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South Dakota’s Medicaid program offers limited Personal Care services to eligible individuals in their homes. The program's primary objective is to prevent the placement of persons in skilled nursing facilities unless it is absolutely necessary. It achieves this goal by offering them support to help remain living at home. The highest level of skilled nursing care is not available through Personal Care services. However, at the other end of the care spectrum, some support is offered that is decidedly non-medical in nature, such as assistance with shopping for food and other household essentials. Personal care provided under the state’s regular Medicaid program is not age-restricted.
To avoid confusion, it should be mentioned that there is also a Medicaid Waiver in South Dakota called the HCBS Waiver for the Elderly, which provides similar but not identical services. One cannot simultaneously receive assistance from both programs. Also confusing is the fact that Medicaid in SD is also called the South Dakota Medical Assistance Program or SDMA.
Personal Care is open to anyone over the age of 18 who is qualified for Medicaid and found to be medically in need of assistance.
SD's Regular Medicaid program (under which personal care in an option) has different, more restrictive, financial eligible guidelines than does the state's HCBS Medicaid Waiver. As of 2018, single applicants are permitted monthly income up to $750. Annually, this is equal to $9,000. Their countable resources, excluding the value of their home, given it is valued under $572,000, must be no greater than $2,000. Also excluded is a single vehicle, personal items and home furnishings.
Married applicants' monthly combined income limit is set at $1,125 and their asset limit is $3,000 (in 2018). However, if only one spouse is applying, there are different, considerably higher asset limits.
Candidates who would otherwise qualify, but have incomes and resources in excess of these limits might consider working with a Medicaid planning professional to help them gain eligibility. There are several types of Medicaid planners, some that offer free assistance and others provide fee-based services. Learn more about Medicaid planning here.
Personal Care services are intended to prevent nursing home placement by helping individuals remain living at home and as such, the specific types of assistance are chosen with that in mind. Benefits can include assistance with the activities of daily living, such as maintaining personal hygiene, eating, dressing, and mobility. However, there are limits in this area. Individuals with severe incontinence, for example, would not be eligible. Other support includes instrumental activities of daily living, such as grocery shopping, light housekeeping, laundry, and meal preparation and organization (storage, labeling, and heating instructions). Services are only provided during weekday work hours, and most program participants have primary caregivers supporting them outside that time frame.
A recent change to this program limits the annual hours of personal care any one Medicaid beneficiary can receive to 500 hours. This is approximately 10 hours / week.
To begin the application process one can use the online referral form available on the Department of Social Services website or, alternatively, call the support line at 1-866-854-5465.