How to Access the HOPE Waiver After Hospital Discharge in South Dakota

If your parent just had a hospital stay in South Dakota and needs nursing-facility-level care but you want them home instead of in a nursing home, the HOPE waiver is the mechanism that makes this possible. Here's the direct path: call Dakota at Home (833-663-9673) before discharge to request a Home Care Assessment. Do not wait until your parent is home — the assessment scheduling backlog in rural counties can add weeks of delay, and the hospital discharge team will not initiate this referral for you.

The HOPE waiver — Home and Community-Based Options and Person-Centered Excellence — allows individuals who qualify for nursing facility placement to receive equivalent care in their home or an assisted living community. It covers personal care, homemaker services, case management, respite care, and environmental modifications. But accessing it during a hospital discharge requires hitting specific steps in the right order, and the gap between "eligible" and "receiving services" is where most families get stuck.

HOPE Waiver Eligibility Requirements

Your parent qualifies for the HOPE waiver if they meet all three conditions:

1. Nursing-facility level of care — a clinical determination that your parent needs the type of ongoing assistance typically provided in a nursing home (help with multiple activities of daily living, medication management, skilled nursing oversight)
2. Residing in a non-institutional setting — home, apartment, or assisted living community (not a nursing facility)
3. Cost control — the total cost of HOPE waiver services must be less than 85% of comparable nursing facility care

The clinical determination happens through the Home Care Assessment (HCA), conducted by a Long Term Services and Supports (LTSS) Case Management Specialist. This is not a form you fill out yourself — it's an in-person evaluation of your parent's functional abilities, cognitive status, and care needs.

The Step-by-Step Process

Step 1: Call Dakota at Home Before Discharge

Contact Dakota at Home at 833-663-9673 while your parent is still in the hospital. Tell them your parent is being discharged and you want to explore the HOPE waiver. They'll connect you with the regional LTSS office that covers your parent's home county.

Step 2: Request the Home Care Assessment

The LTSS Case Management Specialist will schedule an in-person Home Care Assessment. In the Sioux Falls and Rapid City metro areas, this typically happens within 1–2 weeks. In rural and frontier counties (Meade, Lyman, Spink, and others), scheduling can take 3–4 weeks because specialists cover large geographic areas.

This is the bottleneck. The HCA cannot be done remotely or by phone. The specialist must evaluate your parent in person — at home, at the hospital, or at a transitional facility.

Step 3: Bridge the Gap

If your parent is discharged before the HCA is completed, you're in a care vacuum. Options to bridge this gap:

• Medicare home health — if your parent has a qualifying hospital stay (3+ consecutive inpatient days) and needs skilled nursing or therapy, Medicare covers home health for the initial recovery period. This is separate from HOPE waiver services.
• Private-pay home care — hiring a home care aide out of pocket while waiting for the HOPE waiver to activate. Rates in South Dakota range from $20–$30 per hour.
• Family caregiving — the most common bridge, and the one that creates the most caregiver burnout. If this is your only option, document everything — hours, tasks, expenses — because the HOPE waiver's respite care benefit can provide relief once services begin.

Step 4: Service Plan Development

After the HCA confirms nursing-facility level of care, the LTSS specialist develops a person-centered service plan. This plan specifies which services your parent will receive, how many hours per week, and which Medicaid-enrolled providers will deliver them.

The cost-control cap matters here: total HOPE waiver services cannot exceed 85% of what comparable nursing facility care would cost. In practice, this means the service plan is budget-constrained. If your parent needs 24/7 supervision, the HOPE waiver may not cover enough hours — and the specialist will tell you this during the planning process.

Step 5: Provider Enrollment and Service Start

Once the service plan is approved, you need Medicaid-enrolled home care providers willing to serve your parent's county. In metro areas, this is straightforward. In rural counties, provider availability is the second major bottleneck — some areas have no enrolled providers within reasonable travel distance.

Common Obstacles and How to Handle Them

The hospital discharge planner doesn't mention the HOPE waiver. This is normal. Hospital discharge planners focus on immediate post-acute placements (SNF, home health) and may not be familiar with HCBS waiver programs. You need to initiate the referral yourself through Dakota at Home.

The HCA can't be scheduled before discharge. Ask the LTSS office whether the assessment can be conducted at a transitional facility or whether a temporary SNF stay can serve as a bridge while the HCA is completed. A short SNF stay doesn't disqualify your parent from the HOPE waiver once they return home.

Your parent's income exceeds the $2,982 monthly Medicaid cap. A Miller Trust (Qualified Income Trust) can resolve this. The trust holds income above the cap and pays it directly to the care providers. An elder law attorney can draft the trust document, typically for $1,500–$3,000.

Rural provider shortage. If no Medicaid-enrolled providers serve your parent's county, ask the LTSS specialist about self-directed services, where your parent (or you, as representative) hires and manages caregivers directly through the waiver program.

Who This Is For

• Families whose parent was just hospitalized and needs ongoing nursing-level care but wants to return home
• Adult children evaluating whether to place a parent in a nursing facility or pursue home-based care through the HOPE waiver
• Caregivers in rural South Dakota counties where nursing facility placement would move a parent far from family
• Families who want to understand the process and timeline before making a discharge decision

Who This Is NOT For

• Parents who need short-term rehabilitation only (Medicare home health or SNF rehab covers this without the HOPE waiver)
• Families seeking immediate 24/7 in-home care (the HOPE waiver's cost cap may not cover full-time supervision)
• Parents already enrolled in HOPE waiver services before the hospitalization

The Hospital-to-Home South Dakota guide includes a complete HOPE waiver roadmap with the referral timeline, HCA preparation checklist, and provider coordination worksheets — covering each step from the initial Dakota at Home call through service activation.

Frequently Asked Questions

How long does it take to start receiving HOPE waiver services after a hospital discharge?

From the initial call to Dakota at Home through HCA completion, service plan approval, and provider enrollment, expect 4–8 weeks in metro areas and 6–12 weeks in rural counties. This is why starting the process before discharge is critical — the earlier you call, the shorter the gap.

Can my parent receive HOPE waiver services in assisted living?

Yes. The HOPE waiver covers services in assisted living communities, not just private homes. The nursing-facility level of care determination and cost cap still apply, but the setting can be any non-institutional residence.

What happens if HOPE waiver services aren't enough?

If your parent's care needs exceed what the HOPE waiver can provide within the 85% cost cap, the LTSS specialist will discuss nursing facility placement as an alternative. The guide's facility comparison scorecard helps you evaluate SNF options if this becomes necessary.

Is there a waiting list for the HOPE waiver in South Dakota?

South Dakota does not currently maintain a formal waiting list for the HOPE waiver, but practical delays from HCA scheduling and provider availability create de facto waits, especially in rural areas.

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