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SD HCBWS - Medical Assistance - Elderly Individuals

Elderly individuals living independently in their own homes may be eligible for Medical Assistance.

Eligibility Requirements

To be eligible for these Home and Community-Based Waiver Services (HCBWS):

·      You must be 65 years or older and in need of nursing facility care.

·      You must not be a resident of a hospital, nursing facility or an intermediate care facility for the mentally retarded (ICF-MR). You may become a resident of an assistive living facility.

·      You must be a resident of South Dakota and meet certain citizenship requirements of the United States.

·      You must be receiving Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), or Foster Care Maintenance Payment - OR - your gross monthly income must not exceed 300% of the SSI Standard Benefit Amount.

·      Your resources must not exceed $2,000. Resources include items such as checking or savings accounts and certificates of deposit. (If you are married, see the handbook, Medicaid Can Help Couples Pay the Cost of a Spouse's Care in a Medical Facility. It is available at: http://www.state.sd.us/social/MedElig/SpouseCare/index.htm

Cost Sharing

You are not required to pay part of the cost of care if you qualify for this assistance because you receive SSI, TANF or Foster Care assistance.

If you qualify because you have a monthly income that is less than 300% of the SSI Standard Benefit Amount (but you are ineligible for SSI), then your payment for HCBWS services is based on the difference between your income (minus allowable deductions) and your monthly care costs.

Allowable Deductions:

·      A deduction equal to the Supplemental Security Income (SSI) standard benefit amount plus $20 for your personal needs; and

·      Private health insurance premiums; and

·      Medicare Part B premium; and

·      Spousal allowance: If you are married, see the handbook, Medicaid Can Help Couples Pay the Cost of a Spouse's Care in a Medical Facility. It is available at: http://www.state.sd.us/social/MedElig/SpouseCare/index.htm; and

·      Dependent allowance: If you do not have a spouse who lives in the community, then you are allowed a dependent allowance equal to the TANF Standard of Assistance.

Covered Services

If you are eligible, you are entitled to full Medical Assistance coverage. Covered services include doctor appointments, hospital stays, dental and vision services, prescription drugs, rehab/therapy, chiropractic, etc. (For a list of services under full Medical Assistance coverage, see: http://www.state.sd.us/social/Medical/Recipient/covered.htm.)

In addition, the following services are also covered:

·      Homemaker Services: Teaching and providing home management skills, promoting self-care, making beds, changing linens, washing dishes, laundry work, floor care and housecleaning. Providing meal preparation, shopping and menu planning. Providing non-medical assistance in mobility, personal comfort and grooming of the individual. Arranging for transportation.

·      Private Duty Nursing: Nursing services provided by a licensed nursing professional for recipients with chronic and stable conditions who require more individual and continuous care than is available from a part-time or intermittent nursing service.

·      Adult Day Care: Services that provide out-of-home structured health and social services on a regularly scheduled basis and in daytime settings.

·      Emergency Response Systems: An emergency response system is an electronic device that enables individuals to alert neighbors or family and summon assistance in the event of an emergency.

·      Meals-Nutritional Supplements: Meals may be arranged in those areas where no home delivered meals program is available. The service may include a prepared meal, a frozen entrée or a nutritional supplement.

Sources:

http://www.state.sd.us/social/MedElig/LTC/Elderly.htm (General Information)
http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=67:44 (Eligibility and Cost Sharing)
http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=67:46 (HCBWS Deductions)

Back to:

Home and Community Based Waiver Services (HCBWS)

Office of Medical Eligibility - Overview

South Dakota Department of Social Services (DSS)

Welcome and Introduction to the South Dakota Benefits Information System

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