South Dakota Home Modifications for Seniors: Medicaid Coverage and Funding Options

What Medicaid Covers Under the HOPE Waiver

If your parent is enrolled in South Dakota's HOPE Waiver, environmental accessibility adaptations are a covered benefit. This means Medicaid can pay for structural modifications to your parent's home that directly address their safety and functional limitations.

Covered modifications typically include:

• Grab bars in bathrooms and along hallways
• Wheelchair ramps at entrances
• Doorway widening to accommodate walkers or wheelchairs
• Bathroom modifications — roll-in showers, raised toilets, accessible vanities
• Handrail installation on stairways and in transition areas
• Non-slip flooring in high-risk areas (bathroom, kitchen, entryways)
• Threshold modifications to eliminate tripping hazards between rooms

The modifications must be recommended as part of your parent's LTSS care plan. The LTSS Specialist authorizes them based on the functional assessment — meaning the home changes need to connect directly to your parent's documented physical limitations, not just be generally convenient.

There are cost caps on waiver-funded modifications, and the work must be performed by approved contractors. Your LTSS Specialist coordinates the authorization process.

DakotaLink: South Dakota's Assistive Technology Program

Beyond structural modifications, your parent may benefit from assistive devices — and South Dakota has a dedicated program for this.

DakotaLink is the state's assistive technology program, providing assessments, device demonstrations, and distribution of adaptive equipment for daily living. DakotaLink helps seniors find and access:

• Specialized kitchen tools (rocker knives, jar openers, plate guards)
• Adaptive dressing aids (button hooks, long-handled shoe horns, sock aids)
• Mobility devices (transfer poles, bed rails, portable ramps)
• Communication devices for hearing or speech impairments
• Medication management systems (automatic dispensers, large-print organizers)

DakotaLink offers free assessments — an assistive technology specialist evaluates your parent's daily challenges and recommends specific devices. Some devices are available through the program's lending library for trial before purchase. Others can be funded through the HOPE Waiver's assistive daily living services or through Medicaid durable medical equipment (DME) coverage.

Contact DakotaLink at 1-800-645-0673 or through dakotalink.net.

The DIY Safety Audit: What to Fix Before the Formal Assessment

You don't need to wait for Medicaid authorization to address the most immediate hazards. A weekend of targeted fixes can meaningfully reduce fall risk.

Bathroom (highest-risk room):

• Install grab bars next to the toilet and inside the shower/tub (use proper wall anchors into studs — suction-cup bars fail under load)
• Place non-slip mats inside the tub and on the bathroom floor
• Remove glass shower doors and replace with a curtain (glass shatters during a fall)
• Add a handheld showerhead and shower bench if your parent can't stand safely

Hallways and transitions:

• Remove throw rugs entirely — they're the single most common trip hazard
• Ensure adequate lighting with motion-activated night lights along paths from bedroom to bathroom
• Clear clutter from hallways and stairways
• Tape down or remove any raised carpet edges or transition strips

Kitchen:

• Move frequently used items to counter level or lower shelves (no reaching above shoulder height)
• Replace round doorknobs with lever handles if grip strength is limited
• Install an automatic stove shutoff device if your parent forgets burners

Entrances:

• Ensure handrails exist on both sides of exterior steps
• Check that steps are even, stable, and well-lit
• If your parent uses a walker, a temporary threshold ramp ($30–$80 at most hardware stores) eliminates the most common entry-point stumble

Funding Sources Beyond Medicaid

If your parent isn't on the HOPE Waiver — or if needed modifications exceed the waiver's cost caps — other funding exists:

VA Home Modification Grants: Eligible veterans with service-connected disabilities may qualify for VA housing-adaptation or home-improvement grants. The program, grant limit, and eligibility depend on the modification and disability, so check current VA rules before relying on a grant amount.

USDA Rural Development: The Section 504 Home Repair program may offer grants or loans to qualifying very-low-income rural homeowners to repair or modify their homes for safety and accessibility. Check current income, location, and funding limits before applying.

Area Agencies on Aging: Local aging services sometimes offer small grants or volunteer labor programs for basic home safety modifications — particularly grab bar installation and ramp building. Contact Dakota at Home (1-833-663-9673) to ask about what's available in your parent's county.

Tax deductions: Home modifications prescribed by a physician for a medical condition may qualify as deductible medical expenses on federal taxes if they don't increase the home's value. Consult a tax professional, but keep receipts and the physician's recommendation.

Getting the Modifications Authorized

If your parent is on the HOPE Waiver, the process runs through their LTSS Specialist:

1. The LTSS Specialist documents the functional need during the care plan review
2. An occupational therapist or home safety assessor evaluates the home (sometimes the LTSS Specialist does this directly)
3. The specialist authorizes specific modifications and a budget
4. An approved contractor performs the work
5. The LTSS office inspects the completed modifications

The South Dakota Home Care Navigator includes a home safety assessment checklist that mirrors the criteria LTSS Specialists use, so you can identify needed modifications before the formal evaluation.

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