Medical Eligibility

Long-Term Care

Medical Assistance for Individuals in Adult Foster Care Facilities

Individuals in adult foster care homes that meet all eligibility criteria may qualify for Medical Assistance.

Eligibility Requirements

  • A person must be 65 years or older. If under age 65, a person must be blind or disabled.
  • A person must be a resident of South Dakota and meet certain citizenship requirements of the United States.
  • Medical needs of the individual are such that they require a level of care that must be provided in an adult foster care home.
  • The applicant’s monthly income minus allowable deductions must be less than the current state reimbursement rate to an adult foster care home.
  • The resource limit is $2,000. Resources include items such as checking and 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 provide payment or partial payment of a person's nursing home bill.

Basic Budget

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

  • $60 personal needs allowance
  • Private health insurance premiums
  • Medicare Part B premium
  • Spousal allowance
  • Dependent allowance

*Costs related to prescription drugs not covered by Medicaid, Medicare, or other liable third party.

Application

  • Apply Now!
  • After completing the application, return it to the local office where you live. If you need assistance completing this application or have any questions, contact your local DSS office.