South Dakota HOPE Waiver: South Dakota 2026 Guide

South Dakota’s Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver helps older adults and adults with qualifying disabilities who need nursing facility level care live at home or in assisted living. It is administered by the South Dakota Department of Human Services, Division of Long Term Services and Supports, with intake through Dakota at Home, the state’s Aging and Disability Resource Center.

Here is a plain-language walk-through of the HOPE Waiver: who qualifies in 2026, what help it covers, how a family gets started, whether there is a wait, and how it connects to nursing home coverage. For the full statewide rules on income, assets, spouses and the look-back, see our South Dakota Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What the HOPE Waiver is

HOPE is a 1915(c) waiver. A specialist assesses the person, and a case manager writes a person-centered plan. Services can be provided in the person’s home, an adult foster care home or an assisted living center. Some services can be self-directed.

A home and community-based services (HCBS) waiver is a Medicaid program a state runs with federal approval. “Waiver” means the state may set aside some normal Medicaid rules, such as the rule that long-term care is paid only in a nursing home, so it can pay for care at home or in a community setting instead. Waivers are optional for states, so each sets its own services and, often, a limit on enrollment. That is the main difference from regular Medicaid benefits: meeting the rules does not by itself guarantee a slot.

Who qualifies in 2026

Eligibility for the HOPE Waiver rests on two tests, care need and finances, plus an available slot. In general, an applicant must:

be 65 or older, or 18 or older with a qualifying disability;
live in South Dakota at home or in an approved community setting;
meet a nursing facility level of care;
meet the financial rules; and
need at least one HOPE service each month.

Income and assets. The financial side of the HOPE Waiver follows South Dakota’s long-term care Medicaid rules. Countable assets include bank accounts, investments and property other than the home, while the home, one car, personal belongings and certain burial funds are usually not counted. The five-year look-back on gifts and below-value transfers applies here too, so large gifts in the past five years can delay services.

In 2026, the income limit is $2,982 a month (300% of the SSI rate). Income above that can be placed in a Medicaid income (Miller) trust. The single-person asset limit is $2,000.

For reference, these are South Dakota’s key 2026 long-term care Medicaid figures:

Item	2026 figure
Income limit (applicant)	$2,982 a month (300% of the SSI rate)
Asset limit (single applicant)	$2,000
Asset limit (couple, both applying)	$3,000
Home equity limit	$752,000
Spouse at home: resource allowance (CSRA)	Half the couple’s assets, minimum $32,532 / maximum $162,660
Spouse at home: monthly income allowance	Minimum $2,705 (from July 1, 2026) / maximum $4,066.50
Personal needs allowance (nursing home)	$100 a month
Look-back period	60 months (5 years)

If you are married. The spouse who stays home is protected: federal spousal impoverishment rules let them keep a share of the couple’s assets and, if their own income is low, part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services the HOPE Waiver can cover

The care plan picks from a menu of services. For the HOPE Waiver, that menu includes:

case management
in-home services, including personal care and homemaker help
respite care
adult day services
meals
assisted living services
adult companion services
nursing services
personal emergency response systems
specialized medical equipment and supplies
environmental accessibility adaptations
chore services
consumer preparation and self-direction services

Limits to keep in mind. the HOPE Waiver does not pay for rent, groceries or utilities; in residential settings, room and board is the resident’s responsibility. Family help is usually factored into the plan, and medical coverage runs alongside the waiver as before.

How to apply for the HOPE Waiver

The steps below describe the usual path. Many people apply for Medicaid and request the waiver at the same time, so that the money and care tests run side by side.

Contact Dakota at Home to request an assessment.
Apply for Medicaid through the Department of Social Services, if not already enrolled.
A specialist completes the level of care assessment.
A case manager writes the plan of care.
Choose providers, and services start.

Tips for the paperwork. Keep a folder of copies, and log every call with the date and name. At the assessment, talk about the hardest days, not the best ones, and bring someone who sees the care needs firsthand. Supervision needs, confusion and falls matter as much as hands-on help. A denial notice explains the fair hearing process and its deadline.

Waiting lists and timing

South Dakota reported no waiting list for older adults and people with physical disabilities in 2026.

Because openings can be limited, it usually makes sense to get on any list early, even before needs are urgent. While waiting, other options can help: state plan personal care, adult day programs, PACE where offered, Older Americans Act services through the Area Agency on Aging, and family caregiver support. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

the HOPE Waiver serves people who meet the same care-need standard as nursing home residents, so it is an alternative to a nursing home rather than a lower level of care. Nursing home Medicaid is an entitlement for people who qualify, so it has no waiting list, while a waiver may. Switching settings is possible in both directions: from home to a nursing home if needs grow, and back home with help from Money Follows the Person.

Tips for families

Time is the biggest factor, so start the process early. Gather five years of bank statements before the caseworker requests them, and keep a two-week care diary before the assessment. Higher income may call for a Miller trust or spend-down; past gifts may cause a penalty, so review them first. If needs change, request a reassessment rather than waiting for the yearly review.

Many families find it worthwhile to talk with a Certified Medicaid Planner before applying for the HOPE Waiver. A planner who knows South Dakota’s rules can review income and assets, explain which program fits, map the timing against any waiting list, and help with the paperwork. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.