Does South Dakota Medicaid Cover Nutrition Counseling?
Medicaid provides health coverage to eligible low-income adults, children, pregnant women, older adults, and people with disabilities.
The federal government has certain requirements that all state Medicaid programs must follow, but each state administers its own program.
In this way, states are required to cover services but have the option to cover others.
One of the services states have the option to cover is nutrition counseling by a registered dietitian.
This article explains whether South Dakota Medicaid covers nutrition counseling by a registered dietitian, and if so, for which conditions.
South Dakota Medicaid covers nutrition counseling
South Dakota Medicaid covers nutrition counseling when provided by a registered dietitian.
The dietitian must be licensed with the state and enrolled as a Medicaid provider.
There are two basic forms of South Dakota Medicaid coverage — full and limited.
With full coverage, you can receive nutrition counseling from a registered dietitian when ordered by your doctor for the following conditions (1):
- phenylketonuria (PKU) and other inherited metabolic disorders
- anorexia nervosa
- bulimia nervosa
- celiac disease
- failure to thrive in childhood or adulthood
- low appetite
- feeding difficulties
- insulin resistance or high blood sugar
- end-stage renal disease
- underweight
- obesity
Other conditions like high cholesterol, high triglycerides, high blood pressure, kidney disease, and heart disease are also covered if you have obesity.
Limited Medicaid coverage is generally for prenatal and pregnancy care.
With limited Medicaid coverage, only conditions that could adversely affect the baby or mother are eligible for nutrition counseling.
Examples include conditions that affect the heart, thyroid, immune system, or digestive system.
Regardless of whether you have full or limited coverage, South Dakota limits nutrition counseling to one hour per day and five hours per year (1).
Those under 21 years of age can receive additional nutrition counseling if deemed medically necessary by the state.
Summary
South Dakota Medicaid covers nutrition counseling provided by a licensed registered dietitian when ordered by your doctor. You can receive up to five hours of nutrition counseling for eligible conditions per year.
Nutritional supplements covered by South Dakota Medicaid
Along with nutrition counseling, South Dakota Medicaid also covers certain forms of nutrition.
Medicaid covers oral nutritional supplements — like Boost, Ensure, or Kate Farms — for children under 21 years who cannot maintain adequate protein or calorie intake or when normal infant formula isn’t tolerated due to a medical condition (1).
South Dakota Medicaid also covers enteral nutrition — or tube feeding — if you cannot maintain normal weight and strength due to a medical condition. There are additional restrictions based on your age.
For parental nutrition — which is nutrition provided through a vein — Medicaid provides coverage when it is medically indicated and ordered by your doctor.
Summary
South Dakota Medicaid covers oral nutrition supplements as well as enteral and parental nutrition to patients who meet certain criteria.
What South Dakota Medicaid doesn’t cover
While South Dakota Medicaid covers nutrition counseling for obesity, it doesn’t cover other weight loss services or products.
Weight loss services or products not covered include (1):
- nutritional supplements marketed for weight loss
- exercise classes
- health club or gym memberships
- instructional materials or books
- motivational classes
When it comes to nutritional supplements, South Dakota Medicaid doesn’t cover (1):
- oral nutrition supplements for those aged 21 years or older unless there is a medical need due to an inborn error of metabolism
- nutrition supplements or enteral or parental nutrition for situations that are temporary, such as a nutritional issue during pregnancy
Summary
South Dakota Medicaid doesn’t cover weight loss services or products — outside of nutritional counseling for obesity — or nutritional supplements or therapy for those aged 21 years or older or for situations that are temporary.
Does Medicare cover nutrition counseling?
It’s easy to confuse Medicaid with Medicare and vice versa.
However, Medicare is a federal health insurance program for people aged 65 years and older and younger people with certain disabilities or conditions.
Unlike Medicaid, Medicare is not administered at the state level.
Medicare covers nutrition counseling if you have diabetes, chronic kidney disease, or have had a kidney transplant within the previous three years.
Similar to South Dakota Medicaid, Medicare beneficiaries must receive a referral from their doctor to receive nutrition counseling for these conditions.
The dietitian providing the nutrition counseling must be enrolled as a Medicare provider.
Medicare covers up to three hours of nutrition counseling in the first year and up to two hours of counseling in the following years.
Medicare will cover additional hours or sessions if the doctor provides a second referral.
Summary
Medicare covers nutrition counseling if you have diabetes, chronic kidney disease, or have had a kidney transplant within the previous three years.
The bottom line
South Dakota Medicaid covers nutrition counseling by a registered dietitian who is licensed with the state and enrolled as a Medicaid provider.
The type of Medicaid coverage — full or limited — determines the conditions and under which circumstances for which you can receive nutrition counseling.
South Dakota Medicaid covers nutritional supplements and therapy — enteral and parenteral nutrition — when deemed medically necessary.
The state doesn’t cover weight loss services or products — outside of nutrition counseling for obesity — or nutritional supplements or therapy for those aged 21 years or older or for temporary nutritional issues.
Medicare — a federal health insurance program not administered by each state — covers nutrition counseling for eligible beneficiaries with diabetes, chronic kidney disease, or who have had a kidney transplant within the previous three years.
