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SD HCBWS - Medical Assistance - Individuals with Developmental Disabilities

Individuals with Developmental Disabilities (DD) who would otherwise be institutionalized in a Medicaid-funded hospital, nursing facility or an Intermediate Care Facility for the Mentally Retarded (ICF-MR) may be eligible for Medical Assistance that enables them to live in the community.

Eligibility Requirements

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

·      Have a Developmental Disability (DD); and

·      Be residing:

In the home a of parent, other relative, legal guardian; or

In an Adult Foster Care home licensed by the Department of Social Services (DSS); or

In special therapeutic foster care homes licensed by DSS; or

In community residential facilities approved by the Department of Human Services (DHS); or

In supervised apartments approved by the Department of Human Services; or

In community habilitation facilities approved by the Department of Human Services; or

In you own home (as long as it is not shared with more than three other people with developmental disabilities and is not owned by a provider); or

In assisted living centers licensed by the Department of Health; and

·       Meet one of the two following requirements:

You must be receiving Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF); or Foster Care assistance; or

You must have a gross monthly income that is less than 300% of the Supplemental Security Income (SSI) Standard Benefit Amount; and

·      Have resources that do not exceed the resource limit of $2,000 for an individual. 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 for your personal needs; and

·      If you are employed, a deduction of $400 from gross wages; 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

Individuals who are eligible 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 service are also covered:

·      Case Management and Consumer Support: Includes adaptive equipment needed not to exceed $500 per person per year. Examples of adaptive equipment would be communication devices, eyeglasses, hearing aids etc. It also includes transportation costs, such as drivers, vehicle purchase, insurance, depreciation, repair and maintenance, and purchase of consumer transportation related to the receipt of habilitation services.

·      Habilitation and Consumer Training: Habilitation and training includes instruction and training in community living skills, personal living skills, social and communication skills, gross and fine motor skills, and activities of daily living.

See Also:

Division of Developmental Disabilities Programs

Sources:

http://www.state.sd.us/social/MedElig/LTC/Disabled.htm and http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=67:54

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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