South Dakota HOPE Waiver Waiting List: What to Do While You Wait

You got through the assessment, your parent qualifies clinically, the financial paperwork is submitted — and then you're told there's a waitlist. The HOPE waiver is South Dakota's primary Medicaid pathway for home and community-based services, but because it's a waiver (not an entitlement like standard Medicaid), the state can cap enrollment based on available funding and slot capacity.

How the HOPE Waiver Waitlist Works

Unlike standard Medicaid, which must serve everyone who meets eligibility criteria, HCBS waivers operate under a fixed number of authorized slots. When all slots are filled, approved applicants go on a waiting list maintained by the Division of Long Term Services and Supports (LTSS) under the Department of Human Services.

Ask your LTSS Specialist how South Dakota is handling your parent's position and whether changes in need can trigger a priority review. Do not assume that first-come order or acuity alone determines placement.

Waits can reach one to two years. Ask your LTSS Specialist for the current estimate for your parent's case.

What to Do While Waiting

A spot on the waitlist doesn't mean your parent goes without any help. Several options can bridge the gap:

Title III-E Caregiver Support (Older Americans Act): Dakota at Home can connect you with short-term respite and caregiver support services funded through the federal Older Americans Act. These don't require Medicaid eligibility and can provide limited in-home help, adult day care hours, or respite vouchers while you wait for the HOPE waiver.

Medicare Home Health: If your parent has a qualifying medical condition and is homebound, Medicare Part A covers skilled nursing visits, physical therapy, and occupational therapy on a short-term basis. This doesn't replace ongoing personal care, but it addresses acute medical needs.

Structured Family Caregiving through a provider agency: Contact an enrolled SFC provider to ask about requirements and timing, but the stipend begins only after HOPE service authorization.

Private pay at a reduced schedule: If the family can cover some costs out-of-pocket, even a few hours per week of nonmedical home care provides a safety baseline. Ask agencies about minimum-hour requirements — some offer flexible scheduling for families awaiting Medicaid approval.

Escalation Options

If your parent's condition is deteriorating while on the waitlist, contact your LTSS Specialist directly and document any changes — new falls, ER visits, increased confusion, weight loss — then ask whether a reassessment or priority review is available.

If you believe the wait is unreasonably long or your parent is at genuine risk, contact the South Dakota Department of Human Services/LTSS directly and ask what review or appeal process applies. The Long-Term Care Ombudsman is for complaints about facility resident rights and quality of care.

The Institutional Alternative Trap

Here's the structural tension families need to understand: if your parent enters a nursing home while waiting for the HOPE waiver, institutional Medicaid may be available under a separate pathway. Unlike HOPE, it is not limited by HCBS slots, but eligibility rules still apply. The state's 1988 nursing facility bed moratorium caps the total number of licensed beds statewide, but beds do become available. Some families end up choosing institutional placement not because it's what they want, but because the waiver waitlist forced their hand.

This is exactly the kind of decision point where preparation matters. Knowing the waitlist exists before you start the application — and having bridge strategies in place — keeps institutional placement as a genuine choice rather than a default.

The South Dakota Home Care Navigator covers the full HOPE waiver application timeline, including the bridge-care strategies families use most often when waiver slots aren't immediately available.

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