28-13-32.11. Determination of household's ability to purchase health insurance.
For purposes of subsections 28-13-27(6)(c) and (d), when determining whether the household was financially able to purchase health insurance which would have covered the medical costs the county is being requested to pay, the county shall use the following methodology:
(1)Determine the household's income and resources according to §§ 28-13-32.7 and 28-13-32.8;
(2)Determine the household's contributions for taxes, social security, medicare, and payments to other standard retirement programs according to subdivision 28-13-32.9(1);
(3)Except for the medical expenses for which the household is requesting assistance, determine the household's expenses according to subdivision 28-13-32.9(2);
(4)Determine the amount of the household's discretionary income by subtracting the sum of the household's contributions and expenses from the household's income. Divide the amount of the household's discretionary income in half. The result added to the household's adjusted resources determined according to §28-13-32.8 equals the household's discretionary income that was available to purchase health insurance;
(5)Subtract the amount of the monthly health insurance premium that was available to the household if known or, if unknown, an estimate of the premium the household could be expected to incur. For purposes of this subdivision, the county shall establish such estimate either by obtaining premium estimates from two major medical insurance carriers doing business in the state or by using an estimate based on the rate data provided to the county by the Division of Insurance of the Department of Labor and Regulation. The policy used shall have a benefit design that equals or exceeds the benefit design of the basic benefit plan as developed by the Health Benefit Plan Committee pursuant to §58-18B-32. If the result is a negative number, the health insurance was not affordable. If the result is a positive number, health insurance was affordable and the individual is considered to be indigent by design.
Source: SL 2000, ch 134, §2; SL 2004, ch 17, §36; SL 2011, ch 1 (Ex. Ord. 11-1), §162, eff. Apr. 12, 2011.
Structure South Dakota Codified Laws
Title 28 - Public Welfare and Assistance
Chapter 13 - County Poor Relief
Section 28-13-1 - County duty to relieve poor persons--Taxation--Determination of eligibility.
Section 28-13-1.1 - "Indigent or poor person" defined--Eligibility standards.
Section 28-13-1.2 - Considerations in establishing eligibility standards.
Section 28-13-1.3 - Medically indigent person defined.
Section 28-13-1.4 - Appeal regarding medical indigence.
Section 28-13-2 - Residency acquired for poor relief purposes.
Section 28-13-3 - Residency required for assistance--Establishment.
Section 28-13-5 - Children's residency.
Section 28-13-8 - Residency continued until lost by new residency.
Section 28-13-12 - Residency not established by state acceptance of application.
Section 28-13-14 - Residency not established by residence in health care facility.
Section 28-13-16 - County commissioners to have responsibility for care and relief of poor persons.
Section 28-13-16.1 - Waiting period imposed at board's discretion while residency investigated.
Section 28-13-16.2 - Intentional fraud or deceit to receive assistance.
Section 28-13-17 - Proceedings by and against commissioners in name of county.
Section 28-13-18 - Record of poor relief payments available in investigation of residency.
Section 28-13-20 - Services required of applicant--Contract for repayment of assistance.
Section 28-13-20.2 - Refusal to work without just cause--Eligibility for assistance terminated.
Section 28-13-22 - Employment of welfare workers to distribute funds and supplies to poor.
Section 28-13-23 - Annual allowances to competent poor persons.
Section 28-13-27 - Hospitalization of poor persons--Definition of terms.
Section 28-13-27.1 - Medically necessary hospital services.
Section 28-13-27.2 - Cost guidelines for medical and remedial services.
Section 28-13-30 - Approval of statement by secretary--Modification of items in statement.
Section 28-13-32 - County commissioners' objections to statements.
Section 28-13-32.5 - Determining medical indigence--Annual income guideline.
Section 28-13-32.6 - Housing indexes by county.
Section 28-13-32.7 - Determining household income--Sources.
Section 28-13-32.8 - Household resources.
Section 28-13-32.9 - Determination of person's ability to pay--Factors.
Section 28-13-32.10 - Indigency by design.
Section 28-13-32.11 - Determination of household's ability to purchase health insurance.
Section 28-13-33.1 - Experimental procedures and treatment for medically indigent patient.
Section 28-13-33.2 - Billing for care of medically indigent patients.
Section 28-13-34.2 - Release of information.
Section 28-13-36 - Contractual arrangements between county and hospital not impaired.
Section 28-13-37 - County duty to relieve nonresidents in distress.
Section 28-13-37.1 - Medical review by county or Department of Social Services.
Section 28-13-38 - Temporary relief to nonresident--Reimbursement by home county.
Section 28-13-38.1 - When hospitals outside state are eligible for reimbursement by county.
Section 28-13-40 - Appeal to circuit court from county commissioners--Direction for assistance.
Section 28-13-42 - Names of recipients not released for publication.
Section 28-13-43 - Assignment or transfer of property to qualify for assistance as misdemeanor.
Section 28-13-44 - Bankruptcy not admissible in making determination of indigency.