"Home care" and "home health" sound interchangeable, but in South Dakota they're two different services, and the difference decides who pays. Home health is the skilled nursing and therapy a doctor orders from a Medicare-certified agency, and it's the care Medicare can cover; home care is non-medical daily help that Medicare won't pay for when it's the only care a person needs.,

This guide draws that line so a South Dakota family doesn't pay out of pocket for care a program would have covered, or wait on Medicare coverage that was never coming. What matters isn't the word on the agency's sign, it's whether the care is skilled or non-medical, and which program pays the bill.

In This Guide

The Two Services, Defined

The split is skilled versus non-medical. In South Dakota, a certified home health agency needs no state license and the Department of Health doesn't regulate non-medical in-home care providers, so what separates the two is whether the care is medical and which program will pay.

A home health agency provides skilled care. The National Institute on Aging describes home health care as typically part-time medical services a physician orders for a specific condition, which may include nursing care to help someone recover from surgery, an accident, or an illness, and physical, occupational, or speech therapy. In South Dakota, a certified home health agency doesn't need a state license, and Medicare pays for its care only when the agency is Medicare-certified.

Non-medical home care sends an aide to help with daily activities such as bathing, dressing, and grooming, and sometimes light housekeeping, transportation, and errands. These aides don't provide skilled medical care and usually aren't medical professionals. It's a separate kind of service from skilled home health, and the South Dakota Department of Health does not regulate non-medical in-home care providers.

That separation is what decides the money. Medicare pays for home health only when a Medicare-certified agency provides it. Non-medical personal care is care Medicare doesn't pay for at all when it is the only care needed. So the label matters less than the care itself: skilled, doctor-ordered care is the Medicare-certified track, and help with bathing, housekeeping, or meals is the non-medical one, even though South Dakota's health department calls those providers non-medical home health providers.

The same person can need both at once. Someone discharged after a hip replacement might need home health, a nurse and a physical therapist for a few weeks, and also personal care, an aide for bathing and meals over the months that follow. Those run on separate payment tracks: Medicare pays for the skilled piece, including aide help while the skilled care continues, and something else pays for the personal-care help once the skilled care ends.

Home Health: What Medicare Covers in South Dakota

For Medicare to pay, skilled home health in South Dakota has to come from a Medicare-certified agency; the state doesn't require a separate license for a certified home health agency. The agency provides skilled nursing plus at least one other therapeutic service, such as physical therapy, occupational therapy, speech-language pathology, medical social services, or home health aide services, following a written plan of treatment the patient's attending physician sets up with agency staff and the patient.

Medicare's home health benefit covers this care only when a beneficiary meets every condition. Two of them deserve a closer look:

  • Homebound. The person is normally unable to leave home, and leaving takes a lot of effort. On top of that, either leaving isn't recommended because of their condition, or it requires help such as a cane, wheelchair, walker, or another person. Being homebound doesn't mean never going out: leaving for medical treatment, short and infrequent trips for non-medical reasons such as religious services, and attending adult day care don't disqualify someone.
  • Intermittent skilled need. A doctor or other allowed practitioner certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care a physician or other allowed practitioner establishes and reviews, and the care comes from a Medicare-certified agency. Part-time or intermittent generally means combined skilled nursing and home health aide help of less than 8 hours a day and 28 or fewer hours a week, or up to 35 hours a week on case-by-case review.

When those conditions are met, Medicare pays for the covered skilled services, generally at $0 to the patient: the nursing visits, the therapy, and the home health aide help attached to that skilled care. What Medicare home health will not do is staff an aide in the home for general daily help with no skilled-care purpose. That's personal care, and it's the next section.

What Home Care Costs and Other Ways to Pay

Non-medical home care is in-home help such as bathing, dressing, meal preparation, and light housekeeping, and Medicare does not pay for it when it is the only care a person needs. Because it isn't skilled medical care, the payer picture looks nothing like home health, and the cost question lives almost entirely on this side.

Per the CareScout 2025 Cost of Care Survey, the most recent state-level data (released March 2026), a non-medical caregiver in South Dakota runs about $101,244 a year. That annual figure is built on a 44-hour week, which works out to about $44 an hour. That distinction matters: a family hiring an aide for only a few hours a day pays a fraction of the annual number, because the cost follows the hours actually booked. The "non-medical caregiver" line is the survey's 2025 category, which merged the former homemaker and home health aide rows into one. These are industry-survey medians, not government rates and not a ceiling, so what a specific South Dakota agency charges can land above or below them. South Dakota's in-home care runs well above the national figure of about $80,080, even though the state's facility care is among the most affordable in the country, which makes the cost question sharper here than the cheap-facility picture might suggest.

The table sets the in-home figure against South Dakota's facility costs, so a family weighing care at home against a move can see both.

Care type South Dakota (per year) National median
Assisted living about $58,800 about $74,400
Non-medical caregiver (in-home, 44-hr week) about $101,244 about $80,080
Nursing home, semi-private room about $113,333 about $114,975
Nursing home, private room about $122,275 about $129,575

Who pays for personal care comes down to a few routes:

  • Private pay. Without Medicaid or a long-term care insurance policy, the family pays out of pocket, because Medicare does not pay for personal care when that is the only care a person needs. Home care services generally charge by the hour, and some charge a flat rate for an overnight stay.
  • South Dakota Medicaid. South Dakota Medicaid covers home- and community-based services, mainly through the HOPE Waiver. HOPE provides home- and community-based services to people at risk of institutionalization, and to qualify, a person must be 65 or older (or, if younger, blind or disabled), need a nursing-home level of care, and meet all South Dakota Medicaid eligibility rules.
  • Long-term care insurance. Medicare.gov points people who need long-term care, which includes help at home with activities like bathing and dressing, to Medicaid or to private long-term care insurance. If the person holds a policy, check what in-home care it pays for.

How South Dakota Medicaid sets eligibility is worth understanding before counting on it. South Dakota is a 1634 state, so a person approved for Supplemental Security Income (SSI) is automatically eligible for Medicaid with no separate application. For long-term-care eligibility, including the HOPE waiver, the state uses an income cap of 300 percent of the federal SSI benefit rate, about $2,982 a month for a single applicant in 2026, and the countable-resource limit is $2,000 for an individual ($3,000 for a couple when both spouses begin long-term care services in the same month). When one spouse needs care, federal spousal-impoverishment rules let the at-home spouse keep a community spouse resource allowance of at least $32,532 and up to $162,660 in 2026.

One line is worth stating plainly. Medicare does not pay for non-medical personal care when that is the only care needed. A family expecting Medicare to cover an aide for daily help, with no skilled care in the picture, will find it won't, no matter how much that help is needed. The ways to pay are private funds, long-term care insurance, or, for South Dakotans who meet its eligibility rules, South Dakota Medicaid's HOPE waiver.

How to Choose and Vet an Agency in South Dakota

Start with the need, not the brochure. The table maps the two services across the dimensions that decide what the care is and who pays. Whether the care is skilled is your first clue: skilled, physician-ordered care points to home health, and everyday non-medical help points to personal care.,

Home Health (Skilled) Home Care (Non-Medical)
South Dakota oversight No state license required for a certified agency; Medicare pays only a Medicare-certified agency; the Department of Health publishes agency survey reports Not regulated by the Department of Health; personal care and homemaker help, a separate service from skilled home health
What it is Skilled, physician-ordered care: nursing and physical, occupational, or speech therapy under a plan of care, part-time or intermittent Everyday non-medical help with daily living (bathing, dressing, grooming, meals, homemaking)
Who provides it A home health agency; Medicare pays only a Medicare-certified one A non-medical in-home care provider, whose aides usually aren't medical professionals
Who pays Medicare (when homebound + intermittent skilled need), generally $0 to the patient Private pay, long-term care insurance, or South Dakota Medicaid's HOPE waiver for those who meet its eligibility rules

A quick way to place a situation: if a physician has ordered skilled care and the person is homebound, you're looking at home health, and Medicare is the payer to check first. If the need is ongoing help with everyday tasks and there's no skilled medical component, you're looking at personal care, and the question becomes whether to pay privately or qualify through South Dakota Medicaid.

Once you know which service you need, the checks differ by track. For skilled home health, the Medicare certification is the substance, not the marketing:

  • Confirm Medicare certification. South Dakota doesn't require a state license for a certified home health agency, and Medicare pays only when a Medicare-certified agency provides the care. Ask the agency to confirm its Medicare certification before assuming Medicare will pay, and use Medicare.gov's home health comparison tool, Care Compare, to find Medicare-certified agencies.
  • Read the survey reports. The South Dakota Department of Health's home health page publishes home health agency survey reports, and its Consumer Home Health Hotline, 1-800-738-2301, takes questions and complaints.
  • Match the agency to the doctor's order. Medicare coverage hinges on a plan of care from a doctor or other allowed practitioner and the homebound and intermittent-skilled tests, so confirm the agency will work from your doctor's order.

For non-medical home care, the National Institute on Aging suggests asking a doctor, family, or friends to recommend services, asking providers for references, and gathering as much as you can about services, fees, terms, and restrictions before you sign an agreement. A few steps are worth taking before you hire:

  • Ask how caregivers are screened. Because the South Dakota Department of Health does not regulate non-medical in-home care providers, this diligence falls to you: ask whether the agency runs criminal background checks on the aides it sends, whether caregivers are the agency's employees or independent contractors, and who carries liability and workers' compensation coverage.
  • Check references. Ask for references from people who have used the agency's services, and follow up on them.
  • Get a written care plan and rate. Insist on a written plan that lists the specific tasks, the hours, the hourly rate, and any minimums, so expectations and cost are clear before care starts.
  • Check the Medicaid path early if money is tight. If private pay isn't sustainable, ask South Dakota Medicaid about the HOPE waiver before a crisis forces the decision.

Frequently Asked Questions

Does Medicare cover home health in South Dakota?

Yes, but only when the person needs skilled care. Medicare's home health benefit covers nursing and physical, occupational, or speech therapy, plus home health aide help while that skilled care continues, under a plan of care from a doctor or other allowed practitioner, for a person who is homebound and needs that care on a part-time or intermittent basis, delivered by a Medicare-certified agency, and the patient generally pays $0 for the covered services. It does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support an aide provides, when that is the only care needed.

What is the difference between home care and home health in South Dakota?

Home health is skilled care a doctor orders, such as nursing or physical, occupational, or speech therapy, covered by Medicare when the person is homebound and needs intermittent skilled care. Non-medical home care is everyday help with daily living that Medicare does not cover when it is the only care a person needs. In South Dakota, a certified home health agency doesn't need a state license and Medicare pays only a Medicare-certified agency, while non-medical in-home care providers aren't regulated by the South Dakota Department of Health and that care runs on a separate payment track.

How much does home care cost in South Dakota?

Per the CareScout 2025 Cost of Care Survey, a non-medical caregiver in South Dakota runs about $101,244 a year on a 44-hour week, which is well above the national figure of about $80,080. That annual figure assumes a near full-time schedule, which works out to roughly $44 an hour, so a family hiring an aide for only a few hours a day pays far less than the annual number. The figures are survey medians, not fixed rates, so a given agency can charge above or below them.

Does South Dakota Medicaid cover personal care?

For people who qualify, South Dakota Medicaid covers home- and community-based services, mainly through the HOPE waiver. HOPE is for people 65 or older (or younger and blind or disabled) who need a nursing-home level of care and meet all South Dakota Medicaid eligibility rules. South Dakota is a 1634 state, so a person approved for Supplemental Security Income (SSI) is automatically eligible for Medicaid; for long-term-care eligibility the state uses an income cap of 300 percent of the federal SSI benefit rate, about $2,982 a month for a single applicant in 2026, with a countable-resource limit of $2,000 for an individual.

Is home care more expensive in South Dakota than elsewhere?

For in-home care, yes. A non-medical caregiver runs about $101,244 a year in South Dakota in the CareScout 2025 survey, well above the national figure of about $80,080, while the state's facility care, including assisted living and nursing homes, sits at or below the national medians. That gap is part of why the home-care payer question matters here: in the same survey, assisted living in South Dakota runs about $58,800 a year and a semi-private nursing home room about $113,333.

Learn More

Care TypesHome Care vs. Home Health by State: What's the Difference and Who PaysHome care is non-medical help; home health is skilled, doctor-ordered care. See what each costs, who pays (Medicare vs. Medicaid), and your state's guide. Care TypesAssisted Living in South DakotaAssisted living in South Dakota runs about $4,900 a month, among the nation's lowest. How the state licenses it, what it costs, and what Medicaid pays. Care TypesNursing Homes in South DakotaNursing homes in South Dakota in 2026: a semi-private room runs about $113,333/year, below the national median. What it costs, who pays, and how to choose. Care TypesMemory Care in South DakotaSouth Dakota has no separate memory care license. Dementia care is a regulated unit inside an assisted living center, priced above standard assisted living. Care TypesCost of Senior Care in South DakotaSenior care costs in South Dakota: assisted living about $4,900 a month, a semi-private nursing-home room about $113,333 a year. Each setting, and how to pay. Care TypesAssisted Living vs. Nursing Home in South DakotaAssisted living vs. a nursing home in South Dakota comes down to level of care and who pays: about $4,900/month private-pay vs. roughly $113,333/year nursing.
MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. CaregiverCaregiver Burnout: Signs and SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools.

Find personalized help matching the right in-home service to the need and payer in South Dakota at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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