How to Pay for In-Home Care
How to Pay for Home Care in South Dakota
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
South Dakota families typically start with Dakota at Home for older-adult or physical-disability screening, since the HOPE Waiver can cover personal care, homemaker help, respite, nursing, meals, safety supports, and Structured Family Caregiving for those who meet a nursing-facility level of care. Adults with quadriplegia who meet program criteria should look at the ADLS Waiver, a major self-directed route that explicitly allows qualifying family members or friends to be paid as personal attendants, while people with intellectual/developmental disabilities living at home can use Family Support 360 for self-direction or Agency With Choice to hire chosen workers for personal care, respite, companion care, and supported employment. Home Again can fund transition-related supports for eligible Medicaid members leaving institutions, and every plan can be layered with DDD respite, Title III caregiver programs, Medicare Savings, food and energy assistance, South Dakota tax or property relief, and Veteran benefits.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
South Dakota Medicaid HCBS
HOPE Waiver
YesHelps pay for: Broad HCBS package that can replace or reduce privately purchased home/community care.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Call Dakota at Home for LTSS screening and waiver application guidance.
Good to know: Family caregiver payment: Depends on service; Structured Family Caregiving is the clearest family-payment route
Assistive Daily Living Services (ADLS) Waiver
YesHelps pay for: HCBS package for qualifying adults with quadriplegia who would otherwise require nursing-home care.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Contact Division of Rehabilitation Services / Dakota at Home for ADLS screening.
Good to know: Family caregiver payment: Yes for qualifying personal-attendant arrangements
Family Support 360 (FS360) Waiver
YesHelps pay for: Self-directed HCBS package designed to support a person with I/DD in the family or individual home.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Call DDD intake through Dakota at Home (Option 2) for application and service planning.
Good to know: Family caregiver payment: Potentially yes through self-direction; worker eligibility and relationship rules apply
CHOICES Waiver
Yes / indirectHelps pay for: Residential, day, employment, technology and medically related supports for children and adults with I/DD.
Who qualifies: Developmental disability, appropriate for home/community placement, ICF/IID level-of-care criteria and Medicaid financial eligibility; 2026 income below $2,982/month and $2,000 resource limit.
How to start: Apply through DDD intake and complete functional/financial screening.
Good to know: Family caregiver payment: Depends on service/provider model; not a general family-wage benefit
Paid Family Caregiver / HOPE
Structured Family Caregiving
YesHelps pay for: Shared-living support for an eligible participant residing with a primary/principal caregiver; can offset substantial daily caregiving costs.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000. Participant must live in own home or caregiver home and meet SFC/provider-plan requirements.
How to start: Ask Dakota at Home specifically for HOPE Structured Family Caregiving screening.
Good to know: Family caregiver payment: Yes - qualified live-in family/principal caregiver arrangements can be paid through the approved SFC provider model
HOPE Waiver Service
HOPE Personal Care
YesHelps pay for: Hands-on ADL help such as bathing, dressing, grooming, toileting, transfers and related personal assistance.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: Usually agency/provider service; SFC is the clearer family route
HOPE Homemaker
YesHelps pay for: Meal preparation, laundry, housekeeping and household support needed to remain safely at home.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: Usually provider service
HOPE Adult Companion
YesHelps pay for: Supervision, cueing, social support and help with independent living routines.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: Usually provider service
HOPE Chore Services
YesHelps pay for: Heavier household tasks needed to keep the residence safe and usable.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: Usually provider service
HOPE In-Home Respite
YesHelps pay for: Temporary in-home relief for an unpaid primary caregiver.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: Not normally paid to the caregiver being relieved
HOPE Residential Respite
YesHelps pay for: Short-term out-of-home respite when the regular caregiver needs relief.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No direct family wage
HOPE In-Home Nursing
YesHelps pay for: Skilled nursing services in the home under the waiver care plan.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No direct family wage unless separately qualified/authorized under applicable rules
HOPE Adult Day Services
YesHelps pay for: Daytime supervision, activities and supports that can reduce in-home caregiver hours.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No
HOPE Meals
YesHelps pay for: Covered meal services can reduce food preparation and meal-delivery costs.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No
HOPE Emergency Response System
YesHelps pay for: Personal emergency response monitoring can reduce safety risk and some supervision needs.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No
HOPE Environmental Accessibility Adaptations
IndirectHelps pay for: Home modifications that improve safety and independence, subject to authorization and waiver limits.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No direct wage
HOPE Specialized Medical Equipment & Supplies
IndirectHelps pay for: Approved adaptive/medical equipment and supplies can reduce out-of-pocket purchases.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No
HOPE Nutritional Supplements
YesHelps pay for: Prescribed/authorized supplements can offset medically necessary nutrition expenses.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No
HOPE Community Transition Coordination & Supports
YesHelps pay for: One-time and coordination supports can help an eligible person move from an institution back to community living.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No
HOPE Community Living Home
YesHelps pay for: Medicaid-funded service package in a small family-style community living home can offset personal care, supervision, meals, homemaking and related supports.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No direct family wage
HOPE Assisted Living Services
YesHelps pay for: Waiver-funded services in an eligible assisted-living setting can offset care-service costs, though room/board and personal obligations may remain.
Who qualifies: Generally age 65+ or under 65 blind/disabled, South Dakota resident, nursing-facility level of care, Medicaid financial eligibility; 2026 waiver income limit $2,982/month and resource limit $2,000.
How to start: Request assessment/authorization through LTSS and the person-centered plan.
Good to know: Family caregiver payment: No direct family wage
Medicaid Transition
Home Again SD - Transition Services
IndirectHelps pay for: One-time/short-term help to secure, set up or modify a home when transitioning from an institution.
Who qualifies: South Dakota resident in a nursing facility, ICF or other institution and enrolled in or eligible for South Dakota Medicaid.
How to start: Contact Home Again SD before discharge planning is finalized.
Good to know: Family caregiver payment: No
Home Again SD - Relocation Transportation
IndirectHelps pay for: Can cover transition-related transportation needed to relocate from an institution to community living.
Who qualifies: Must meet Home Again transition eligibility; service is tied to a qualifying institutional-to-community move.
How to start: Coordinate with Home Again and discharge planner.
Good to know: Family caregiver payment: No
Home Again SD - Assistive Technology
IndirectHelps pay for: One-time/short-term assistive technology can reduce the cost of establishing safe community living after institutional care.
Who qualifies: Must meet Home Again transition eligibility and have an approved transition need.
How to start: Ask Home Again whether the item is allowable before purchase.
Good to know: Family caregiver payment: No
Paid Family Caregiver / ADLS
ADLS Personal Attendant Services
YesHelps pay for: Pays for bathing, grooming, oral hygiene, medication assistance, bowel/bladder care and, when allowed, meal preparation/housekeeping.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Ask DRS about ADLS eligibility and attendant enrollment/qualification requirements.
Good to know: Family caregiver payment: Yes - family or friends may be paid if they meet all personal-attendant qualifications
ADLS Waiver Service
ADLS Respite
YesHelps pay for: Temporary care/supervision during absence of a parent, guardian or other immediate caregiver.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Add the service through the ADLS person-centered plan and obtain authorization before purchase/service.
Good to know: Family caregiver payment: No direct family wage except eligible personal-attendant service
ADLS Consumer Preparation
IndirectHelps pay for: Training/support on hiring and training attendants plus personal health-maintenance skills.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Add the service through the ADLS person-centered plan and obtain authorization before purchase/service.
Good to know: Family caregiver payment: No direct family wage except eligible personal-attendant service
ADLS Skilled Nursing
YesHelps pay for: Physician-directed nursing that cannot be provided by the personal attendant.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Add the service through the ADLS person-centered plan and obtain authorization before purchase/service.
Good to know: Family caregiver payment: No direct family wage except eligible personal-attendant service
ADLS Emergency Response Services
IndirectHelps pay for: Monthly emergency-response monitoring such as Lifeline.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Add the service through the ADLS person-centered plan and obtain authorization before purchase/service.
Good to know: Family caregiver payment: No direct family wage except eligible personal-attendant service
ADLS Specialized Medical Equipment & Supplies
IndirectHelps pay for: Adaptive positioning, mobility, communication and other approved equipment/supplies.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Add the service through the ADLS person-centered plan and obtain authorization before purchase/service.
Good to know: Family caregiver payment: No direct family wage except eligible personal-attendant service
ADLS Vehicle Modifications
IndirectHelps pay for: Approved lifts, ramps, driving adaptations and wheelchair securement/seating modifications.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Add the service through the ADLS person-centered plan and obtain authorization before purchase/service.
Good to know: Family caregiver payment: No direct family wage except eligible personal-attendant service
ADLS Environmental Accessibility Adaptations
IndirectHelps pay for: Approved home changes such as ramps, grab bars and widened doorways.
Who qualifies: Age 18+ with quadriplegia, living independently, nursing-home level of care and Medicaid financial eligibility; 2026 income up to $2,982/month and $2,000 resource limit.
How to start: Add the service through the ADLS person-centered plan and obtain authorization before purchase/service.
Good to know: Family caregiver payment: No direct family wage except eligible personal-attendant service
Self-Direction / FS360
Agency With Choice
YesHelps pay for: Lets the person/family choose and co-employ workers for personal care, respite, companion care and supported employment while a vendor handles payroll/tax functions.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Ask the FS360 service coordinator about Agency With Choice and current fiscal/employer-agent steps.
Good to know: Family caregiver payment: Yes when the chosen worker meets program/employment rules; confirm relationship-specific eligibility
Family Support 360 Service
FS360 Personal Care
YesHelps pay for: Help with bathing, eating, personal hygiene and other authorized personal-care tasks.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
FS360 Respite Care
YesHelps pay for: Short-term relief for family caregivers.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
FS360 Companion Services
YesHelps pay for: Support for social and independent-living skills.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
FS360 Supported Employment
IndirectHelps pay for: Job supports that can reduce the need for unpaid family supervision during work hours.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
FS360 Environmental Accessibility Adaptations
IndirectHelps pay for: Home changes that improve independence and accessibility.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
FS360 Vehicle Modifications
IndirectHelps pay for: Vehicle changes that improve community access.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
FS360 Specialized Medical Equipment, Supplies & Nutritional Supports
IndirectHelps pay for: Approved adaptive equipment/supplies and prescribed nutritional supports.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
FS360 Specialized Therapies
IndirectHelps pay for: Approved specialized therapies under the waiver service plan.
Who qualifies: Developmental disability; living in own home or a family member home; Medicaid/waiver eligibility including 2026 income below $2,982/month and $2,000 resource limit; ICF/IID level-of-care rules apply.
How to start: Work through the FS360 service coordinator and approved individual budget/service plan.
Good to know: Family caregiver payment: Potentially through self-direction for services that allow a participant-hired worker; verify specific service/relationship rules
CHOICES Waiver Service
CHOICES Shared Living Residential Habilitation
YesHelps pay for: Shared-living residential support that can substitute for more costly facility care and provide daily supervision/support.
Who qualifies: Developmental disability, appropriate for home/community placement, ICF/IID level-of-care criteria and Medicaid financial eligibility; 2026 income below $2,982/month and $2,000 resource limit.
How to start: Work through the DDD service coordinator and individual plan.
Good to know: Family caregiver payment: No direct family wage unless an applicable provider arrangement separately permits it
CHOICES Residential Habilitation
YesHelps pay for: Residential supports ranging from around-the-clock supervision to daily check-ins.
Who qualifies: Developmental disability, appropriate for home/community placement, ICF/IID level-of-care criteria and Medicaid financial eligibility; 2026 income below $2,982/month and $2,000 resource limit.
How to start: Work through the DDD service coordinator and individual plan.
Good to know: Family caregiver payment: No direct family wage unless an applicable provider arrangement separately permits it
CHOICES Day Services
IndirectHelps pay for: Day habilitation and skill-building supports that can reduce daytime unpaid-caregiver burden.
Who qualifies: Developmental disability, appropriate for home/community placement, ICF/IID level-of-care criteria and Medicaid financial eligibility; 2026 income below $2,982/month and $2,000 resource limit.
How to start: Work through the DDD service coordinator and individual plan.
Good to know: Family caregiver payment: No direct family wage unless an applicable provider arrangement separately permits it
CHOICES Supported Employment & Career Exploration
IndirectHelps pay for: Employment supports, career exploration and vocational services.
Who qualifies: Developmental disability, appropriate for home/community placement, ICF/IID level-of-care criteria and Medicaid financial eligibility; 2026 income below $2,982/month and $2,000 resource limit.
How to start: Work through the DDD service coordinator and individual plan.
Good to know: Family caregiver payment: No direct family wage unless an applicable provider arrangement separately permits it
CHOICES Assistive Technology / Specialized Medical Equipment
IndirectHelps pay for: Approved assistive technology, equipment and related supports that improve independence.
Who qualifies: Developmental disability, appropriate for home/community placement, ICF/IID level-of-care criteria and Medicaid financial eligibility; 2026 income below $2,982/month and $2,000 resource limit.
How to start: Work through the DDD service coordinator and individual plan.
Good to know: Family caregiver payment: No direct family wage unless an applicable provider arrangement separately permits it
South Dakota Medicaid
Disabled Children's Program
YesHelps pay for: Full Medicaid can pay medically necessary home services for certain medically fragile disabled children who would otherwise require institutional-level care.
Who qualifies: Under 19; disability and institutional-level medical needs; home care must be no more costly than institutional care. Parent income/resources are not counted; child's 2026 income < $2,982/month and resources < $2,000.
How to start: Apply through DSS Economic Assistance/Medicaid and submit disability/medical documentation.
Good to know: Family caregiver payment: Depends on covered service/provider rules; not a blanket parent wage
South Dakota Medicaid State Plan
Medicaid Home Health
Yes - skilled/covered careHelps pay for: Physician-ordered skilled nursing, therapy and home-health services can reduce private-pay medical home-care costs.
Who qualifies: Must be Medicaid eligible and meet state-plan medical-necessity/authorization rules.
How to start: Ask the treating provider and Medicaid about covered home-health authorization.
Good to know: Family caregiver payment: No direct family wage unless worker is separately qualified/enrolled
Private Duty Nursing / Extended Home Health Aide
YesHelps pay for: Extended skilled nursing or aide services can cover high-acuity home care when medical-necessity and prior-authorization rules are met.
Who qualifies: Medicaid eligibility, physician order/plan of care and prior authorization required; provider enrollment rules apply.
How to start: Ask the clinical team to submit required prior authorization.
Good to know: Family caregiver payment: Possibly only under specific approved provider/family exceptions
Personal Care Agency Services
YesHelps pay for: Covered personal-care agency services can reduce private-pay ADL assistance when medically/financially eligible and authorized.
Who qualifies: Medicaid eligibility and applicable service authorization/provider rules.
How to start: Ask Medicaid/Dakota at Home whether state-plan personal care or a waiver is the better fit.
Good to know: Family caregiver payment: Agency service; family payment is not presumed
Family Caregiver / Medicaid Clinical
Temporary Family-Member PDN Exemption
Yes - if approvedHelps pay for: South Dakota Medicaid maintains a prior-authorization form for a temporary exemption allowing a family member to provide private-duty nursing in qualifying circumstances.
Who qualifies: Not a general family-caregiver program. Approval is case-specific and tied to PDN medical necessity, licensure/provider standards and prior authorization.
How to start: Ask the member's Medicaid clinical team/provider about PA-114 before relying on a family nurse arrangement.
Good to know: Family caregiver payment: Yes - but only through the specific temporary exemption and provider/clinical requirements
Transportation Cost Offset
Medicaid Non-Emergency Medical Transportation / Travel Reimbursement
IndirectHelps pay for: May pay or reimburse qualifying transportation, mileage and certain travel costs for covered medically necessary care.
Who qualifies: Must be Medicaid eligible and follow prior approval/documentation requirements where applicable.
How to start: Contact Medicaid transportation before non-emergency travel when possible.
Good to know: Family caregiver payment: A driver may be reimbursable only under program rules; verify before travel
Working With a Disability
Medicaid for Workers with Disabilities (MAWD)
Indirect / enables Medicaid home careHelps pay for: Allows eligible workers with significant disabilities to keep Medicaid coverage that can support home/community services while employed.
Who qualifies: Employed with significant disability; resources under $8,000; total income below 250% FPL; countable unearned income must remain below the SSI FBR plus $20 disregard.
How to start: Apply through DSS Economic Assistance / SD BEES and identify MAWD on the application.
Good to know: Family caregiver payment: Depends on the underlying covered service
Caregiver Respite
South Dakota DDD Respite Care Program
Yes - respiteHelps pay for: Provides a family-controlled respite budget; the family selects a provider who is reimbursed by the program.
Who qualifies: For qualifying child/adult living in a family member home with specified disability, delay, SED, chronic medical condition, TBI or adoption status; not available to FS360 participants because FS360 includes respite.
How to start: Apply to the DDD Respite Care Program Specialist.
Good to know: Family caregiver payment: Yes - family chooses provider, but provider eligibility/payment rules apply
Caregiver Support / OAA
National Family Caregiver Support Program
Yes - respite/supportHelps pay for: Information, counseling/training, respite and supplemental services can reduce unpaid-caregiver burden and replacement-care costs.
Who qualifies: Targets qualifying family caregivers under Older Americans Act categories; not the same as Medicaid waiver respite.
How to start: Call Dakota at Home and ask for caregiver support / Title III-E screening.
Good to know: Family caregiver payment: Can support caregiver-selected respite arrangements subject to current program rules
Medicare Cost Offset
Medicare Savings Program (QMB / SLMB / QI-1)
IndirectHelps pay for: Pays Medicare premiums and, for QMB, deductibles and coinsurance, freeing household funds for care.
Who qualifies: South Dakota Medicaid financial rules apply; current resource limit published as $9,950 individual / $14,910 couple.
How to start: Apply through DSS Economic Assistance and provide proof of Medicare enrollment.
Good to know: Family caregiver payment: No
Medicare
Medicare Home Health
Yes - limited skilled/home-health coverageHelps pay for: Part A/Part B may cover intermittent skilled nursing, therapy and home health aide services when federal home-health eligibility rules are met.
Who qualifies: Must meet Medicare home-health requirements; Medicare does not cover 24/7 custodial care or homemaker services when those are the only needs.
How to start: Ask physician/care team for home-health certification and use a Medicare-certified agency.
Good to know: Family caregiver payment: No direct family wage
Medicare Hospice
Yes - hospice-related home careHelps pay for: Hospice benefit can cover hospice nursing, aides, medications/equipment related to terminal illness and respite, reducing end-of-life home-care costs.
Who qualifies: Requires Medicare hospice eligibility and election of the hospice benefit for a terminal illness.
How to start: Ask physician/hospice for eligibility assessment.
Good to know: Family caregiver payment: No direct family wage
Prescription Cost Offset
Medicare Part D Extra Help
IndirectHelps pay for: Reduces Medicare prescription premiums, deductibles and copays, preserving income for caregiving needs.
Who qualifies: Federal income/resource rules apply; some people qualify automatically through Medicaid/MSP/SSI.
How to start: Apply through Social Security or screen through SHIINE.
Good to know: Family caregiver payment: No
Food Cost Offset
SNAP
IndirectHelps pay for: Monthly food assistance can lower grocery costs and preserve household funds for care.
Who qualifies: Household income/resources and program rules apply.
How to start: Apply through SD DSS / SD BEES or a local DSS office.
Good to know: Family caregiver payment: No
Utility / Home Cost Offset
Low Income Energy Assistance & Weatherization
IndirectHelps pay for: Heating assistance and weatherization can reduce utility/home-energy costs; crisis help may be available for disconnection or low fuel.
Who qualifies: Income and household rules apply; energy assistance is generally paid to the supplier.
How to start: Apply through DSS Energy Assistance; call immediately for an energy crisis.
Good to know: Family caregiver payment: No
Tax / Property Cost Offset
Senior & Disabled Tax Refund
IndirectHelps pay for: Annual state refund can return a portion of sales/property taxes and preserve household funds for care.
Who qualifies: For the 2026 application covering 2025: South Dakota resident all year; age 65 by Jan. 1, 2025 or disabled during 2025; income limits were $17,215 living alone or $23,265 household. The 2026 deadline was July 1.
How to start: Calendar the next annual application cycle with SD DOR; do not assume late applications are accepted.
Good to know: Family caregiver payment: No
Assessment Freeze for Elderly & Disabled
IndirectHelps pay for: Freezes qualifying property assessment for tax purposes, reducing exposure to rising home values and preserving funds for care.
Who qualifies: For 2026: age 65+ or disabled, ownership/residency rules, income below $56,595 single-member or $66,885 multi-member household, and property value limit $514,500 unless previously qualified. April 1 deadline passed.
How to start: Apply annually through the local county treasurer; calendar the next April 1 cycle.
Good to know: Family caregiver payment: No
Property Tax Homestead Exemption / Deferral
IndirectHelps pay for: Allows qualifying older homeowners to delay property taxes until the property is sold, easing current cash-flow pressure.
Who qualifies: Generally age 70+ or surviving spouse with income/residency requirements; annual application and repayment/lien rules apply.
How to start: Review current DOR homestead rules and apply through the local county treasurer by the annual deadline.
Good to know: Family caregiver payment: No
Municipal Property Tax Reduction for Elderly & Disabled
IndirectHelps pay for: Reduces qualifying city property taxes in municipalities that have adopted the program; currently South Dakota DOR identifies Rapid City.
Who qualifies: Age 65+ or disabled, property ownership, income and annual filing rules apply; availability is municipality-specific.
How to start: Check DOR and the local county treasurer to confirm municipality participation and next filing window.
Good to know: Family caregiver payment: No
VA Benefits
VA Homemaker & Home Health Aide
YesHelps pay for: VA may authorize community-based aides to help an eligible Veteran with ADLs and selected daily tasks at home.
Who qualifies: VA health-care eligibility, clinical need, authorization and local provider availability; copays may apply. Ask the Veteran's VA primary care/social work team for assessment and authorization.
How to start: Ask the VA social worker or care team about VA Homemaker & Home Health Aide.
Good to know: Family caregiver payment: No direct family wage
Veteran-Directed Care
YesHelps pay for: Flexible self-directed budget for eligible Veterans needing personal care; participant can exercise more choice over workers and services within local program rules.
Who qualifies: VA enrollment, clinical need and local VDC availability; program is not available in every location. Ask VA social work/care team whether VDC is available in the Veteran's service area.
How to start: Ask the VA social worker or care team about Veteran-Directed Care.
Good to know: Family caregiver payment: Often yes - family/friends may be hired subject to local VDC rules
VA Skilled Home Health
Yes - skilled careHelps pay for: VA may purchase skilled nursing, therapy and related home-health services from authorized community providers.
Who qualifies: Clinical need, VA eligibility/authorization and provider availability. Request through the VA care team.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No
VA Respite Care
Yes - respiteHelps pay for: VA may provide in-home, adult-day or facility respite to give caregivers a break.
Who qualifies: VA enrollment, clinical need and local availability/authorization. Ask VA social work or Caregiver Support about respite.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No direct wage
VA Adult Day Health Care
Indirect / daytime careHelps pay for: Health, rehabilitation, socialization and supervision in an adult-day setting can reduce in-home caregiver hours.
Who qualifies: VA eligibility, clinical need, authorization and local program/provider availability. Ask the VA care team whether adult day health care is appropriate and available.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No
VA Home Based Primary Care
Yes - medical home careHelps pay for: Interdisciplinary primary care delivered in the home can reduce travel and help medically complex Veterans remain at home.
Who qualifies: Generally for Veterans with complex chronic conditions for whom routine clinic care is difficult; VA clinical enrollment/acceptance required. Ask the VA primary care team for HBPC screening.
How to start: Ask the VA social worker or care team about VA Home Based Primary Care.
Good to know: Family caregiver payment: No
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Indirect - caregiver stipend supports home careHelps pay for: Eligible primary family caregivers may receive a monthly stipend plus training, support and other benefits.
Who qualifies: Veteran and caregiver must meet PCAFC clinical/service criteria; approval is not based solely on diagnosis or age. Contact the local VA Caregiver Support Team for application/screening.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes - eligible primary family caregiver
Program of General Caregiver Support Services (PGCSS)
IndirectHelps pay for: Coaching, education, peer support and caregiver resources can reduce burnout and help sustain care at home.
Who qualifies: For caregivers of Veterans enrolled in VA health care; no PCAFC stipend approval required for general supports. Contact Sioux Falls VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of General Caregiver Support Services (PGCSS).
Good to know: Family caregiver payment: No monthly stipend under PGCSS
VA Pension with Aid & Attendance / Housebound
Indirect - cash benefit can help fund careHelps pay for: Additional pension amounts can help an eligible wartime Veteran or survivor with care and household costs when assistance or housebound criteria are met.
Who qualifies: Pension eligibility plus Aid & Attendance or Housebound medical/functional criteria; income/net-worth rules apply. Work with a VA-accredited VSO to file pension and supporting medical evidence.
How to start: Ask the VA social worker or care team about VA Pension with Aid & Attendance / Housebound.
Good to know: Family caregiver payment: No designated caregiver wage
VA Community Care Network Region 2
Yes - if authorized service includes home/community careHelps pay for: Authorized community care can provide covered services outside VA when eligibility/referral requirements are met.
Who qualifies: South Dakota is in CCN Region 2, administered by Optum Serve; community care generally requires VA authorization/referral. Start with the VA care team/community care office rather than self-referring as ordinary insurance.
How to start: Ask the VA social worker or care team about VA Community Care Network Region 2.
Good to know: Family caregiver payment: Depends on the specific VA benefit
South Dakota County / Tribal Veterans Service Officers
IndirectHelps pay for: Free accredited help can identify and file for VA pension, disability, health, survivor and state Veteran benefits.
Who qualifies: County VSOs are available statewide and some reservations have Tribal VSOs; benefit eligibility varies. Use the SDDVA locator to contact the appropriate county/tribal VSO.
How to start: Ask the VA social worker or care team about South Dakota County / Tribal Veterans Service Officers.
Good to know: Family caregiver payment: No
South Dakota Disabled Veteran Property Tax Exemption
IndirectHelps pay for: Property-tax relief for qualifying disabled Veterans can reduce housing costs and preserve funds for care.
Who qualifies: South Dakota has separate disabled-veteran and paraplegic-veteran property-tax relief; disability, ownership/residency and filing rules apply. Review DOR eligibility and work with a VSO/local assessor on documentation.
How to start: Ask the VA social worker or care team about South Dakota Disabled Veteran Property Tax Exemption.
Good to know: Family caregiver payment: No
Where South Dakota Families Can Start
Not sure where to begin? Match your situation to a contact below.
Primary statewide entry point for HOPE/LTSS, in-home services, caregiver support and options counseling
Dakota at Home
Apply for/ask about Medicaid, HOPE financial eligibility, MAWD and Disabled Children's coverage
South Dakota Medicaid Eligibility
Covered-service, authorization and member questions
South Dakota Medicaid Recipient Information
FS360, CHOICES, DDD respite and developmental-disability services
Division of Developmental Disabilities Intake
Fiscal/employer-agent support for Family Support 360 Agency With Choice
Consumer Direct Care Network South Dakota
ADLS Waiver and services for people with quadriplegia/disabilities
Division of Rehabilitation Services
Institution-to-community transition services, relocation transportation and assistive technology
Home Again South Dakota
Free Medicare counseling, MSP/Extra Help screening and coverage questions
SHIINE
LIEAP, energy crisis help and weatherization
DSS Energy Assistance
Senior/disabled tax refund, assessment freeze, homestead and Veteran property-tax relief
South Dakota Department of Revenue
VA home-care referrals, PCAFC/PGCSS, respite and Veteran benefits coordination
Sioux Falls VA / Caregiver Support
Before You Rely on Any Payment Source
Planning Point
Why It Matters
Start with Dakota at Home for older-adult/physical-disability screening
Dakota at Home is the statewide ADRC/LTSS front door. For someone 65+ or an adult with physical disability, use one intake to screen HOPE, caregiver supports, nutrition, safety and other home/community services before privately purchasing care.
HOPE requires nursing-facility level of care, not just age or low income
For 2026, the published HOPE financial ceiling is $2,982/month with a $2,000 resource limit, but a person also must meet nursing-facility level-of-care and other Medicaid criteria.
Structured Family Caregiving is a shared-living model
HOPE SFC is not an hourly blank-check caregiver wage. The participant lives with a primary/principal caregiver in the participant home or caregiver home and the arrangement must run through an approved SFC/provider and person-centered plan.
ADLS has unusually explicit family/friend payment language
South Dakota states that family or friends may be paid for ADLS personal-attendant services if they meet all attendant qualifications. A separate state rule also addresses reimbursement to a spouse, parent or adult child under chapter requirements; verify relationship and enrollment rules before relying on payment.
Family Support 360 is self-directed but worker rules still matter
FS360 lets the person/family choose services, staff and schedule. Agency With Choice supports participant-hired workers for personal care, respite, companion care and supported employment, but chosen workers still must meet employment, background, service-plan and relationship rules.
DDD Respite and FS360 respite cannot be double-counted
The separate DDD Respite Care Program is not available to individuals already served by Family Support 360 because respite is included in FS360. Screen the funding source before arranging a provider.
Current CMS HOPE approval period ends September 30, 2026
CMS currently lists 09/30/2026 as the expiration of the present HOPE waiver approval period. That does not by itself mean services stop; after that date, verify the renewal/amendment status before citing current authorities or limits.
South Dakota Medicaid provider rates rolled into a new state fiscal year July 1, 2026
The state fee-schedule hub now identifies July 1, 2026-June 30, 2027 as the current state fiscal year. Do not reuse a 2025/early-2026 provider rate without checking the current schedule.
Federal Medicaid eligibility changes begin October 1, 2026
South Dakota DSS says some noncitizen categories lose Medicaid eligibility effective October 1, 2026, with additional Medicaid Expansion community-engagement changes beginning in 2027. Recheck eligibility for affected households before assuming HCBS coverage will continue unchanged.
PACE is not included as a current South Dakota payment pathway
South Dakota completed a PACE feasibility study, but this workbook does not count PACE among current enrollment options because no active South Dakota PACE program was identified in the state Medicaid coverage list as of August 14, 2026.
Tax/property relief deadlines require advance planning
As of August 14, 2026, the April 1 Assessment Freeze deadline and July 1 Senior/Disabled Tax Refund deadline have passed for the 2026 cycle. Calendar the next cycle; other DOR relief programs have separate deadlines and eligibility rules.
Use Veteran benefits as a separate layer rather than replacing Medicaid screening
VA home care, Veteran-Directed Care, PCAFC, pension Aid & Attendance and South Dakota Veteran tax relief have separate eligibility/authorization systems. A Veteran may qualify for VA and state/federal programs at the same time, but benefits coordination and payer rules still apply.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in South Dakota to help you navigate the application process.
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