South Dakota Home and Community-Based Services for Seniors: Dakota at Home, ADRC, and HOPE Waiver
When a South Dakota senior starts needing help at home — with meals, bathing, medication reminders, or getting to medical appointments — the question is rarely "what's available?" It's "which program, which agency, and how do I get in?" The state has several overlapping systems, and families waste weeks bouncing between the wrong ones.
Here's how the main programs connect and where to start.
Dakota at Home and the ADRC
Dakota at Home is South Dakota's Aging and Disability Resource Center (ADRC), part of the Long-Term Services and Supports (LTSS) system administered through the Department of Human Services. It serves as the front door for aging and disability services statewide.
The Aging and Disability Resource Center (ADRC) operates under the Dakota at Home umbrella. The ADRC is an information and referral hub — call them, describe your parent's situation, and they'll identify which programs apply and help connect you to the right agency. This is the single best starting point for families who don't know which program they need.
Contact Dakota at Home at 1-833-663-9673, or visit dakotaathome.sd.gov.
The ADRC can help identify aging and disability service options and connect you with the right agency. For Medicare Savings Program eligibility screening, contact SHIINE; DSS handles the applications.
The HOPE Waiver
South Dakota's HOPE (Home and Community-Based Options and Person Centered Excellence) Waiver is a Medicaid Home and Community-Based Services (HCBS) program. It pays for services that help eligible seniors stay in the community instead of moving to a nursing facility:
- Personal care assistance (bathing, dressing, grooming)
- Homemaker services (meal preparation, housekeeping)
- Adult day services
- Respite care for family caregivers
- Environmental modifications (wheelchair ramps, grab bars)
- Assistive technology
HOPE Waiver eligibility requires meeting both Medicaid financial criteria and a nursing-facility level of care determination. The financial requirements are stricter than Medicare Savings Programs — generally, income must be under the Medicaid institutional limit (the Special Income Level or through a Qualified Income Trust), and resources are limited.
One important distinction: HOPE Waiver costs are subject to Medicaid estate recovery under SDCL 28-6-23. After the recipient passes, South Dakota DSS can seek repayment from the estate for HCBS services provided while the person was age 55 or older. This is different from Medicare Savings Programs, which are federally exempt from estate recovery.
How These Programs Connect to Medicare Savings
Medicare Savings Programs and home care programs serve different needs but often apply to the same person. A senior who qualifies for the HOPE Waiver to receive personal care at home may also qualify for QMB, depending on the separate Medicare Savings Program income and resource rules.
The programs don't conflict — they can be combined when a person qualifies for each. QMB handles Medicare cost-sharing. The HOPE Waiver handles personal care. Extra Help (triggered automatically by MSP enrollment) reduces prescription costs. Together, they can lower a low-income senior's out-of-pocket costs for covered care and prescriptions.
SHIINE can screen for Medicare Savings Program eligibility. If your parent's immediate need is specifically Medicare premium relief (the $202.90 monthly Part B deduction from Social Security), the application is handled separately through the DSS Division of Economic Assistance using Form DSS-EA-270. The Medicare Savings Program application guide walks through that process.
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SHIINE for Medicare-Specific Questions
For questions specifically about Medicare plan choices — which Part D drug plan covers your parent's medications, whether to choose Medicare Advantage or Original Medicare, what Medigap supplement to buy — the right resource is SHIINE (Senior Health Information & Insurance Education), not the ADRC. SHIINE handles Medicare plan navigation; the ADRC handles long-term care and aging services.
SHIINE regional contacts:
- Eastern Region (Sioux Falls): 800-536-8197
- Central Region (Pierre): 877-331-4834
- Western Region (Rapid City): 877-286-9072
Where to Start
If your parent needs help at home, call Dakota at Home at 1-833-663-9673. If the immediate issue is Medicare costs eating into a Social Security check, start with the South Dakota Medicare Savings Program guide — the eligibility calculation takes less than five minutes, and the Part B premium savings start within 60–90 days of approval.
Get Your Free South Dakota — Medicare Savings Program Eligibility Checklist
Download the South Dakota — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.