ABA insurance and Medicaid coverage in South Dakota
Last researched October 21, 2026
Who pays for ABA in South Dakota, and what a practice has to do to bill them. Coverage details here come from statutes and agency pages we read, not from payer marketing.
Autism insurance mandate
- State mandate for autism coverage
Yes, the research found a state autism coverage law.
- Statute
S.D. Codified Laws §§ 58-17-154 to 58-17-162 (mandate to cover applied behavior analysis for autism spectrum disorders at § 58-17-157; SL 2015, ch. 250, applicable to the first plan year, policy year, or renewal date on or after Jan. 1, 2016; amended by SL 2017, ch. 212, § 2, eff. Jan. 1, 2018; also amended by SL 2020, ch. 209, § 6, effective date not confirmed)
- Age limits
Coverage of ABA for autism spectrum disorder; the statute sets minimum annual maximum benefits by age band through age 18. It does not expressly state that coverage ends after age 18, and no coverage floor is stated above age 18.
- Annual cap
The annual maximum benefit may not be less than: $36,000 through age 6; $25,000 for ages 7 through 13; $12,500 for ages 14 through 18 (§ 58-17-158). These are minimum permissible annual maximum benefits, not fixed caps. Coverage may be subject to pre-authorization, prior approval, and other care management requirements, including limits on the number of individual visits. Per the fact-checker's corrections, the general-plan limitation on visit management applies, and dollar limits and cost sharing are compared against medical/surgical coverage; the exact wording of that comparison was not quoted and should be confirmed against the statute.
- Excludes self-funded employer plans
It depends.
- Notes
§ 58-17-155 exempts nongrandfathered individual and small-group ACA plans that must include essential health benefits, certain limited-benefit policies, and any plan or coverage exempt from state regulation by ERISA, so self-funded ERISA plans are excluded. § 58-17-156 applies the mandate to individual and group policies issued by health carriers and expressly to self-funded nonfederal governmental plans, except the state employee health plan. § 58-17-159: anyone performing or supervising ABA must be licensed by the Board of Medical and Osteopathic Examiners or Board of Examiners of Psychologists with documented ABA training and competence, or be licensed by the Board of Social Work Examiners as a licensed behavior analyst.
Medicaid ABA coverage
- Medicaid covers ABA
Yes, per the sources below.
- Program
South Dakota Medicaid ABA services under the EPSDT benefit (children 20 and younger with ASD)
- Agency
South Dakota Department of Social Services (DSS), Division of Medical Services
- Provider enrollment
We could not verify this yet - check with South Dakota Department of Social Services (DSS), Division of Medical Services.
Payers named in our research
Names come from the research behind this page. Appearing here does not mean a payer is accepting new providers or that networks are open. Always confirm directly with the payer.
Other payers
- South Dakota Medicaid (fee-for-service, DSS) - Manual refers to prior authorization by South Dakota Medicaid and a Care Management program; no MCO names verified.
How to enroll
- We could not verify the Medicaid provider enrollment page for South Dakota yet - check with the state Medicaid agency.
- Ask each commercial payer you want to bill for its credentialing application and timeline. We have not verified payer timelines.
- Confirm which staff types the payer reimburses, including whether technicians must hold the RBT credential. See BT vs RBT in South Dakota.
Related guides for South Dakota
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