Medicaid for Senior Care in South Dakota
What Medicaid Actually Covers for Senior Care
In South Dakota, Medicaid provides vital support through Nursing Home Medicaid and the Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver. Nursing Home Medicaid covers the full cost of care in a nursing facility, including room, board, skilled nursing, and personal care. For those preferring to stay home or in assisted living, the HOPE Waiver offers services like personal care, homemaker support, adult day care, respite care, delivered meals, home modifications, and emergency response systems. It's important to know that while nursing home care includes room and board, the HOPE Waiver generally does not cover these costs in assisted living or other community settings.
Do You Qualify?
Medicaid eligibility in South Dakota depends on specific financial limits for 2026. A single senior applying for Nursing Home Medicaid or the HOPE Waiver must have a monthly income of no more than $2,982 and countable assets under $2,000. For married applicants where one spouse needs care, the applicant’s limits are the same, but the non-applicant spouse can keep up to $162,660 in assets. Countable assets typically include bank accounts, stocks, and even IRAs/401Ks in South Dakota.
Your parent’s primary home is usually exempt if a spouse, a child under 21, or a disabled child resides there. Otherwise, there’s a home equity limit of $752,000 in 2026, and an "intent to return" home is often required. Pensions count as income. If income is too high, a Qualified Income Trust can help meet the income cap. For excess assets, a "spend-down" allows converting them into non-countable items like home improvements or prepaid funeral expenses. Be aware of the 60-month (five-year) look-back period for asset transfers, which can cause a penalty period if assets were gifted.
Waitlists & How to Apply
Nursing Home Medicaid is an entitlement, meaning no waitlist for eligible individuals, though facility availability varies. However, the HOPE Waiver is not an entitlement program, so enrollment slots are limited and waitlists can exist. To apply, you can visit dss.sd.gov/applyonline, go to your local Department of Social Services (DSS) office, or mail/fax a paper application (DSS-EA-240). For assistance or to request an application by mail, call 877-999-5612. You’ll need to provide income, resource, and expense information. Applications not requiring a disability determination are typically processed within 45 days, while those needing a disability review can take up to 90 days.
Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.