South Dakota Medicaid & Elder Care
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.
Medicaid Report Card
Overall State Performance Index
Based on CMS Nursing Home Compare + state Medicaid agency data
View Methodology arrow_forwardSouth Dakota Monthly Costs
South Dakota's senior care costs are generally lower than the national average, though some long-term care services have seen increases that exceed national trends, making aging in place potentially more expensive than assisted living.
Waiver Programs
HOPE Waiver for Individuals in Assisted Living or Community Home Facilities / HOPE Waiver for Individuals Living in their Homes
Also called: HCBS Waiver, Structured Family Caregiving
The HOPE Waiver provides services to individuals who meet nursing home level of care but wish to remain in their homes, community living homes, structured family caregiving homes, or assisted living facilities. This program aims to prevent unnecessary nursing home placements by offering support in less restrictive environments.
- check_circle Homemaker and chore services
- check_circle Personal care
- check_circle Meals and meal preparation
- check_circle Emergency response systems
- check_circle Environmental accessibility adaptations
- check_circle Supervision and security
- check_circle Recreational programming and activities
- check_circle Social programming
- check_circle Community transition
- check_circle Specialized medical equipment and supplies
- check_circle Nutritional supplements
insights Program Snapshot
- Functional criterion
- Nursing Home Level of Care
- Administered by
- South Dakota Department of Social Services, Adult Services and Aging
- Self-direction
- Includes Structured Family Caregiving, allowing family members to be paid caregivers.
- Income Limit
- $2,982/month (2026)
- Asset Limit
- $2,000 (2026)
2026 Eligibility Requirements
| Criteria | Individual Limit | Married (Both Applying) |
|---|---|---|
| Monthly Income | $2,982 | $5,964 |
| Asset Limit | $2,000 | $3,000 |
| Home Equity Limit | $752,000 | |
| Level of Care | Nursing Home Level of Care (NHLOC) | |
Estate Recovery Warning
South Dakota's Estate Recovery Program is mandatory, seeking reimbursement for long-term care costs from the deceased recipient's estate, including the home. Recovery is delayed if a surviving spouse or disabled child lives in the home, but the state can place a lien.
Spend-Down & Asset Protection
PROTECTED ASSETS
COMMON PITFALLS
- warning Look-back Period: Gifts or asset transfers made within 60 months prior to applying for Medicaid can trigger heavy penalties and periods of ineligibility.
- warning Excess Income: Failing to establish a Miller Trust (Medicaid Income Trust) if monthly income exceeds the state's income cap will result in ineligibility.
- warning Joint Accounts: All assets of a married couple are considered jointly owned, which can impact eligibility if not properly planned.
First Steps for Families
Locate your ADRC
Contact your local South Dakota Aging and Disability Resource Center.
Gather 5 years of records
Bank statements, deeds, asset transfers for the Medicaid look-back period.
Financial assessment
Consult a Medicaid planner if assets exceed $2,000.
Resource Contact
South Dakota Department of Social Services
How to Apply for South Dakota Long-Term Care Medicaid
Assess Level of Care
Obtain medical certification confirming the need for a Nursing Home Level of Care.
Gather Records
Collect at least 60 months of financial statements and other necessary documentation.
Setup Miller Trust
Establish a Miller Trust if your monthly income exceeds South Dakota's Medicaid income cap.
Submit Application
Apply through the South Dakota Department of Social Services online, in person at a local office, or by mailing a completed application.
Application Review
The state Medicaid agency will review your application and may request additional documentation for verification.
Approval & Care
Receive a final eligibility determination and activate your Medicaid benefits for long-term care services.
Documents You'll Need
Financial Verification
- 5 years of bank statements
- Stock/bond certificates
- Retirement account information
- Proof of resources
Income Verification
- Social Security award letters
- Pension stubs
- VA benefit statements
- Pay stubs
- Tax returns
Medical/Identity
- Social Security card
- Medicare card
- Doctor's clinical assessments
- Proof of identity (driver's license, passport, or birth certificate)
- Proof of citizenship or immigration status
Property/Residency
- Home deed
- Vehicle registration
- Proof of South Dakota residency
- Utility bills
- Lease agreement
Frequently Asked Questions About South Dakota Medicaid
Does South Dakota Medicaid pay for assisted living?
Yes, South Dakota Medicaid provides coverage for services in assisted living facilities through the HOPE Waiver. This waiver helps eligible seniors and individuals with disabilities who require a nursing home level of care. However, it is important to note that the HOPE Waiver covers care services but does not pay for room and board costs in assisted living facilities.
What is the South Dakota Medicaid income limit for seniors in 2026?
For a single senior applicant in South Dakota in 2026, the monthly income limit for long-term care Medicaid is $2,982. For married couples where both spouses are applying, the combined income limit is $5,964 per month. If only one spouse is applying, only the applicant's income is counted, and the non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance.
How long is the HCBS waiver waitlist in South Dakota?
South Dakota's Home and Community Based Services (HCBS) Waivers, including the HOPE Waiver, are not an entitlement, meaning there are limited enrollment slots and waiting lists may exist. However, specific data regarding the current number of individuals on the waitlist or estimated wait times for the HOPE Waiver are not publicly available.
Will Medicaid take my parent's house in South Dakota?
South Dakota's Estate Recovery Program is mandated to seek reimbursement for Medicaid long-term care costs after the death of a recipient. This may involve placing a lien on the deceased's home. Recovery efforts are delayed if a surviving spouse or a permanently disabled child resides in the home, but the state can still pursue recovery from the estate.
Can I be paid to care for my parent through South Dakota Medicaid?
Yes, South Dakota Medicaid offers the Structured Family Caregiving (SFC) program, which is a component of the HOPE Waiver. This program allows eligible family members, excluding spouses in some cases, to receive financial compensation for providing care to a loved loved one who qualifies for the HOPE Waiver. Organizations like Paid.care and Careforth assist with this process.
Medicaid vs Medicare for long-term care in South Dakota?
Medicare in South Dakota primarily covers short-term, skilled nursing care, and rehabilitation following a hospital stay, but generally does not cover long-term custodial care. In contrast, South Dakota Medicaid provides comprehensive long-term care benefits for eligible low-income seniors, including nursing home care, home health services, and support for assisted living through programs like the HOPE Waiver.
TOPICAL GUIDES — HOW MEDICAID WORKS
EXPLORE SOUTH DAKOTA
Last updated: April 24, 2026. Sources: South Dakota Department of Social Services, CMS Nursing Home Compare, Genworth 2024 Cost of Care Survey. Eligibility rules are set by each state Medicaid agency and update annually. We cite the agency name, statute, or CMS data source for every figure on this page; see our methodology and editor.