How to Pay for Assisted Living in South Dakota (2026)

In South Dakota, Medicaid's HOPE waiver can pay for assisted-living care, but the resident still pays for room and board.1

That split shapes every plan below. Most South Dakota families begin with income and savings, then add long-term care insurance or VA benefits if a parent has them, and turn to South Dakota Medicaid when the money runs low. Medicare isn't on that list, because Medicare Part A and Part B don't pay an assisted living facility's room and board or its custodial care.2

In This Guide

• Why Medicare Won't Pay the Monthly Bill
• Paying Privately in South Dakota
• Does South Dakota Medicaid Pay for Assisted Living?
• Protecting a Spouse, and the 60-Month Look-Back
• What Estate Recovery Can Reach
• VA Aid and Attendance and Long-Term Care Insurance
• Choosing a Licensed Assisted Living Center
• How to Pay for Assisted Living in South Dakota: Putting It Together
• Frequently Asked Questions

Why Medicare Won't Pay the Monthly Bill

Many families learn this late, so it's worth knowing before you start comparing communities. Medicare Part A and Part B don't pay the room-and-board or custodial-care costs of an assisted living facility, meaning the help with bathing, dressing, and eating that most assisted living provides.2

That doesn't mean your parent loses Medicare by moving in. A Medicare-covered medical service doesn't stop being covered because the person receiving it lives in an assisted living facility; what Medicare won't pay is the facility's own room-and-board and personal-care charge.2 A Medigap policy doesn't fill that gap either.2

Medicare itself points to the real options: paying privately, buying private long-term care insurance, or getting long-term care through Medicaid if you meet your state's eligibility rules.2 The rest of this guide takes those one at a time, the way they usually line up for a South Dakota family.

Paying Privately in South Dakota

For most families the first months come out of their own pocket, and the hard part is watching savings drain with no sense of when they'll run out. Putting a timeline on paper turns that dread into something you can plan around. The usual sources:

• Income. Social Security, a pension, and scheduled withdrawals from retirement accounts are the steadiest base.
• Savings and investments, drawn down on a schedule you write out in advance, so you know roughly which month they would run low.
• The family home, sold once no one lives there, or borrowed against if a spouse still does. If Medicaid may be needed later, get advice on timing first, because how the proceeds are held can affect eligibility.
• Annuities and life-insurance conversions, which some families use to turn a lump sum or an old policy into predictable monthly income.

To see what South Dakota assisted living typically costs, and how it compares with home care and nursing homes, read our guide to the cost of senior care in South Dakota. Then check the quote you were given against it, and ask the community to put the monthly price in writing with the rent and the care charges shown separately. That split matters more in South Dakota than you might expect, because South Dakota Medicaid's HOPE waiver can pay for assisted-living services but not for room and board.1

Write down the month private funds would run low. That date is what lets you apply for South Dakota Medicaid on your own schedule instead of in a crisis.

Does South Dakota Medicaid Pay for Assisted Living?

Yes, for the care, not for the rent. South Dakota Medicaid can cover assisted-living services through the HOPE waiver, its home- and community-based waiver for individuals in assisted living or community home facilities.1 The HOPE waiver is South Dakota's main home- and community-based long-term-care waiver, and South Dakota Medicaid is administered by the Department of Social Services (DSS).3

The room-and-board rule

Federal rules bar Medicaid from paying the cost of room and board in a home- and community-based waiver, with two exceptions: room and board that is part of respite care in a state-approved facility, and, in waivers that allow personal caregivers, a reasonable share of the rent and food attributable to a live-in caregiver. So an assisted living resident on South Dakota's HOPE waiver still pays for room and board.1

In plain terms, the waiver pays for the care and your parent pays for the roof. How a community's monthly price divides between the two is set by the community, not by any published figure, so ask each one for that split in writing, and ask DSS what your parent's share would be before you plan around the waiver.

Who qualifies for the HOPE waiver in assisted living

To qualify for South Dakota Medicaid's HOPE waiver, an applicant must:1

• be 65 or older, or, if under 65, be blind or disabled;
• medically require a level of care provided in a nursing home;
• have monthly income no higher than 300 percent of the SSI benefit amount, which is $2,982 in 2026; and1
• have resources no higher than $2,000.1

The level-of-care test is the one families most often underestimate. The HOPE waiver is not for someone who simply prefers assisted living; it requires medical needs at the level of care a nursing home provides. If your parent is on the edge, ask DSS how the assessment works before you rule the waiver in or out.

One shortcut is worth knowing. South Dakota is a 1634 state, so a person approved for SSI is automatically eligible for South Dakota Medicaid with no separate application.3

If income is over South Dakota's cap: the Medicaid income trust

If your parent's monthly income is above the $2,982 cap South Dakota Medicaid uses in 2026 for a single applicant's long-term-care and HOPE waiver eligibility, that does not end the conversation.3 For South Dakota Medicaid's institutional and waiver long-term-care eligibility, an applicant whose income exceeds the ceiling can still qualify by routing income through what South Dakota's rules call a Medicaid income trust, the qualified income or "Miller" trust.3

South Dakota's rules set four requirements for that trust:3

• It holds only the beneficiary's own pension, Social Security, or other income.
• The trustee must pay the beneficiary monthly, without discretion, the income paid in, but what the beneficiary keeps may not exceed 300 percent of the maximum SSI standard benefit amount when added to their other monthly income.
• The trustee must pay the rest monthly to the nursing facility or waiver provider.
• On the beneficiary's death, the South Dakota Department of Social Services must be repaid from whatever remains, up to the total medical assistance paid on the beneficiary's behalf.

Setting one up is legal paperwork with real consequences if it's done wrong. Ask DSS or an elder law attorney to walk through it with you before your parent applies.

What counts toward South Dakota's $2,000 resource limit

The countable-resource limit for South Dakota Medicaid long-term-care assistance is $2,000 for an individual, and $3,000 for an individual with a spouse if both spouses begin receiving long-term care services in the same month.3

That $2,000 isn't everything your parent owns. South Dakota Medicaid excludes one automobile regardless of its value if it is used for necessary transportation, and household goods, personal effects, and all items essential to everyday living. Home property is governed by a separate South Dakota Medicaid rule and a home-equity limit, which for 2026 runs from a minimum of $752,000 to a maximum of $1,130,000.3 Our guide to South Dakota Medicaid income and asset limits goes further into what counts.

Protecting a Spouse, and the 60-Month Look-Back

If one parent needs care and the other stays home, the at-home spouse is not expected to give everything up. Under federal spousal-impoverishment rules, South Dakota Medicaid lets the at-home spouse keep a community spouse resource allowance of at least the $32,532 minimum resource standard and up to the $162,660 maximum in 2026.3 Our guide to South Dakota Medicaid spousal impoverishment rules explains how that allowance is worked out.

Timing matters too. South Dakota Medicaid enforces a 60-month look-back on asset transfers, running back to the date 60 months before the first date on which the individual is institutionalized and applies for long-term care assistance.3 A gift to a grandchild, or a house quietly signed over to an adult child, can fall inside that window. If Medicaid is anywhere on your horizon, get advice before moving money, not after.

What Estate Recovery Can Reach

Nobody wants to think about this while a parent is still alive, but knowing it early is what gives you choices. Like every state, South Dakota must seek recovery from the estate of someone who was 55 or older when they received long-term-care Medicaid.3

Federal law confines South Dakota Medicaid estate recovery to medical assistance consisting of nursing facility services, home- and community-based services, and related hospital and prescription-drug services, and allows that recovery only after the death of a surviving spouse and only when there is no surviving child who is under 21, blind, or permanently and totally disabled.3

South Dakota's own rules on what counts as the estate, and on how a surviving family can respond, deserve a careful read of their own. Our guide to South Dakota Medicaid estate recovery walks through them, and it's worth reading before anyone retitles the house.

VA Aid and Attendance and Long-Term Care Insurance

If your parent is a veteran or a veteran's surviving spouse, don't skip this one. Veterans and surviving spouses may qualify for VA Aid and Attendance, which our guide to VA Aid and Attendance for assisted living in South Dakota explains.

Long-term care insurance is the other private source to check, and it is not the same as a Medigap policy: Medicare.gov says Medigap doesn't pay for long-term care.2 If your parent bought a policy years ago, find it now and call the insurer to ask, in writing, whether it pays for care in an assisted living center before you count on it. Our national guide on how to pay for assisted living covers long-term care insurance in more depth.

Choosing a Licensed Assisted Living Center

However you end up paying, make sure the place you're paying is licensed. In South Dakota, assisted living centers are licensed by the South Dakota Department of Health under South Dakota Codified Laws chapter 34-12 and the Administrative Rules of South Dakota article 44:70.1

Two South Dakota admission rules are worth planning around, because they affect how fast a move can happen. Under ARSD 44:70:04:13, before admission to an assisted living center each resident must have written orders from a physician, physician assistant, or nurse practitioner of symptoms and diagnoses, and a physical examination certifying the resident is in reasonably good health. The center must also evaluate and document each resident's care needs at the time of admission, thirty days after admission, and annually thereafter.1

So book the doctor's visit early if a move is coming. And ask each community whether its thirty-day evaluation could change the care charges on your bill. Our guide to assisted living in South Dakota covers choosing a community in more detail.

How to Pay for Assisted Living in South Dakota: Putting It Together

No two families end up with the same plan, and it's fine if yours takes a few conversations to work out. Here is how the payers usually line up in South Dakota, by situation.

• Your parent has savings or a home. Private pay covers the early months. Write out how long the money lasts, and learn South Dakota Medicaid's 60-month look-back before moving any assets.3
• Your parent needs nursing-home-level care and money is running low. Talk to DSS about the HOPE waiver. It can pay for assisted-living services, while your parent keeps paying room and board.1
• Your parent's monthly income is above South Dakota Medicaid's 2026 long-term-care cap of $2,982. Ask about a Medicaid income trust before assuming the HOPE waiver is out of reach.3
• One parent still lives at home. Ask how South Dakota Medicaid's community spouse resource allowance applies before you spend down.3
• Your parent is a veteran or a veteran's surviving spouse. Ask whether VA Aid and Attendance could add to whichever plan fits.

Whichever line fits, the first phone call is usually the hardest step. Making it before savings run low gives you time to choose a community on your own terms.

Learn More

Find personalized help paying for assisted living 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.