If you or your family member has South Dakota Medicaid and needs a wheelchair ramp, grab bars, or other accessibility work at home, the HOPE Waiver may help pay for it. HOPE stands for Home and Community-Based Options and Person-Centered Excellence. It is run by the South Dakota Department of Social Services (DSS), working with the Department of Human Services' Division of Long Term Services and Supports (LTSS). The waiver covers what the state calls Environmental Accessibility Adaptations (EAA), physical changes to a home that support health, safety, and independence.
What South Dakota offers#
HOPE is a 1915(c) waiver, renamed in 2018 from the former HCBS Elderly waiver. It serves people age 65 and up, or age 18 and up with a qualifying disability. A qualifying disability means the person receives Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), or has been determined disabled by the state's Disability Review Team. Everyone must also meet institutional level-of-care criteria under the Administrative Rules of South Dakota (ARSD) 67:45:01, measured through a standardized Home Care Assessment (HCA).
EAA covers physical adaptations to the participant's home, or a family member's home if that is where the participant lives, when the change is necessary for health, welfare, safety, or greater independence. The need must be assessed and written into the participant's Individual Service Plan (ISP). Covered examples include ramps, grab bars, widened doorways, bathroom modifications, and specialized electrical or plumbing work for medical equipment.
EAA does not cover general utility improvements or routine repair and maintenance. It also will not pay for added square footage, except when extra space is genuinely required to complete an approved adaptation, such as widening a bathroom for a wheelchair. One detail worth planning around: EAA is not available to participants living in assisted living, since accessibility changes there are bundled into that setting's own service instead.
Amounts and eligibility#
South Dakota does not publish a dollar cap on EAA. There is a processing detail that sometimes gets mistaken for a limit: when the authorized EAA work totals more than $5,000, the provider must attach a Therap Service Authorization to the claim for supervisor review. That is a paperwork checkpoint, not a ceiling on what can be approved.
The process also builds in a quality check. The EAA provider bills an Initial Assessment, during which it gathers project specifics and collects at least two bids, and later a Final Assessment, during which it inspects the completed work. Families are not left to vet contractor bids alone.
Financial eligibility follows the same rule used across many state waivers: gross income up to 300% of the federal SSI standard, which is $2,982 per month for an individual in 2026. DSS's Division of Economic Assistance may also apply a cost share, meaning Medicaid covers part of the cost and the participant pays the difference. Participants keep a standard needs allowance, also set at 300% of the SSI standard, before any cost share applies.
South Dakota has not published a waitlist for the HOPE Waiver. Contact Dakota at Home directly for current availability in your area.
How to apply in South Dakota#
Start with Dakota at Home at 1-833-663-9673, the state's long-term services entry point, or contact your local DSS office directly. A DSS Long Term Care Benefits Specialist determines financial eligibility, while the Home Care Assessment establishes functional eligibility.
South Dakota does not deliver the HOPE Waiver through managed care. Once your ISP is approved, your EAA provider handles the assessments and bids directly, and South Dakota Medicaid pays the provider, not an insurance plan. For general questions about aging services in the state, Dakota at Home (dakotaathome.org) is the primary contact point, with the federal Eldercare Locator (eldercare.acl.gov, 1-800-677-1116) as a fallback.
How it stacks with federal programs#
If the person needing modifications is a veteran, check VA housing grants alongside Medicaid. Programs like Specially Adapted Housing can fund larger projects and may stack with waiver services. See our VA home modification grants guide.
Original Medicare does not cover structural home modifications. Some Medicare Advantage plans offer supplemental benefits like grab bars or ramps, but coverage is plan-specific with no standard amount. Call your plan directly to ask what it covers.
Finding a provider who knows this program: Not every contractor has handled HOPE Waiver paperwork and billing. Adapta Home USA verifies providers' Medicaid Waiver Billing experience, so you can filter for pros who have done this before. Find Home Modifications & Remodeling providers with Medicaid Waiver Billing experience →
For the bigger picture on combining programs, see our national Medicaid HCBS waiver guide and our full guide to paying for home modifications.
FAQ#
Does South Dakota Medicaid pay for home modifications like wheelchair ramps or grab bars?#
Yes. The HOPE Waiver covers Environmental Accessibility Adaptations, which include ramps, grab bars, widened doorways, and bathroom modifications, when the need is assessed and documented in your Individual Service Plan.
What is the HOPE Waiver and who is eligible?#
HOPE stands for Home and Community-Based Options and Person-Centered Excellence, a 1915(c) Medicaid waiver run by South Dakota DSS. It serves people 65 and up, or 18 and up with a qualifying disability, who meet institutional level-of-care criteria confirmed through a Home Care Assessment.
Is there an income limit for South Dakota's HOPE Waiver in 2026?#
Yes. The limit is 300% of the federal SSI standard, which is $2,982 per month for an individual in 2026. A cost share determined by DSS may also apply, and participants keep a standard needs allowance before that cost share is calculated.
How do I apply for the HOPE Waiver in South Dakota?#
Contact Dakota at Home at 1-833-663-9673 or your local Department of Social Services office. A DSS Long Term Care Benefits Specialist reviews financial eligibility, while a Home Care Assessment determines functional eligibility.
Find a verified provider near you#
Adapta Home USA's directory lets you search Home Modifications & Remodeling providers by state and filter for Medicaid Waiver Billing experience. Our wheelchair ramp cost guide can help you budget while your application is in process.
This article is for general educational purposes only and does not constitute medical, legal, or financial advice. Consult a qualified professional about your specific situation.
Program amounts, eligibility rules, and application procedures change. Figures on this page were verified against official government sources on the date shown, but you should confirm current details at VA.gov or with the administering agency before making decisions. Adapta Home USA is not affiliated with the U.S. Department of Veterans Affairs or any government agency.