South Dakota Long-Term Services and Supports LTSS
How South Dakota Organizes Long-Term Care
South Dakota's long-term care system is split across two state agencies. The Department of Human Services (DHS) handles clinical assessments and care coordination through its Division of Long Term Services and Supports (LTSS). The Department of Social Services (DSS) handles the financial side — Medicaid eligibility, applications, and benefit administration.
For families, this split means you are often dealing with two separate bureaucracies at the same time. DHS decides whether your parent clinically qualifies for services. DSS decides whether they financially qualify for Medicaid to pay for those services. Understanding who does what saves time and prevents the frustration of calling the wrong office.
Dakota at Home: The Front Door
Dakota at Home is the state's single point of entry for long-term care services. When a parent needs help — whether from a hospital discharge, a gradual decline, or a caregiver who can no longer manage alone — Dakota at Home is the first call.
Contact: 1-833-663-9673 or [email protected].
A Dakota at Home counselor will:
- Assess the situation and explain what programs may be available
- Connect the family with an LTSS Case Management Specialist for a clinical evaluation
- Refer the family to DSS for the Medicaid financial application if public funding is needed
The LTSS Case Management Specialist conducts the Home Care Assessment (HCA) — a standardized in-person evaluation of the parent's ability to perform activities of daily living (bathing, dressing, toileting, transferring, eating). The HCA results help determine whether the parent meets the nursing home level of care required for the HOPE waiver. Nursing-facility applicants separately undergo PASRR screening.
This clinical assessment is free and state-funded. It does not obligate the family to accept any particular service or apply for Medicaid.
Area Agencies on Aging
South Dakota's aging services are delivered through Area Agencies on Aging, regional planning districts, and tribal programs. These offices provide:
- Information and referral for community services (meal delivery, transportation, caregiver support)
- Medicare counseling through the SHINE program (Senior Health Information and Insurance Education)
- Caregiver support programs, including respite care referrals
For families in rural areas, the regional aging services office may be the most accessible resource for understanding what non-Medicaid supports are available — things like home-delivered meals, volunteer transportation, and community-based adult day programs that can supplement formal care.
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The Long-Term Care Ombudsman
The Ombudsman program, managed by DHS, is an independent advocacy office for residents of nursing homes, assisted living facilities, and adult foster care homes. The Ombudsman's role is to investigate complaints, mediate disputes between residents and facilities, and ensure that residents' rights are protected.
Common situations where the Ombudsman can help:
- A facility is threatening to discharge a resident for nonpayment during a Medicaid application
- A resident's personal belongings are missing or being restricted
- A family suspects neglect, poor care, or understaffing
- A resident is being moved to a different room or unit without consent
The Ombudsman is not a regulatory enforcement body — they cannot fine or shut down a facility. For serious safety violations (abuse, severe neglect), families should contact the Department of Health's Office of Health Care Facilities Licensure & Certification directly at 1-800-738-2301 or [email protected].
HOPE Waiver Waiting Lists
The HOPE waiver is South Dakota's primary home and community-based services program for people who meet nursing home level of care but want to remain at home. Its capacity is set by the number of slots approved in the state's waiver agreement with CMS.
When all slots are filled, new applicants go on a waiting list. The wait time varies depending on the region and the number of people ahead in the queue. During the wait:
- The clinical assessment and level of care determination remain valid for a period, but may need to be repeated if the wait extends beyond the certification window
- The family remains responsible for arranging and paying for care privately
- The applicant must remain clinically and financially eligible — if their condition improves or their assets change, they may need to requalify when a slot opens
If a parent's condition deteriorates significantly while on the waiting list and they need immediate nursing home placement, they can apply for institutional Medicaid separately. Being on the HOPE waiver waiting list does not prevent or delay a nursing home Medicaid application.
Putting the Pieces Together
The LTSS system is the clinical pathway. Medicaid is the financial pathway. Both must align for a parent to receive publicly funded long-term care in South Dakota. Dakota at Home coordinates the clinical side, DSS handles the financial side, and the Ombudsman steps in when something goes wrong at the facility level.
The South Dakota Medicaid Long-Term Care & Asset Protection Guide maps both pathways step by step — from the initial Dakota at Home intake through the HOPE waiver or nursing home placement, the Medicaid application, and the financial protections available to the applicant and their spouse.
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Download the South Dakota — Medicaid Long-Term Care Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.