South Dakota Medicaid HCBS waivers for an aging parent or an adult with a disability run mainly through one program: the HOPE Waiver. HOPE is short for Home and Community-Based Options and Person-Centered Excellence, and it is the state's primary Medicaid pathway for home- and community-based services (HCBS) for that group. It serves people who need a nursing facility level of care, so they can live at home or in the setting that is most independent for them.

South Dakota runs other waivers too, but they serve different populations under different eligibility tests. If you are helping an aging parent or a disabled adult sort through the state's long-term care options, HOPE is the program to understand first.

In This Guide

What Are South Dakota Medicaid HCBS Waivers?

Home- and community-based services, usually shortened to HCBS, are the long-term care supports that Medicaid pays for outside of an institution: in a person's own home, a family member's home, an adult day center, or a community residential setting. The idea is straightforward: someone who meets the clinical bar for a nursing home gets the supports to live at home or in the most independent setting for them instead.

South Dakota runs several Medicaid waivers, each one aimed at a specific population with its own eligibility rules. The waiver for older adults and for adults with a qualifying disability who need a nursing facility level of care is the HOPE Waiver, which runs under a federal authority called a section 1915(c) waiver. The federal Centers for Medicare & Medicaid Services approved its renewal, waiver number 0189.R08.00, on July 30, 2026, effective October 1, 2026.

The Department of Social Services' home and community based services page lists the state's other waivers: the CHOICES Waiver and Family Support 360, which turn on developmental disability, and Assistive Daily Living Services (ADLS), for people age 18 or older with quadriplegia. If the person you are helping falls into one of those groups, start with that waiver rather than this guide.

So when you search "South Dakota Medicaid HCBS waivers" with an aging parent in mind, HOPE is the one to understand. The rest of this guide covers it.

Inside the HOPE Waiver

HOPE stands for Home and Community-Based Options and Person-Centered Excellence. It is a section 1915(c) waiver run jointly by two state agencies: the Department of Human Services' Division of Long Term Services and Supports, and the Department of Social Services, which runs South Dakota Medicaid and decides financial eligibility.

The waiver's purpose sits right in its name. It gives people who need a nursing facility level of care options for staying in the community, at home or in the setting that is most independent for them, and every applicant goes through an assessment of needs.

Who Qualifies for South Dakota Medicaid HCBS Waivers?

Qualifying for the HOPE Waiver comes down to two tests: a functional test about your care needs and a financial test about your income and resources. You have to clear both.

The functional test. To be eligible, a person must meet a nursing facility level of care. In the state's words, that means the medical needs are such that they would require the level of care a nursing home provides. Beyond that clinical bar, an applicant must participate in an assessment of needs, must not currently be a resident of a hospital, nursing facility, or Intermediate Care Facility, and must have an assessed need for at least one waiver service at least once per month. The Department of Social Services adds that the person must be a South Dakota resident and meet certain U.S. citizenship requirements, and that someone under 65 must be blind or disabled.

The financial test. HOPE is one of South Dakota Medicaid's long-term care coverage groups, listed alongside nursing facility and assisted living coverage. For 2026, the monthly income limit is $2,982, which is set at 300 percent of the SSI Standard Benefit Amount. The resource limit is $2,000, and the Department of Social Services says the resources it counts include items such as checking and savings accounts and certificates of deposit. Financial eligibility itself is decided by the Department of Social Services' Economic Assistance staff, not by the care-side agency. For the fuller picture of how South Dakota counts income and assets, see our guide to South Dakota Medicaid eligibility and income limits.

If a person's income sits above that cap, don't assume the door is closed. The 300 percent limit is a hard eligibility cap rather than a spend-down threshold, but South Dakota's rules provide a Medicaid income trust, the state's counterpart to what is called a qualified income trust or Miller trust elsewhere, for income above the cap. Under that rule the trustee must pay the beneficiary a monthly amount that, added to income kept outside the trust, cannot exceed the 300 percent limit, and must pay the income remaining in the trust each month to the nursing facility or HCBS provider, though the trustee may draw on that remainder to administer the trust and for health items Medicaid or the facility does not cover. The rules define and provide for the trust rather than ordering every over-cap applicant to create one, so ask DSS Economic Assistance or an elder law attorney whether it fits your situation. Our South Dakota long-term care Medicaid guide walks through how those rules work alongside HOPE.

What the HOPE Waiver Pays For

The point of the waiver is to fund the specific supports that let someone stay out of a nursing facility. Covered services under HOPE may include:

  • In-home services
  • Respite and caregiver services
  • Adult day services
  • Nutrition and meals
  • Safety and help moving around
  • A community living home
  • Assisted living

These are services the waiver may include, not a bundle every participant receives, and a person qualifies only with an assessed need for at least one of them. For someone living at home, the Department of Social Services adds that Structured Family Caregiving may be available: a shared living arrangement in which the participant lives with a primary caregiver, in the participant's home or the caregiver's.

One point is worth calling out. HOPE can cover assisted living services, but federal rules bar Medicaid from paying room and board in a home- and community-based waiver, outside narrow exceptions such as respite care in a state-approved facility. So a resident who uses HOPE in assisted living still pays for room and board; the waiver pays for the care services, not the housing and meals.

How to Apply for the HOPE Waiver

Applying involves both agencies that run the program, because the two tests are decided separately. Here's the path.

To learn more about the waiver, the Department of Human Services says to contact Dakota at Home. Financial eligibility runs on a separate track: the Department of Social Services' Economic Assistance staff decide whether you meet the income and resource limits.

If you also need to apply for South Dakota Medicaid itself, federal rules require the state to accept your application through several channels: online, by phone, by mail, in person, or through other commonly available electronic means. Once your Medicaid application is in, federal timeliness standards set the outer limit on how long the state can take to decide it: no more than 45 days for most applicants, and up to 90 days for people who apply for Medicaid on the basis of disability. The longer window turns on the basis the application was filed under, not on whether a disability determination happens to arise, so an older adult applying on the basis of age sits on the 45-day standard. Those are ceilings on the agency, not typical wait times or a guaranteed decision date, but they tell you when to follow up if you haven't heard back. Our step-by-step guide to applying for South Dakota Medicaid covers the documents and the process in more detail.

Frequently Asked Questions

Can the HOPE Waiver help my parent stay at home instead of moving to a nursing home?

That is exactly what it's built for. The Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver serves people who need a nursing facility level of care so they can live at home or in the setting that is most independent for them, delivering the in-home and community supports that make staying put possible.

Can someone already living in a nursing home apply for the HOPE Waiver?

HOPE is built for people who need a nursing facility level of care but are still in the community, not already in an institution. To qualify, an applicant must not currently be a resident of a hospital, nursing facility, or Intermediate Care Facility (ICF), and must have an assessed need for at least one waiver service at least once a month.

What if my parent's income is above the $2,982 limit?

Being over the monthly income cap does not automatically end the matter. Because HOPE is one of South Dakota's long-term care coverage groups, the tools in those groups' rules can still be relevant when income runs above the limit. One of them is South Dakota's Medicaid income trust, the state's version of a qualified income trust or Miller trust: the trust holds only the person's own income, the trustee pays the beneficiary a monthly amount that, added to income kept outside the trust, cannot exceed 300 percent of the SSI Standard Benefit Amount, and what remains is paid monthly to the HCBS or nursing facility provider, apart from limited trust administration and uncovered health costs. Our South Dakota long-term care Medicaid guide walks through how it works alongside HOPE.

How do I apply, and how long does a decision take?

Start by contacting Dakota at Home to learn more about the waiver, while the Department of Social Services' Economic Assistance staff decide financial eligibility. If you are also applying for Medicaid, federal rules cap the decision at 45 days for most applicants and 90 days for people who apply on the basis of disability, measured by the basis you applied under rather than by whether a disability determination comes up. Those caps limit the agency; they are not a promise that a decision will arrive by then.

Learn More

MedicaidSouth Dakota Medicaid: Programs and CoverageSouth Dakota Medicaid covers long-term care through DSS with a $2,982 income cap, a Miller Trust rule, and a $2,000 asset limit. Full 2026 guide for seniors. MedicaidMedicaid HCBS Waivers by StateMedicaid HCBS waivers pay for care at home instead of a nursing facility. How 1915(c) waivers work, who qualifies, why waitlists happen, and your state's guide. MedicaidSouth Dakota Long-Term Care Medicaid and Nursing HomesHow South Dakota Medicaid covers nursing home care in 2026: eligibility, the asset limit, Miller Trusts, what you pay, spousal protection, and estate recovery. MedicaidSouth Dakota Medicaid Eligibility and Income LimitsSouth Dakota Medicaid income limits cap long-term-care eligibility at $2,982/month in 2026. See the asset limit, the Miller Trust rule, and spousal protections. MedicaidHow to Apply for South Dakota MedicaidHow to apply for South Dakota Medicaid long-term care: the DSS ePortal, the income-trust gate, documents, the 45-day timeline, and how to appeal a denial.

Find personalized help understanding South Dakota's HOPE Waiver and your next step at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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