STATE PROFILE • Last updated: November 11, 2026
South Dakota Elder Care & Medicaid
South Dakota offers income-cap Medicaid for seniors, with the HOPE Waiver providing crucial home and community-based services, including paid family caregiving, to prevent nursing home placement.
leaderboard
RANKED #28
GRADE C
FEATURED
Medicaid Coverage Guide for South Dakota
Full breakdown of HOPE Waiver for seniors: waiver programs, nursing home eligibility, income and asset limits, spend-down rules, and how to apply.
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Program
HOPE Waiver
Income cap
$2,982/mo
Medically-needy
No
Elder Care Index Report Card
5-pillar composite scoring vs other states
C
Grade
AFFORDABILITY
GRADE A · 100
QUALITY
GRADE D · 39
STAFFING
GRADE C · 32
ACCESS
GRADE B · 52
MEDICAID SUPPORT
GRADE F · 5
Composite score: 49.2 / 100 (50 = average state)
Methodology arrow_forward
South Dakota At a Glance
Nursing Home Facilities
97
Senior Medicaid Waivers
1
National Rank
#28 / 51
Range #27–#33 when the pillar weights shift
Senior Care Costs in South Dakota
local_hospital
Nursing Home
$9,086/mo
-17.7% vs national avg
- 97 nursing homes · 5,919 beds
- Avg CMS rating 2.88★ (19 rated 5★, 19 rated 1★)
- 3.89 nurse hrs/resident/day (0.8 RN)
Source: CMS Nursing Home Compare
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home_health
Home Health Aide
$25/hr
-7.4% vs national avg
- Median aide wage $17.68/hr
- ~4,170 aides employed statewide
Source: BLS OEWS
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