South Dakota ADLS Waiver: Can a Spouse or Family Member Be Paid?

South Dakota's Assistive Daily Living Services (ADLS) Waiver can pay a spouse, parent, or adult child to be the personal attendant for an adult with quadriplegia. Under the South Dakota ADLS Waiver, the attendant is employed by a provider agency under contract with the state Department of Human Services, and the person receiving care directs the work.1

Who Can Be Paid Under the South Dakota ADLS Waiver?

ARSD 67:54:06:08, South Dakota's rule for the ADLS program, says a "consumer's spouse, parent, or adult child may receive reimbursement for providing personal attendant services if the requirements of this chapter are met." The South Dakota Medicaid billing manual for the ADLS Waiver goes further: "The waiver encourages the employment of spouses, parents or adult children to provide these services."1

That matters most for spouses. Under South Dakota's State Plan personal care benefit, a spouse counts as a legally responsible person and can't be the paid worker.5 South Dakota's ADLS rule, by contrast, names a spouse.

Does Your Family Member Qualify for the ADLS Waiver?

ADLS isn't a general senior waiver. South Dakota's ADLS manual says the person receiving care must be at least 18; have quadriplegia due to a condition such as a spinal cord injury, multiple sclerosis, muscular dystrophy, cerebral palsy, or traumatic brain injury, or have four limbs absent; and require a nursing facility level of care. Because the South Dakota ADLS Waiver is participant-directed, the person must also be able to direct and manage their own attendant services or have the ability to select an authorized representative.1

Money is the other test. South Dakota's Department of Social Services says that for the ADLS Waiver, the income limit can be up to $2,982 a month in 2026 and the resource limit is $2,000 for an individual, counting items such as checking and savings accounts and certificates of deposit.2 For the South Dakota ADLS Waiver, financial eligibility goes through a Long Term Care application approved by the Department of Social Services' Division of Economic Assistance.4

If the person you care for doesn't meet the quadriplegia test, see how the HOPE Waiver covers home care instead.

What You Need to Become the Paid Attendant

You'll be employed by the agency, not paid directly by Medicaid. South Dakota's ADLS rule requires the attendant to be employed by a provider agency that has a contract with the Department of Human Services to provide assistive daily living services.1

Your family member picks the attendant. Under South Dakota's ADLS rule, the consumer selects a personal attendant from the agency's list of available attendants. If the agency has no attendant available to provide the needed services, the consumer may need to recruit, interview, and select one independently, then submit that attendant's name to the provider agency for review and approval.6 South Dakota's ADLS manual also says participants recruit, screen, train, and direct their personal care attendants.1 If your family member has already chosen you, ask the agency early how it handles that.

South Dakota's ADLS rule (ARSD 67:54:06:08) lists other attendant qualifications, including:

• a basic nurse aide or home health aide course, a personal attendant training program supervised by a registered nurse, or a personal attendant competency assessment shown by a certificate of competency signed by a licensed nurse, a physician, or the consumer
• proof of a Social Security number
• the ability to read, write, and communicate
• no conviction in the last three years for an offense that would directly affect fitness to be a personal attendant
• the ability to perform the needed services and keep information confidential6

What the Paid Attendant Does, and What Isn't Covered

Under South Dakota's ADLS manual, only services on the participant's approved service plan and authorized by an ADLS service coordinator are covered. The manual's list covers the hands-on work a family member already knows: bathing, dressing and undressing, toileting, transfers, turning and positioning in bed, range of motion exercises, bladder and bowel programs, and helping the participant take their own medications. Two tasks are reserved for family: under the South Dakota ADLS Waiver, ventilator management and tracheostomy care are covered only if the personal attendant is a family member.6

Some limits turn on who else lives in the home. Under South Dakota's ADLS manual, feeding, meal preparation, housekeeping, laundry, and help with bills are covered only when no one else in the home is able to do the task, and transportation isn't covered if someone else in the home can provide it.1 If you live with your family member, ask the agency how these limits apply to you. The ADLS manual also lists non-covered tasks such as shoveling snow, yard work, and caring for pets or livestock.6

Under the South Dakota ADLS Waiver, your family member also can't receive State Plan personal care and ADLS personal care at the same time.6

How Much Does the ADLS Waiver Pay a Family Attendant?

South Dakota's ADLS rule handles pay through the agency contract: the Department of Human Services sets the rate of payment in each provider agency's contract. That's hard to plan around when you're deciding whether to cut back at work. The participant may owe part of the cost. Under South Dakota's ADLS rule, payment is based on the difference between the participant's income, minus allowable deductions, and their monthly care costs, and the participant pays any share they owe directly to the provider agency. The rule also says the cost of ADLS services may not exceed the cost of caring for the person in an institutional setting.6

For a rough benchmark, home care aides in South Dakota earned a median of $18.15 an hour in May 2025, according to the U.S. Bureau of Labor Statistics. That isn't a figure any ADLS agency has promised, so ask each agency what it pays attendants and get it in writing.3

Hours follow the approved service plan; South Dakota's ADLS rule and manual state no annual hours cap for attendant services.1

How to Apply for the South Dakota ADLS Waiver

South Dakota's sources describe two ways into the ADLS Waiver, plus a separate financial application. Ask the Division of Rehabilitation Services which to start first.

• Send the ADLS application. The South Dakota Department of Human Services says to print and mail or email the ADLS Application to the address on the application. Answering yes to all of its eligibility questions leads to an assessment to determine eligibility.
• Apply to a provider agency. Under South Dakota's ADLS rule, the Department of Human Services gives you a list of provider agencies, and you select one and apply directly to it.
• Start the Long Term Care application. This is the separate financial step, approved by the Division of Economic Assistance, described in the money test above.4

Once you request services from a provider agency, South Dakota's ADLS rule sets these timelines:

A denial can be challenged, but the first deadline is short, so write down the date on the notice. If South Dakota finds the person ineligible for ADLS, the Department of Social Services sends a written notice of adverse action. Under South Dakota's ADLS rule, you may request a conference with the department that made the decision, and the request must be made within 15 days after the date the notice is sent. If no conference is requested within those 15 days, the notice becomes the final decision, and under South Dakota's ADLS rule you then have 30 days after receiving the final decision to request a hearing.4 See South Dakota Medicaid appeals and fair hearings for how hearings work.

Is ADLS Attendant Pay Taxable?

It may not be, if you live with the person you care for. Under IRS Notice 2014-7, qualified Medicaid waiver payments, including payments from a certified Medicaid provider to a caregiver for care under a plan of care, can be excluded from federal gross income whether or not the caregiver is related. The IRS Notice 2014-7 exclusion applies only to care in the caregiver's own home where the care recipient also lives.7 Ask a tax professional how it applies to agency wages, and see whether Medicaid waiver payments are taxable.

Learn More

Find personalized help getting paid as a family attendant under South Dakota's ADLS Waiver 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.