South Dakota Medicaid pays for in-home personal care and related services through 3 programs, including the HOPE Waiver (Home and Community-Based Options and Person-Centered Excellence) and the Assistive Daily Living Services (ADLS) Waiver. South Dakota has four 1915(c) waivers: HOPE (DHS Long Term Services and Supports), ADLS (DHS Rehabilitation Services), and Family Support 360 and CHOICES (DHS Developmental Disabilities); DSS is the Medicaid agency. HOPE, ADLS and FS360 EVV data did not yet have to go through the Therap aggregator per the February 2024 manual. A HOPE renewal effective 2026-10-01 was pending CMS approval and was not confirmed.
Yes. South Dakota covers State Plan Personal Care, overseen by DHS, including personal care (T1019) and homemaker (S5130), and it has been subject to EVV since 2021-01-01.
Which South Dakota waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
HOPE Waiver (Home and Community-Based Options and Person-Centered Excellence)
Population
People 65 and older, or 18 and older with a qualifying disability, who meet nursing facility level of care and need a waiver service at least monthly.
Services covered
personal care
homemaker
chore
adult companion services
in-home respite care
residential respite care
adult day services
meals
emergency response system
structured family caregiving
in-home nursing services
Billing format
HOPE personal care (T1019), homemaker (S5130), companion (S5135), chore (S5120) and respite (T1005) require EVV; DHS LTSS offers Therap at no cost, or an approved alternative system (open model).
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
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