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 this 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 by 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, community living homes, structured family caregiving 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. Additional benefits may include homemaker support, delivered meals, and assistance for home modifications to improve a home’s safety and accessibility. Please make note: Not all benefits are available in all living settings.
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) was renamed the Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver
-Administrative responsibility 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 2022
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 Administration.
Income Limit – 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 $2,523 per month. If the applicant is married, his or her income will be considered independent of his or her spouse’s income. A limited amount of joint income (up to $3,435 / month) can be allocated to the non-applicant spouse from the applicant 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 long-term Medicaid are permitted higher countable assets. The applicant is limited to $2,000, but the non-applicant is permitted up to $137,400. The house in which the applicant or his or her spouse lives is not included, given the equity value is under $636,000, 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, which may delay 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.
Please note that South Dakota does not offer a Medically Needy pathway into Medicaid.
Benefits and Services
Each applicant receives an Individual Care Plan (ICP) in which his or her needs and the services to fulfill those needs are specified. Potential benefits include the following:
- Adult Day Services / Adult Day Care
- Assisted Living
- Community Living Home
- Companion Services
- Community Transition Supports & Coordination
- Emergency Response System
- Homemaker & Chore Services
- Home Modifications
- Meals and/or Nutritional Supplements
- Personal Care
- Private Duty Nursing
- Respite Care
- Specialized Medical Equipment/Disposable Supplies
- Structured Family Caregiving
How to Apply / Learn More
For more information about the HOPE Waiver, click here. This program is available in all South Dakota counties. HCBS Waivers typically have enrollment caps. In 2020, the HOPE Waiver is capped at 1,895 concurrent participants. It is possible that waiting lists exist, but this is not usually the case in South Dakota. To learn more or to apply, persons can visit their local Department of Social Service office or call the Aging & Disability Resource Connections (ADRC) 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
