South Dakota provides long-term care resources to seniors through the Department of Social Services, Division of Adult Services and Aging (ASA). The ASA provides home and community-based service options to individuals 60 years of age and older and 18 years of age and older with disabilities. In accordance with the Older Americans Act and other applicable state and federal laws, ASA provides or purchases services for South Dakotans who meet program eligibility. Some of the services provided include Adult Day Services; Adult Foster Care; Adult Protective Services; Aging and Disability Resource Connections (ADRC); Assisted Living; Assistive Devices; Caregiver Program; Emergency Response System; Home & Community-Based Services Waiver Program; Homemaker Services; Legal Services; Nursing; Facility Care; Nursing Services; Ombudsman Program; Personal Care; Prescription Assistance.

Senior Health Information and Insurance Education (SHIINE); Senior Meals; Telehealth; Transportation

The Home and Community Based Services Waiver, operated by the Division of Adult Services and Aging, allows the Department to use Title XIX Medicaid to provide home and community-based services to individuals that are at risk for institutionalization.

Medicaid Waiver Program for Assisted Living and In-Home Care

Home and Community-Based Options and Person-Centered Excellence (HOPE) Medicaid Waiver (HCBS HOPE Waiver)

South Dakota has combined its two long-term services and supports waiver into the HOPE Waiver, which is available to seniors over 65 years of age who require a nursing facility level of care, are not currently residing in a nursing home, and require at least one of the following waiver services below. In addition to the health criteria, certain financial eligibility requirements apply.


Services include: Adult Companion Services, Adult Day Services, Assisted Living, Chore Services, Emergency Response Systems, Environmental Accessibility Adaptations, Homemaker Services, Home-delivered Meals, In-Home Nursing Services, Nutritional Supplements, Personal Care Services, Respite Care, Specialized Medical Equipment, Specialized Medical Supplies.


  1. Health: An applicant must require a nursing home level of care.
  2. Financial: Applicants must meet specific income and asset limits to qualify for Medicaid for long-term care, for either assisted living facility assistance or in-home care through the HOPE waiver. South Dakota is a special income limit state, and the income limit for an individual is $2,523 for 2022 (300% of the Federal Benefit Rate). In addition, the applicant must have $2,000 or less in resources. If the applicant has too much income, a Miller Trust, also known as a Qualified Income Trust, can allow them to access benefits by funnelling their income into the trust for purposes of paying for care.  The Miller Trust allows the non-applicant to have $137,400 in assets.

Practical Considerations

South Dakota’s program is relatively small but offers the ability to use a Miller Trust for persons who have too much income to qualify for medical assistance through Medicaid for long-term care.


Medicaid Planning would be helpful for someone who has certain health needs and requires help with services but makes too much income to qualify for traditional Medicaid.

Access all state Medicaid Waiver pages.