Overview of South Dakota Medicaid Personal Care Services
South Dakota’s Medicaid State Plan Personal Care Services (PCS) provides personal care assistance for South Dakotans who are aged and disabled. Intended to assist these persons in living independently at home, program participants receive assistance with their daily living activities. This includes bathing and grooming, dressing and undressing, mobility, medication assistance, and eating.
Program participants can live in their own home or that of a loved one. PCS are not available to persons residing in assisted living residences or adult foster care homes.
While many home and community based services (HCBS) Medicaid programs allow program participants to self-direct their own care, specifically allowing them to hire their own caregiver, this is not an option for State Plan Personal Care Services. Instead, program participants must receive personal care services via a licensed Medicaid personal care agency (provider agency).
South Dakota’s Medicaid Personal Care Services are available through the state’s Regular Medicaid Plan. PCS are an entitlement. This means meeting the state’s Medicaid eligibility requirements guarantees one will receive assistance; there is never a waiting list for program participation.
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. This means meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they are filled, a waitlist for benefits forms. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of Personal Care Services
Program participants can receive up to 500 hours / year of Personal Care Services. Assistance with the following activities may be provided.
– Bathing / Showering
– Dressing / Undressing
– Eating
– Household Services – related to medical need and essential to health
– Maintenance Nursing – i.e., injections, medication monitoring, blood draws
– Medication Assistance – with medications that are generally self-administered
– Personal Hygiene / Grooming – i.e., nails, skin, hair, shaving
– Toileting
Eligibility Requirements for South Dakota Medicaid Personal Care Services
PCS are for South Dakota residents 18+ years of age. Additional eligibility criteria follow and are relevant for seniors.
Financial Criteria: Income, Assets & Home Ownership
Income
In 2024, the individual applicant income limit is $943 / month. For a married applicant, regardless of if one spouse or both spouses is applying, the income limit is $1,415 / month.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, it is $3,000, regardless of whether one spouse or both are applicants.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it does not apply to South Dakota’s State Plan Personal Care Services.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, SD Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “Intent” to Return.
– A spouse lives in the home.
– The applicant has a permanently disabled or blind child living in the home.
– The applicant has a minor child (under 21) living in the home.
Unlike other SD Medicaid programs that offer long-term care, such as Nursing Home Medicaid and the HOPE Waiver, applicants for State Plan Personal Care Services do not have a home equity interest limit for home exemption. Learn more about home exemption and when Medicaid can and cannot take the home here.
Medical Criteria: Functional Need
While many Medicaid long-term care programs require an applicant to need a Nursing Facility Level of Care (NFLOC), this is not required for State Plan Personal Care Services. The need for assistance, however, must be “medically necessary”. To make this determination, a needs assessment is completed. A need for assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is generally indicative that the level of care need will be met. ADLs and IADLs include bathing, dressing, toileting, mobility, eating, preparing meals, and light housework. While persons with Alzheimer’s disease or a related dementia might meet the functional need for care, a diagnosis of dementia in and of itself does not mean one will do so.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for SD Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Utilizing Miller Trusts, called Medicaid Income Trusts in South Dakota, is a common strategy used to lower an applicant’s monthly countable income for long-term care Medicaid eligibility. Essentially, “excess” income is deposited into the trust, no longer counting as income. However, these trusts are not permitted for applicants to become income-eligible for State Plan Personal Care Services.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons may also “spend down” countable assets on assets that Medicaid considers to be exempt (non-countable). Examples include making home reparations and modifications, purchasing home furnishings, and even taking a vacation. There are many other planning strategies available when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in South Dakota to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month Look-Back Rule does not apply for State Plan Personal Care Services, it does apply to Nursing Home Medicaid and the HOPE Medicaid Waiver. As more extensive Medicaid-funded care might be required in the future, it is vital that one not violate the Look Back Rule. Medicaid planning strategies should ideally only be implemented with careful planning and well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for South Dakota Medicaid Personal Care Services
Before You Apply
Prior to submitting an application for State Plan PCS, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Application Process
To be eligible for State Plan Personal Care Services, one must be eligible for SD Medicaid. Persons can apply via their local Department of Social Services office. A mailed application can be requested by calling 800-305-3064. Very limited information about Personal Care Services can be found here. Persons can also call Dakota at Home at 833-663-9673 for more information.
Personal Care Services are administered by South Dakota’s Department of Social Services (DSS) and are operated by the Department of Human Services’ (DHS) Division of Long-Term Services and Supports (LTSS).
Approval Process & Timing
The South Dakota Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.