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SD HCBWS - Medical Assistance - Individuals with Quadriplegia

Individuals with quadriplegia living independently in their own homes who would require Nursing Home Care if not for Home and Community Based Waiver Services (HCBWS) performed in their home may be eligible for Medical Assistance.

Eligibility Requirements

      You must be age 18 older and have quadriplegia.

      You must require a nursing facility level of care

      You must be receiving Supplemental Security Income (SSI) - 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.

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 SSI standard benefit amount plus $20 for your personal needs; and

      If you are employed, a deduction of $400 from gross wages for work expenses; 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 Temporary Assistance for Needy Families 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:

      Case Management: Monitor and assist an individual to gain access to services in their care plan.

      Consumer Preparation: Trains the individual in areas such as medical self-care, activities of daily living, time management and management of personal attendant.

      Personal Attendant: Completes tasks on behalf of the individual or assists in the completion of tasks.

      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.

Sources:

http://www.state.sd.us/social/MedElig/LTC/Quadriplegics.htm (General Information)
http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=67:54 (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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