How to Get Paid as a Family Caregiver in South Dakota (2026)

In South Dakota, you can get paid as a family caregiver through two kinds of programs: Medicaid home care programs and VA programs. If you are already doing the daily care for a parent or spouse, some of these programs can turn that unpaid work into income, depending on each program's rules. On the Medicaid side, the HOPE Waiver's structured family caregiving service lets a family member or non-relative fictive kin be the principal caregiver and receive a financial stipend from a structured family caregiving provider agency.1 The HOPE Waiver manual never uses the word spouse, so it does not settle whether a spouse can be hired; confirm that with the South Dakota Department of Social Services (DSS) before counting on it.1 For veteran families who meet VA's tests, VA programs can also pay a caregiver, including a spouse.

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to the designated Primary Family Caregiver of an eligible veteran, and a spouse is among the family members who can qualify, but the veteran must have a VA disability rating of 70% or higher and meet VA's other requirements.2 VA Aid and Attendance provides up to $34,488 a year for a veteran with one dependent in 2026.3

The Short Version

If the care recipient is a veteran, start with the VA programs. PCAFC pays a monthly stipend to a Primary Family Caregiver, and spouses and other family members can qualify when the veteran has a VA disability rating of 70% or higher and meets VA's other requirements.2 Where a local VA medical center offers it, Veteran-Directed Care gives the veteran a flexible budget and lets the veteran hire their own personal care aides, which VA says might include a family member.5 Aid and Attendance is a higher VA pension rate paid to veterans and surviving spouses who qualify.3

If the care recipient is 65 or older (or 18 to 64 with a physical or other disability), meets a nursing facility level of care and meets South Dakota's Medicaid financial rules, the HOPE Waiver's structured family caregiving service can pay a family member a stipend through a provider agency.1 The caregiver must live with the participant, and the sources do not say whether a spouse can fill that role, so confirm with DSS.4 If the care recipient is an adult with quadriplegia who meets the Assistive Daily Living Services Waiver's rules (below), that waiver can pay a spouse, parent or adult child as the personal attendant through a provider agency.7

If neither VA benefits nor Medicaid applies, a private personal services contract is the fallback. Put it in writing before care begins, with the services, schedule and rate spelled out, and ask a South Dakota elder-law attorney how Medicaid would treat it.

How Do You Get Paid as a Family Caregiver in South Dakota?

Personal Care Services (PCS) State Plan Benefit

South Dakota's Medicaid State Plan covers personal care, meaning help with activities of daily living for a participant living at home. It has a ceiling: the HOPE Waiver's personal care service begins only once 500 hours of personal care (a combination of homemaker, personal care, and nursing) under the State Plan limits are used up, and the HOPE Waiver manual says its personal care service may not be authorized for a participant living in an assisted living.1 A spouse cannot be the paid worker under this benefit: South Dakota's personal care manual says the services cannot be provided by a recipient's legally responsible person, which includes a spouse or the parent of a minor child. For an adult child or a relative who lives with the recipient, the answer is less clear. The state rule describes personal care as provided by someone who is not a member of the recipient's family, but its definitions do not define family, so ask before planning around it.8

HOPE Waiver and the Assistive Daily Living Services Waiver

Two of South Dakota's Medicaid waivers can pay a family caregiver, and both require a nursing facility level of care. The Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver covers adult day services, in-home respite care, homemaker, in-home nursing, personal care, assisted living and structured family caregiving for people 65 or older and people 18 to 64 with physical or other disabilities. The Assistive Daily Living Services (ADLS) Waiver covers personal attendant care, respite and in-home nursing.1

CMS's waiver factsheet describes ADLS as serving people 65 or older and people 18 to 64 with physical disabilities, but South Dakota's eligibility rule, ARSD 67:54:06:02, is narrower: a participant must be 18 or older, have quadriplegia from a listed cause (such as cerebral palsy, multiple sclerosis or a spinal cord injury) or four limbs absent, need a nursing facility level of care, and receive SSI or qualify for Medicaid. Age 65 alone does not qualify.1 For a participant who does qualify, the waiver lets a spouse, parent or adult child be paid as the attendant through a DHS-contracted provider agency.7

The HOPE Waiver is operated by the Department of Human Services (DHS), Division of Long Term Services and Supports (LTSS), while the DSS Division of Economic Assistance decides financial eligibility for long-term care.1

NFCSP: Support for Caregivers, Not a Wage

The National Family Caregiver Support Program, authorized by Title III-E of the Older Americans Act, gives federal grants to states and territories based on their share of the population age 70 and over. It funds five types of services: information about available services; help gaining access to them; individual counseling, support groups and caregiver training; respite care; and supplemental services on a limited basis. A wage paid to the family caregiver is not among those five.1

To find caregiver support services near you, use the Eldercare Locator, a free federal service that connects families to their local Area Agency on Aging and other community services, at eldercare.acl.gov or 1-800-677-1116.9

Six Ways to Get Paid as a Family Caregiver in South Dakota

Pathway 1: PCS State Plan Personal Care

For Medicaid-eligible South Dakotans living at home, State Plan personal care is the first layer of help with daily activities, up to the State Plan's 500-hour limit, which counts homemaker, personal care and nursing together.1 A spouse cannot be the paid worker, and an adult child or live-in relative should ask first, given the rule's "not a member of the recipient's family" wording.8

Pathway 2: HOPE Waiver Structured Family Caregiving

Under the HOPE Waiver's structured family caregiving (SFC) service, a related family member or non-relative fictive kin can be the participant's principal caregiver. The caregiver receives education, ongoing coaching and a financial stipend from an SFC provider agency.1 DHS's SFC provider rules require the principal caregiver to live in the same home as the participant, be the main person responsible for daily care, be 18 or older, pass a background check and support no more than two people in SFC.4 SFC has three rate tiers (base, U1 and U2) based on how much support the participant needs. Each provider agency sets its own stipend amount, but caregiver stipends must equal at least 50 percent of the established rate tier.1 The enrollment steps:

Pathway 3: VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to a designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 years old and must be either the veteran's spouse, son, daughter, parent, stepfamily member or extended family member, or someone who lives full time with the veteran (or is willing to, if VA designates them).2

VA lists four requirements for the veteran: a VA disability rating (individual or combined) of 70% or higher; a discharge from the U.S. military or a date of medical discharge; a need for at least six months of continuous, in-person personal care services; and enrollment in VA health care. Those are a first screen, not a decision: the caregiver and the veteran apply together and go through an application process that determines eligibility.2

The monthly stipend starts from the OPM General Schedule grade 4, step 1 annual salary for the veteran's locality pay area, divided by 12. That monthly base is then multiplied by a factor set in 38 CFR 71.40(c)(4)(i), and which factor applies depends first on whether the veteran is in the current program or is a legacy participant or legacy applicant:2,10

• Current program (veteran meeting 38 CFR 71.20(a)): the factor is 0.625, or 1.00 if VA determines the veteran is "unable to self-sustain in the community."2
• Legacy participant or legacy applicant (veteran meeting 38 CFR 71.20(b) or (c)): the factor comes from the sum of the veteran's 2019 clinical ratings instead, and no self-sustain determination is required. A sum of 21 or higher pays 1.00, a sum of 13 to 20 pays 0.625, and a sum of 1 to 12 pays 0.25. This legacy schedule runs for eight years beginning October 1, 2020, so it lapses October 1, 2028.2

A veteran who meets both the current-program and the legacy criteria is paid whichever of the two amounts is higher. A legacy participant under 38 CFR 71.20(b) also has a floor: the stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, as long as the veteran remains at the same address.2

To receive the stipend, the caregiver must be enrolled in direct deposit through the VA customer engagement portal. A Primary Family Caregiver may also get CHAMPVA health care benefits if not already qualified for care or services under another health care plan, at least 30 days of respite care per year, and free legal and financial planning help related to the veteran's needs.2 For enrollment questions, VA's Caregiver Support Line is 1-855-260-3274, Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.11

Pathway 4: VA Veteran-Directed Care (VDC)

VA Veteran-Directed Care is a VA program, developed with the Administration for Community Living in 2008, for veterans who need help with daily activities such as bathing, dressing or fixing meals. The veteran gets a flexible budget for services that the veteran or the family caregiver can manage, and can hire their own personal care aides, which VA says might include a family member or neighbor.5 The VA medical center delivers the program through a local aging and disability network agency, such as an area agency on aging, and the budget amount is based on the veteran's needs.12 VA tells veterans to talk with their VA social worker about whether VDC is available where they live, and that is also the person to ask whether your local program lets you hire a spouse.5

Enrolled veterans who meet the clinical need are eligible where VDC is offered, but VA says the program is only available in certain locations.5 In ACL's model VDC handbook, a template local agencies can modify, a financial management services provider acts as the veteran's payroll agent and issues W-2 forms; ask how your local program handles payroll.12

Pathway 5: VA Aid and Attendance

VA Aid and Attendance is a higher Veterans Pension and Survivors Pension rate paid to veterans and surviving spouses who qualify for Aid and Attendance benefits.3

2026 Aid and Attendance maximum annual pension rates (effective December 1, 2025 through November 30, 2026). Each is a ceiling, not a payment: VA pays the difference between the claimant's countable income and the ceiling, and the monthly rate is that remainder divided by 12, rounded down to the whole dollar:3

• Single veteran: up to $29,093 per year
• Veteran with one dependent: up to $34,488
• Surviving spouse (no dependents): up to $18,6973

The net worth limit is $163,699. VA pension is subject to a 36-month look-back on transfers under 38 CFR 3.276 made on or after October 18, 2018.3

VA pays the pension to the veteran or surviving spouse, not to a caregiver.3,10 To pay a family member from it, use a written contract (Pathway 6).

Pathway 6: Private Personal Services Contract

For families outside both VA and South Dakota Medicaid systems, a personal services contract documents and compensates caregiving work. A careful contract is:

• Written and signed before care begins
• Specific about services, schedule, and rate
• Supported by ongoing service logs

South Dakota Medicaid looks back 60 months at asset transfers, and an asset transferred for less than fair market value makes a person ineligible for long-term care services.6 If the care recipient might apply later, ask a South Dakota elder-law attorney how Medicaid would treat payments to a family member before you start paying them.

What If You Are Denied or Waitlisted?

If the VA denies PCAFC or sets a stipend factor lower than you expected, ask VA two things: which factor (0.25, 0.625 or 1.00) was applied, and whether the current-program or legacy schedule was used.2 Then ask how to challenge the decision, and whether a new application makes sense if the veteran's care needs increase.

If South Dakota Medicaid denies or reduces a personal care or waiver authorization, read the notice you receive and ask DSS how to challenge the decision.

If you are told waiver services are not available right away, ask DSS whether State Plan personal care can cover help in the meantime, and look for caregiver support services in your community through the Eldercare Locator.9

How Do You Choose the Right South Dakota Pathway?

Veteran household: If the veteran meets PCAFC's four requirements (Pathway 3), apply together; VA's application process decides eligibility, and a spouse can qualify as the caregiver.2 If the veteran also receives VA pension, VA counts a spouse-caregiver's PCAFC stipend as income, which reduces the pension, including pension paid at the Aid and Attendance rate.13 Ask the veteran's VA social worker whether Veteran-Directed Care is available locally.5

Non-veteran Medicaid household: Ask about the HOPE Waiver's structured family caregiving service, which pays a relative or fictive kin a stipend through a provider agency, and confirm with DSS whether a spouse can fill that role.1

Private-pay household: Use a written personal services contract (Pathway 6), reviewed by a South Dakota elder-law attorney if Medicaid may come later.

IRS Notice 2014-7 and Taxes

Under IRS Notice 2014-7, qualified Medicaid home and community-based services waiver payments made to an individual care provider for the personal care of a recipient who lives in the same home may be excluded from the provider's federal gross income. What decides it is where the care is given: it applies only to care in the provider's home where the care recipient lives.14 Whether a structured family caregiving stipend paid through a provider agency counts as a qualifying payment is a question for a tax professional.

VA considers the PCAFC monthly stipend a non-taxable benefit, similar to Veteran disability payments.10

The notice does not let a provider exclude payments a care recipient makes from their own private funds, so ask a tax professional how to report personal services contract income.14

Common Misconceptions

"Medicaid pays any family member an hourly wage to give care." In South Dakota, each Medicaid route has its own limits. Under the HOPE Waiver's structured family caregiving service, the principal caregiver receives a financial stipend from an SFC provider agency, and the waiver manual does not settle whether a spouse can be the caregiver.1 The ADLS Waiver can pay a spouse, parent or adult child, but only for adults with quadriplegia (or four limbs absent).7

"Medicare pays for ongoing personal care." Medicare does not cover custodial care, meaning help with daily activities such as bathing, dressing and using the bathroom, when that is the only care a person needs. It covers skilled nursing and therapy care in a Medicare-certified skilled nursing facility or through the home health benefit.15

"A verbal arrangement is enough for Medicaid purposes." Do not assume it is. Ask a South Dakota elder-law attorney how Medicaid would treat payments to a relative, and bring a written contract, signed before care begins, for them to review.

Learn More

Find personalized help choosing the right South Dakota paid-caregiver pathway 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.