South Dakota Home Care Medicaid

The Home and Community-Based Options and Person-Centered Excellence waiver — known as HOPE — is South Dakota's main channel for keeping older adults and people with disabilities out of institutional care. It's a joint program run by the Department of Human Services' Long Term Services and Supports division together with DSS.

HOPE targets South Dakotans age 65 and older, plus adults with a qualifying disability, who need a nursing-facility level of care but can safely be supported in a community setting instead. Getting enrolled runs through several steps: a Home Care Assessment, an LTSS referral and assessment, a Medical Review Team level-of-care review, standard DSS financial eligibility, and finally an individual support plan with authorization.