South Dakota Medicaid for Seniors & Long-Term Care

Updated August 2026

South Dakota Medicaid covers nursing facility care and home and community-based services for eligible seniors and adults with disabilities. Per DSS, Medicaid helps cover long-term care "whether at home, in your community, or in a care facility." DSS also administers the HomeAgainSD program, which supports transitions from nursing facilities back to home-based care for eligible members.

$2,000

Individual asset (resource) limit

$2,982/mo

Individual income limit (300% of the SSI Federal Benefit Rate, 2026)

HomeAgainSD

Nursing facility-to-home transition program

South Dakota long-term care Medicaid has separate eligibility rules — apply through DSS

Nursing facility and home-based long-term care Medicaid is administered through South Dakota Department of Social Services (DSS). Asset limits ($2,000 for a single applicant) and income limits apply. A separate Long Term Care application form (Form EA-240) is available at dss.sd.gov. Call DSS at 1-888-828-0059 or visit your local county DSS office to start the process.

What South Dakota Medicaid covers for seniors and people needing long-term care

The primary HCBS waiver for South Dakota seniors and adults with physical disabilities is the HOPE Waiver (Home & Community Based Options and Person Centered Excellence Waiver), a statewide 1915(c) Medicaid waiver jointly operated by the Department of Social Services and the Department of Human Services. HOPE Waiver services include adult day care, personal care, homemaker services, structured family caregiving, home modifications, and respite care for people who would otherwise need nursing home care. It is not an entitlement — enrollment slots are limited, and a waitlist can form when they are full.

Skilled nursing facility (nursing home) care
Personal care services at home
Home health aide services
HOPE Waiver — South Dakota's primary Home and Community Based Services (HCBS) waiver for seniors
Adult Day Services
Respite care for family caregivers
HomeAgainSD — nursing facility transition assistance
Long Term Care Partnership Program — asset protection for partnership policyholders
Hospice care
Non-emergency medical transportation

Financial eligibility for South Dakota long-term care Medicaid

South Dakota long-term care Medicaid uses non-MAGI eligibility rules. Both asset limits and income limits apply, and the asset limit for a single applicant is $2,000.

Financial figure	2026 amount
Income limit (300% SSI FBR)	$2,982/mo
Individual asset limit	$2,000
Community spouse minimum resource protection (CSRA)	$32,532 (2026 federal floor)
Community spouse maximum resource protection (CSRA)	$162,660 (2026 federal cap)

Income limit (300% SSI FBR)

2026 amount: $2,982/mo

Individual asset limit

2026 amount: $2,000

Community spouse minimum resource protection (CSRA)

2026 amount: $32,532 (2026 federal floor)

Community spouse maximum resource protection (CSRA)

2026 amount: $162,660 (2026 federal cap)

South Dakota Long Term Care Partnership Program

South Dakota participates in the Long Term Care Partnership Program (available at ltcpartnership.sd.gov). This program lets South Dakotans who purchase a qualifying long-term care insurance policy protect an amount of assets equal to the insurance benefits paid — reducing the amount they must spend down to qualify for Medicaid.

For example, if a qualifying LTC insurance policy pays out $200,000 in benefits before the policyholder applies for Medicaid LTC, the policyholder can keep $200,000 in assets that would otherwise need to be spent down to the $2,000 limit. This is a federally supported program available in most states, and South Dakota's participation is part of DSS's broader long-term care planning infrastructure.

Nursing facility coverage

South Dakota Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Once approved, Medicaid pays the nursing home directly — the resident contributes most of their monthly income toward the cost of care, typically all income minus a personal needs allowance, and Medicaid covers the gap. If income exceeds the institutional Medicaid limit, South Dakota may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Spousal protections and estate recovery

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income, called the minimum monthly maintenance needs allowance (MMMNA), if their own income is insufficient. South Dakota's current CSRA is set by DSS and published on their website.

South Dakota operates an estate recovery program. DSS may seek reimbursement from the estates of members who received nursing facility care or HCBS waiver services at age 55 or older. The home is generally exempt during the lifetime of a surviving spouse or dependent child. South Dakota enforces the federal 60-month (5-year) lookback period for asset transfers. Consult a South Dakota elder law attorney before making asset transfers if a family member may need Medicaid long-term care.