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Getting paid to care for a parent in South Dakota

Updated 2026-08-10 · Every figure below is dated and sourced · Rules change — confirm with the agency
The short answer: South Dakota's door is Structured Family Caregiving (SFC) under the HOPE Waiver (Home and Community Based Options and Person Centered Excellence), run by South Dakota Department of Human Services, Division of Long Term Services and Supports (LTSS); Medicaid eligibility through the Department of Social Services (DSS). Pay: Structured Family Caregiving is paid per day, not per hour. The most recent rate sheet South Dakota DHS has posted is the FY2026 fee schedule, effective July 1, 2025: $80.87/day base, $101.09/day Tier 1, $113.22/day Tier 2. Your parent's tier is set by the LTSS Case Management Specialist from the in-home needs assessment. Watch the date: South Dakota resets these rates every July 1, and FY2026 ended June 30, 2026. As of August 10, 2026 the state had not posted an FY2027 sheet at the same address, so ask LTSS or the provider agency what today's rate is before you count on these numbers. The state pays a provider agency, not you. By state rule the agency must pass at least 50% of that daily rate through to you as a stipend — South Dakota Medicaid's HOPE Waiver billing manual says 'Caregiver stipends must equal at least 50 percent of the established rate tier,' and the Structured Family Caregiving Provider Provisions say the same. At the FY2026 rates that 50% floor is about $40 to $57 a day, roughly $1,230 to $1,720 a month, depending on your parent's tier and how much the agency keeps above the minimum — so it is worth asking each agency what percentage it passes through. Careforth, an agency serving South Dakota, advertises 'up to $1,700 each month.' The stipend is not wages: you sign an independent contractor agreement with the agency and are not its employee.

Who can be the paid caregiver

Adult children, other relatives, and even "fictive kin" (a close non-relative like a family friend) can be the paid caregiver — SD's HOPE Waiver manual says the principal caregiver "may be a related family member or non-relative fictive kin." Requirements: be 18+, live in the same home as your parent (their home or yours), pass a state fingerprint background check, and be assessed as capable by the SFC provider agency. One caregiver may serve at most two participants. If the caregiver is NOT family or fictive kin, the home must be licensed as a Community Living Home.

The spouse question

Honest answer: the state has not written this down in anything the public can read. South Dakota Medicaid's HOPE Waiver billing manual says the Structured Family Caregiving principal caregiver 'may be a related family member or non-relative fictive kin,' and it defines fictive kin as someone 'not related by birth, adoption, or marriage' — which reads as though a husband or wife, being related by marriage, counts as a 'related family member' and is allowed. But the manual, the Structured Family Caregiving Provider Provisions, and the state's home and community-based services rules (ARSD 67:40:19) never use the word 'spouse' either way, and South Dakota does not publish its approved waiver application, which is where a rule about paying a husband or wife would normally live. An outside site (Medicaid Planning Assistance) says a spouse can be hired; Careforth's South Dakota page only lists 'spouse' in a drop-down of relationships, which is not a policy statement. So: likely yes, but get it confirmed in writing by Dakota at Home (1-833-663-9673) or the SFC provider agency before you quit a job or move house. If you are the adult child caring for a parent, none of this uncertainty touches you — an adult child is squarely allowed.

Waitlist reality

The HOPE Waiver is a capped 1915(c) waiver, not an entitlement — the number of enrollment slots is limited and a waiting list can form once they fill. The number usually quoted is about 3,700 slots a year, but that comes from the approved waiver application as summarized by an outside site (Medicaid Planning Assistance); South Dakota does not publish a current slot count or waitlist number anywhere we could find, and DHS does not post the waiver application itself. South Dakota has not had the multi-year aging-waiver waitlists some states have, but treat that as unconfirmed, not a promise — ask Dakota at Home whether slots are open right now. In practice your timeline is driven by three things: the long-term-care Medicaid financial application at DSS, the LTSS in-home assessment, and finding a Structured Family Caregiving provider agency with capacity in your area. Think weeks to a few months, not years. One thing to know about the fallback: the ordinary agency-delivered in-home help South Dakota offers outside the waiver is paid through the state-funded LTSS (KIND) program, not Medicaid, so it is limited by what the Legislature appropriates each year — and it does not pay a family member either.

Worth knowing: Key disqualifiers and realities: (1) You MUST live in the same home as your parent — SFC is a shared-living program; hourly pay for a caregiver living elsewhere does not exist in SD Medicaid. (2) Your parent must meet nursing-facility level of care and Medicaid long-term-care financial limits (~$2,982/month income, $2,000 assets for a single person in 2026); too much income may still work via other pathways — ask DSS. (3) You must pass a state fingerprint background check. (4) The stipend comes through a private SFC provider agency, and you are legally NOT their employee — no minimum wage, overtime, workers' comp, or unemployment coverage; the agency must pass you at least 50% of the Medicaid per-diem, so compare agencies' splits. (5) The exact daily stipend depends on your parent's assessed tier (base/Tier 1/Tier 2). (6) South Dakota has NO consumer-directed hourly personal-assistance program (no IHSS/CDPAP equivalent) — SFC is the one real door. (7) Rates cited are FY2026, effective July 1, 2025, from the official state fee schedule. (8) Veteran-Directed Care availability at SD VA facilities could not be confirmed — verify with a VA social worker before promising it to a family.

Other doors in South Dakota

ProgramWhat to know
HOPE Waiver respite (in-home and residential)Pays an outside provider so the family caregiver gets breaks — FY26 rates $42.64/hr in-home, $297.99/day residential. Does not pay the family caregiver, but pairs with SFC.
Agency employment for personal care (T1019, $44.08/hr FY26 agency billing rate)SD's state-plan and waiver personal care is agency-delivered with no consumer-directed hiring option. Some home-care agencies will hire a family member as a regular employee to serve their relative — ask agencies directly; the $44.08 is what the agency bills, not what an aide earns.
National Family Caregiver Support Program (Title III-E) via Dakota at HomeRespite, supplies, and caregiver counseling for unpaid caregivers of people 60+. No ongoing paycheck, no Medicaid requirement. Call 1-833-663-9673.
Veteran-Directed Care / VA caregiver programsIf your parent is a veteran: VDC lets veterans hire family (including spouses) with a VA budget, but we could not confirm VDC is currently offered by Sioux Falls VA or VA Black Hills — ask your parent's VA social worker. VA Aid & Attendance (extra pension cash) and PCAFC are available regardless.
Community Living HomeThe non-relative version of shared-living care in SD; the home must be licensed by the SD Department of Health. Relevant only if the caregiver is not family or fictive kin.

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

  1. 1. Call Dakota at Home at 1-833-663-9673 — South Dakota's single front door for long-term services and supports — and say you want an assessment for the HOPE Waiver and Structured Family Caregiving for your parent.
  2. 2. An LTSS Case Management Specialist does an in-home needs assessment to confirm your parent meets nursing-facility level of care and to set the SFC payment tier.
  3. 3. Apply for long-term-care Medicaid through the Department of Social Services (dss.sd.gov or your local DSS office). 2026 limits: about $2,982/month income and $2,000 in countable assets for a single applicant.
  4. 4. Move in together if you don't already live together — SFC requires the caregiver and parent to share a home.
  5. 5. Enroll with a Medicaid-approved SFC provider agency (e.g., Careforth, 866-806-4456, or others on the LTSS provider list). The agency credentials you, runs the fingerprint background check, and pays your daily stipend.
  6. 6. Care starts under a written care plan; the agency provides a care coach, daily notes, and pays you; LTSS reviews the plan periodically.

Where to start: Dakota at Home (SD DHS Long Term Services and Supports resource line): 1-833-663-9673, dakotaathome.sd.gov

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.

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Sources & dates checked: Program rules and payment rates change. Everything here is educational — real eligibility is decided by the agencies, based on your family's details.