South Dakota Medicaid HCBS waivers for an aging parent or an adult with a disability run 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 exists so that someone who would otherwise need a nursing facility level of care can stay in their own home, or in the most independent setting that works for them, instead of moving into an institution.

South Dakota runs other 1915(c) waivers too, but they serve different populations. 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. Many people who meet the clinical bar for a nursing home would rather stay in the community, and with the right supports in place, they can.

States deliver these services under a federal authority called a section 1915(c) waiver, named for the part of the Social Security Act that permits it. The "waiver" language refers to the federal rules a state is allowed to set aside so it can offer institutional-level care in a community setting instead. South Dakota uses this authority to run several waivers, each one aimed at a specific population. The waiver for older adults and for adults with a qualifying disability who need a nursing facility level of care is the HOPE Waiver, approved by the federal Centers for Medicare & Medicaid Services under waiver number 0189.R07.00.

The state's other 1915(c) waivers, listed on the Department of Social Services' home and community based services page, are the CHOICES Waiver and Family Support 360, both run through the Division of Developmental Disabilities, and Assistive Daily Living Services (ADLS), for people 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, which oversees the home- and community-based side, 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 a set of options for staying in the community, and it builds each person's services around that individual rather than slotting them into a fixed package. In practice that means an assessment of what a person actually needs, followed by an authorized mix of waiver services delivered where they live.

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 financial test. HOPE follows South Dakota's institutional and long-term care Medicaid rules, and it is what's known as an income-cap program. For 2026, the monthly income limit is $2,982, which is set at 300 percent of the SSI Standard Benefit Amount. The countable resource limit is $2,000 for a single applicant, where resources include things like 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. 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
  • Home safety and accessibility supports
  • A community living home
  • Assisted living services

Every person's plan is different, because services are authorized based on the assessed need rather than handed out as a uniform bundle.

One point trips families up often enough to call out. HOPE can cover the care delivered in an assisted living setting, but Medicaid does not pay the assisted living room-and-board charge. A resident who uses HOPE in assisted living still pays for their own room and meals out of their own income; the waiver covers the personal care and services layered on top.

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 about the waiver and start the process on the care side, a person contacts the state's waiver intake and assessment service, 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, or in person at a local office. 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 meet a nursing facility level of care but want to remain in their own home or the most independent setting that works 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 follows South Dakota's institutional and long-term care Medicaid rules, the tools in those rules can still be relevant when income runs above the limit. Chief among them is South Dakota's Medicaid income trust, the state's version of a qualified income trust or Miller trust: excess income goes into the trust, the beneficiary keeps a monthly amount capped at 300 percent of the SSI Standard Benefit Amount, and what remains is paid monthly to the HCBS or nursing facility provider. 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 for the waiver assessment, while the Department of Social Services handles the financial side. 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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