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South Dakota Medicaid Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver

Table of Contents


What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

 Under the program, participants can receive assistance to help them remain at home or to live in assisted living communities.

The HOPE Waiver (a new name) will likely continue to be referred to be its older names, the HCBS Waiver or the Elderly Waiver. This Medicaid program seeks to limit public expenses by reducing the number of individuals who require full-time nursing home care. The waiver achieves this goal by providing services to nursing home qualified individuals in their homes or in assisted living communities, provided the cost to care for individuals in those locations does not exceed 85% of the cost for the same care in nursing homes.

Program participants can receive personal care and assistance with their activities of daily living at home, in adult day care, and in assisted living communities. Those residing at home can also receive homemaker support, delivered meals, and assistance for home modifications to improve a home's safety and accessibility.

Unlike many state waivers of similar design, the SD HCBS Waiver does not allow for participant direction of services. This means it does not permit beneficiaries to choose their own caregivers or hire family members to serve in that capacity.

2018 Major Waiver Changes
-The Home & Community Based Waiver Services for the Elderly (HCBS) has been renamed the Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver
-Administrative responsibility has been changed to the Department of Human Services, Division of Long Term Services and Supports (DHS-LTSS) from the Division of Adult Services and Aging
-No longer is a physician's order required for eligibility. However, a Community Health Assessment (CHA) is still required.

 

 

Eligibility Guidelines

South Dakota Medicaid (also called the South Dakota Medical Assistance Program or SDMA) considers multiple criteria for eligibility for the Hope Waiver. The following is current for 2018.

Functional Ability - Persons 65 and older qualify if they require nursing home care. Persons 18-64 qualify if they have a formal designation of disabled by the Social Security Administation.

Income Limit – As of 2018, applicants seeking assistance from this waiver are permitted a monthly income of up to three times the Federal Benefit Rate (FBR). This means an applicant can have an income level up to $2,250 per month. If the applicant is married, their income will be considered independent of their spouse’s income. A limited amount of joint income can be allocated to the spouse as a Needs Allowance. Excessive income can be put into a Miller or Pooled Income Trust to help gain eligibility. Interested parties should consult with a Medicaid Planner to take this approach. Read more about the types of assistance with Medicaid planning.

Asset Limit - single or widowed applicants are permitted $2,000 in countable assets. This is typically just the cash that is available in the applicant's checking, savings or other investment accounts. Married couples with one spouse living independently and one applying for Medicaid are permitted higher countable assets. The applicant is limited to $2,000, but the non-applicant is permitted $123,600. The house in which the applicant or their spouse lives is not included, given it is valued under $572,000, when determining their countable assets, nor is their vehicle, provided it is in use.

Past Asset Transfers – South Dakota has a 5-year look back period from the date of application that can disqualify applicants if they have given away or sold assets below fair market value for the purpose of gaining Medicaid eligibility. Even if the transaction was not knowingly completed for the purpose of gaining acceptance, applicants can still be penalized by delaying their acceptance into Medicaid for months or even years.

SD State residents whose finances are above these limits can sometimes still qualify for Medicaid by re-organizing the structure of their resources. Read more about this option.

South Dakota does not offer a Medically Needy pathway into Medicaid.

 

Benefits and Services

Each applicant receives an Individual Care Plan (ICP) in which their needs and the services to fulfill those needs are specified. Potential benefits include the following:

  • Adult Day Services / Adult Day Care
  • Assisted Living
  • Companion Services
  • Emergency Response System
  • Homemaker Services
  • Home Modifications
  • Meals and/or Nutritional Supplements
  • Medication Administration
  • Personal Care
  • Private Duty Nursing
  • Respite Care
  • Specialized Medical Equipment/Disposable Supplies

 

How to Apply / Learn More

This program is available in all South Dakota counties. HCBS Waivers typically have enrollment caps.  In 2018, the HOPE Waiver is capped at 1776 concurrent participants. It is possible that waiting lists exist but this is not usually the case in South Dakota.  To learn more or apply, one can visit their local Department of Social Service office or call the toll-free number in their geographic area.

Rapid City - 855-315-1986
Pierre - 855-642-3055
Watertown - 855-315-1987
Mitchell - 855-315-1988
Sioux Falls - 877-660-0301

 Two other options of which South Dakota residents should be aware are Personal Care Services for Medicaid eligible individuals and Homemaker, Chore and Respite services for those ineligible for Medicaid.