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South Dakota has 4 community health centers across 46 sites serving 124,433 patients — the #43 FQHC state by patients outside California and Texas. As an expansion state, Medicaid anchors the safety net, and H.R. 1 work requirements plus the December 2026 funding cliff are the key risks.
Patient-weighted across the 4 centers with UDS 2024 data.
Medicaid community-engagement (work) requirements under CMS-2454-IFC (80 hrs/month, full implementation Jan 1, 2027) plus expiry of the enhanced ACA premium tax credits (end of 2025) threaten South Dakota's expansion population and FQHC Medicaid revenue.
By patients (HRSA UDS 2024). Tap for the full profile.
| Organization | Patients | Sites | Uninsured | Revenue (990) | District |
|---|---|---|---|---|---|
| Rural Health Care, Inc. Fort Pierre | 78,946 | 13 | 6.3% | $63M | SD-00 |
| Horizon Health Care, Inc. Howard | 26,142 | 26 | 37.48% | $36M | SD-00 |
| Community Health Center of the Black Hills, Inc. Rapid City | 9,951 | 2 | 20.4% | $12M | SD-00 |
| City of Sioux Falls Sioux Falls | 9,394 | 5 | 31.88% | — | SD-00 |
| District | Representative | Sites |
|---|---|---|
| SD-00 | Dusty Johnson | 42 |
South Dakota ranks #43 by FQHC patients and #50 by organization count among the 57 national-breadth states/territories (excludes California and Texas, which have dedicated dashboards). All 4 centers depend on the federal Community Health Center Fund, authorized only through December 31, 2026.
FQHC data from the HRSA bulk-sites file + UDS 2024 + IRS 990. State policy profile via NACHC/KFF/AANP. Federal items apply to all states; state items are South Dakota-only. Updated 2026-06-03.