dakota Benefits Specialist Network
  Phone: 1-800-224-5336

  Hours: 8:00 AM - 5:00 PM, Monday-Friday

  Website

  Free help with disability benefits and applications.

• Can a child with Down Syndrome get SSI in South Dakota?

  Yes, children with Down Syndrome may qualify for SSI if they meet federal income and resource limits and have a condition that causes marked and severe functional limitations. Parents or guardians can apply on their behalf.

• What is the income limit for SSI in South Dakota in 2025?

  The federal SSI income limit in 2025 is $943 per month for an individual. Some income is not counted, such as the first $20 of most income and the first $65 of earned income.

• Can adults with Down Syndrome work and still get benefits?

  Yes, adults with Down Syndrome can work and keep benefits through work incentives like Impairment Related Work Expenses and Plan for Achieving Self-Support. They may also keep Medicaid if their income is below the state threshold.

• What is the South Dakota Medicaid for Workers with Disabilities program?

  This program allows people with disabilities to work and keep Medicaid coverage, even if their income is above the SSI limit, as long as it is below the state threshold of $53,022 per year in 2025.

• How do I apply for Medicaid in South Dakota for someone with Down Syndrome?

  You can apply for Medicaid through the South Dakota Department of Social Services online, by phone, or in person. You will need to provide proof of income, resources, and medical records.

• What are Medicaid waivers in South Dakota?

  Medicaid waivers provide extra support for home and community-based services for people with disabilities. They can help with things like personal care, therapy, and respite care.