South Dakota Medicaid Definition
Medicaid in South Dakota is administered by the South Dakota Department of Social Services (DSS) agency.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of South Dakota residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled children and adults, and seniors. However, the focus of this webpage is strictly on Medicaid eligibility for South Dakota elders, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which South Dakota seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that South Dakota offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program, which is provided only in nursing homes. This means anyone who meets the requirements will receive assistance.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged, Blind, and Disabled – this is an entitlement program, which means all eligible applicants are able to receive services. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an South Dakota Medicaid program. Alternatively, persons can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for South Dakota Medicaid. More.
|2020 South Dakota Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,349 / month*||$2,000||Nursing Home||$4,698 / month (Each spouse can have up to $2,349)*||$3,000||Nursing Home||$2,349 / month for applicant*||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Nursing Home||$4,698 / month (Each spouse can have up to $2,349)||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$783 / month||$2,000||None||$1,175 / month||$3,000||None||$1,175 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted towards the income limit. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits (with the exception of the VA Aid & Attendance Pension), railroad retirement, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, inheritance, and stock dividends.
When only one spouse of a married couple is applying for Medicaid for nursing home care or home and community based services via a waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded and does not affect the applicant spouse’s eligibility. That said, the way income is counted for regular Medicaid in which only one spouse of a married couple is applying for benefits is different. Regardless of if one, or both spouses, are applying for regular Medicaid, the income of both spouses is counted towards the income limit. Learn more about how Medicaid counts income here.
For married couples with non-applicant spouses’ (of nursing home Medicaid applicants or HCBS Medicaid waiver applicants), there is a spousal impoverishment provision called the Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to ensure non-applicant spouses have sufficient monthly incomes. In simple terms, if the non-applicant spouse, also called the community spouse or well spouse, has income under $2,155 / month (this figure is effective July 2020 – June 2021), he or she is entitled to a portion of the applicant spouse’s income, bringing the non-applicant’s monthly income to this amount. If the well spouse has income equivalent to $2,155 / month or more, he or she may be entitled to a greater amount of the applicant spouse’s income, given their shelter and utility costs are high. Please note, the maximum monthly income the non-applicant spouse may be entitled to is $3,216 / month (this figure is effective January 2020 – December 2020).
*As indicated in the chart above, there is an income limit to be eligible for nursing home Medicaid. However, a beneficiary cannot keep monthly income up to this level. Instead, all income, with the exception of a personal needs allowance of approximately $60 / month, and potentially a non-applicant spousal income allowance, must be paid to the nursing home.
What Defines “Assets”
Countable assets include cash, certificates of deposit, stocks, bonds, annuities, credit union, savings, checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are many assets that are not counted. In other words, they are exempt from the asset limit. Exemptions include personal belongings, such as clothing, household furnishings and appliances, an automobile, select prepaid funeral contracts, and one’s primary home (given conditions are met). For the home to be exempt, a single Medicaid applicant must live in it or have an “intent” to do so, and his / her equity interest in the home must be no more than $595,000 (in 2020). (Equity interest is the amount of the home’s value owned by the applicant). The home is also exempt, regardless of any other circumstances, when an applicant is married and his / her non-applicant spouse lives in it.
For married couples (with one spouse as a nursing home Medicaid applicant or a HCBS waiver applicant), as of 2020, the community spouse can retain half of the couples’ joint assets (up to a maximum of $128,640), as the chart indicates above. That said, if a couple has resources equal to or less than $25,728, the non-applicant spouse is able to retain 100% of the assets. This spousal impoverishment rule is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from having too little from which to live. To be clear, this resource allowance for non-applicant spouses does not apply to couples with one spouse applying for regular Medicaid.
Please note: It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because South Dakota has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers (even ones made by non-applicant spouses) to ensure no assets were sold or given away for less than they are worth. Some persons wrongly believe that the IRS gift tax exemption also applies to Medicaid, and therefore, violate Medicaid’s look back rule unknowingly. If one is found to be in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For elderly South Dakota residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are special trusts for Medicaid applicants who are over the income limit, yet still cannot afford to pay for their long-term care. This type of trust, also called a Medicaid Income Trust in South Dakota, offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid income limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. The account must be irrevocable, meaning once it has been established, it cannot be changed or canceled, and must have the South Dakota Department of Social Services listed as the remainder beneficiary. In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee, and, if applicable, the Medicaid enrollee’s personal needs allowance and an income allowance for a community spouse.
Unfortunately, Qualified Income Trusts do not assist one in qualifying for Medicaid if their assets are over the eligibility limit. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in “spending down” their excess assets. However, one can “spend down” assets by spending assets over the asset limit on non-countable ones. Examples include home modifications and additions (wheelchair ramps, roll-in showers, stair lifts, and adding first floor bedrooms), home improvements (replacing faulty electrical wiring, updating plumbing, and replacing old water heaters), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific South Dakota Medicaid Programs
1) Personal Care Services – part of the state Medicaid plan, this program is intended to prevent unnecessary nursing home placements and provides personal care in the homes of eligible applicants. Benefits include help with bathing and grooming, dressing and undressing, eating, mobility, shopping for essentials, light housework, and meal preparation.
2) HOPE (Home and Community-Based Options and Person Centered Excellence) Waiver – previously called the HCBS Waiver for the Elderly, this waiver is also a nursing home diversion program and provides benefits in one’s home or an assisted living facility. Available benefits may include adult day care, private duty nursing, homemaker services, personal care assistance, home modifications, emergency response systems, and more.
How to Apply for South Dakota Medicaid
South Dakota seniors can apply for Medicaid online at DSS South Dakota. Alternatively, persons can download an “Application for Long Term Care Related Programs” from this webpage (at the bottom of the page) and return the completed application to their local DSS office. Seniors can also call 800-305-3064 to ask that an application be mailed to their home, ask Medicaid related questions, or request assistance with the application process. Please note that the application process may vary based on the program in which a senior is applying.
Prior to submitting a Medicaid application for long-term care in South Dakota, it is imperative that seniors are certain that all eligibility requirements, as discussed above, are met. Persons who have excess income and / or assets should seriously consider Medicaid planning for the best chance of acceptance into a Medicaid program. For general information about the long-term care Medicaid application process, click here.