Medical Eligibility

Long-Term Care

Elderly Individuals who would Require Nursing Home Care
if not for Special Services Performed in their Home

Elderly individuals living independently in their own homes may be eligible for Medical Assistance.

Eligibility Requirements

  • A person must be in need of nursing facility care.
  • A person must not be a resident of a hospital, nursing facility or an intermediate care facility for the mentally retarded.
  • A person must be a resident of South Dakota and meet certain citizenship requirements of the United States.
  • The monthly income limit is 300 percent of the SSI Standard Benefit Amount. ($2,022)
  • The resource limit is $2,000. Resources include items such as checking or savings accounts and certificates of deposit.

Covered Services

Individuals who are eligible are entitled to full Medical Assistance coverage. Covered services include doctor appointments, hospital stays, dental and vision services, prescription drugs, rehab/therapy, chiropractic, etc.

In addition, Medical Assistance will cover the following services:

  • Homemaker Services: Teaching and providing home management skills, promoting self-care, making beds, changing linens, washing dishes, laundry work, floor care and housecleaning. Providing meal preparation, shopping and menu planning. Providing non-medical assistance in mobility, personal comfort and grooming of the individual. Arranging for transportation.
  • Private Duty Nursing: Nursing services provided by a licensed nursing professional for recipients with chronic and stable conditions who require more individual and continuous care than is available from a part-time or intermittent nursing service.
  • Adult Day Care: Services providing out-of-home structured health and social services on a regularly scheduled basis and in daytime settings.
  • Emergency Response Systems: An emergency response system is an electronic device enabling individuals to alert neighbors or family and summon assistance in the event of an emergency.
  • Meals-Nutritional Supplements: Meals may be arranged in those areas where no home delivered meals program is available. The service may include a prepared meal, a frozen entrée or a nutritional supplement.

Basic Budget

Once a person is eligible, all income after allowable deductions must be applied to the monthly cost of care. Deductions may include:

  • $657 personal allowance (2008)
  • Private health insurance premiums
  • Medicare premiums
  • Spousal allowance
  • Dependent allowance
  • Co-pay for prescriptions