Medicaid for nursing home and home care in South Dakota

Who qualifies

The South Dakota Department of Social Services (DSS) decides money eligibility. The Department of Human Services, through Dakota at Home, handles care needs and the HOPE Waiver. You must:

• be 65 or older, or blind or disabled
• need nursing-home-level care
• meet the income and resource limits

The same limits apply to nursing home care, assisted living and the HOPE Waiver. The income limit changes each January when the SSI payment goes up. In 2026 the SSI federal payment is $994 a month.

What counts and what does not

Income

Social Security, pensions, annuities, wages and other regular income count. If your income is over the limit, ask DSS what options you have before you give up.

Resources

Resources include things such as checking and savings accounts and certificates of deposit. If you are married, the home your spouse (or a dependent relative) lives in, one vehicle, most household goods and personal items, and certain burial funds are not counted.

Under federal rules, Medicaid will not pay for long-term care if your home equity is above the state's limit. In 2026 the federal minimum limit is $752,000. Ask DSS for South Dakota's limit.

If you are married

South Dakota protects the spouse who stays at home (the "community spouse").

• Resources: DSS adds up your countable resources as of the day you entered the facility. Your spouse can keep half, but not less than a set minimum or more than a set maximum. Under federal rules for 2026, the most a spouse can keep is $162,660. You qualify once your own share is $2,000 or less. Any extra must be moved to your spouse soon after you are approved.
• Income: If your spouse's own income is below a set amount, part of your income can go to them each month. It can be higher if your spouse has high housing costs or a court order.
• Ask for a resource assessment early. Ask a DSS benefits specialist for the "Request for Resource Assessment" form as soon as your spouse enters a nursing home.
• Gifts matter. Money or property either spouse gave away may affect Medicaid payment to the nursing home.

DSS updates the minimum and income amounts each year. Ask DSS for the current figures.

What Medicaid pays for

Nursing home care

Medicaid pays the nursing home. Most of your income goes toward the cost of your care. You keep a small amount each month for personal needs, plus a little more if you have job earnings. Ask DSS for the current amount.

Assisted living and adult foster care

Medicaid can help pay for care in an assisted living center, with the same income and resource limits as nursing home care. It can also help in an adult foster care home if your income after allowed deductions is below the state's payment rate to the home.

HOPE Waiver (care at home)

The HOPE Waiver is for people 65 and over, or adults 18 and over with a disability, who need nursing-home-level care and meet Medicaid limits. It can pay for:

• in-home help and personal care
• respite and caregiver support
• meals
• safety and mobility help
• adult day services
• community living homes and assisted living

There is also a Structured Family Caregiving option, which supports a family caregiver who lives with you.

How to apply, step by step

1. Call Dakota at Home at 1-833-663-9673, Monday to Friday, 8 a.m. to 5 p.m. Central time. They can tell you what help is available and how to apply.
2. Apply for Medicaid with DSS. Apply online at eaportal.sd.gov, call 1-877-999-5612 (TTY 1-877-486-2048) and ask for a benefits specialist, or go to your local DSS office (find it at dss.sd.gov/findyourlocaloffice). Paper application forms are also at most nursing homes and hospitals and at dss.sd.gov/formsandpubs.
   • Long-term care benefits specialist offices: Aberdeen 605-626-3160, Huron 605-353-7100, Milbank 605-432-9588, Pierre 605-773-3612, Rapid City 605-394-2525, Sioux Falls 605-367-5444.
3. Send proof. DSS will ask for proof of income and resources. If you are married, DSS counts both spouses' resources.
4. Answer letters quickly. Send what DSS asks for by the date given.

After you are approved

• Report changes in income, resources or where you live to DSS.
• Renew when asked. Answer every renewal letter so your coverage does not stop.
• Appeals: If you disagree with the decision on your application, including the amount protected for your spouse, you can appeal within 30 days of the date you get the notice. If you get a Notice of Action cutting or ending benefits, ask for a hearing within 10 days to keep your Medicaid while the appeal is decided. Call DSS at 1-877-999-5612 for help.

Things people miss

• Call Dakota at Home first if you want care at home. It is the place to start for home care, meals, caregiver help and other services for older adults.
• No PACE program. South Dakota does not have PACE.
• Estate recovery. South Dakota recovers Medicaid costs from the estates of people who were 55 or older and got nursing home, home care, hospital or drug services, and of people who lived in a nursing home. It waits while a spouse, a child under 21, or a blind or disabled child survives.

Free help

• Dakota at Home: 1-833-663-9673.
• DSS benefits specialists: 1-877-999-5612 (TTY 1-877-486-2048).
• SHIINE (free Medicare counseling): 1-888-854-5321 or shiine.net.

Read more about paying for a nursing home and Medicare coverage, or see all benefits in South Dakota.

Phone numbers: Free help lines for South Dakota agencies

Check what you may qualify for