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SD Long Term Care - Medical Assistance Overview

If you reside in licensed long-term care hospital, nursing home, intermediate care facility, assisted living facility or adult foster care home, you may qualify for Medical Assistance.

NOTE: Eligibility for Long Term Care for participants of Home and Community Based Services is covered in the topic: HCBS Waiver Programs.

Eligibility Requirements

·      You must be 65 years or older, or be blind or disabled.

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

·      You must have medical needs that require a level of care provided in one of the above-mentioned facilities.

·      The resource limit is $2,000. Resources include items such as checking and 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.

·      Income Limits - The applicable Income Limit depends on the type of Long Term Care facility:

Hospitals, Nursing Homes, and Intermediate Care Facilities: The monthly income limit is 300% of the SSI Standard Benefit Amount.

Assisted Living and Adult Foster Care: The person's monthly income - minus allowable deductions (see below) - must be less than the current state reimbursement rate to assisted living or adult foster care facilities.

Allowable Deductions: The following deductions are allowed when determining eligibility for Assisted Living and Adult Foster Care and when determining the amount you must pay toward the cost of staying in the facility:

·      $60 Personal Needs Allowance

·      $75 Earned Income Deduction

NOTE: These amounts current as of April 2006. See: http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=67:46:04:05.

·      Private health insurance premiums

·      Medicare Part B premium

·      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.

·      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

Cost You Must Pay:

The Department of Social Services (DSS) pays the difference between the rate your facility charges and your income (after the above deductions). Your income includes any cash benefits such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI).

What this means to you is that most of your income, whether it comes from benefits or employment, will go toward the payment of your facilities bill.

Covered Services

In addition to having DSS pay all or part of the your facilities cost, 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 full list of covered services see: http://www.state.sd.us/social/Medical/Recipient/covered.htm.

Sources:

http://www.state.sd.us/social/MedElig/LTC/index.htm and http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=67:46

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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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