Caregiver Programs in South Dakota: Paid, Respite & Support (2026)

Caregiver programs in South Dakota can pay a family member to provide care, cover respite when you need a break, and, for veterans' families, add a monthly VA stipend.

If you are caring for an aging parent, a spouse, or an adult child with a disability, this guide sets out what each program offers, who it can pay, and where to start. You don't have to figure this out alone.

South Dakota Caregiver Programs at a Glance

Which South Dakota Caregiver Programs Pay Family Members?

Can I be the one who gets paid to do this? In South Dakota, the answer turns on which Medicaid program the person you care for uses, and the three programs below treat spouses differently.

South Dakota Medicaid is run by the Department of Social Services (DSS), whose Division of Economic Assistance decides financial eligibility for long-term care. In-home help includes personal care under the Medicaid State Plan, which covers help with activities of daily living for someone living at home.9

State Plan Personal Care: A Spouse Cannot Be the Paid Worker

If you hoped to be paid for caring for your husband or wife, this benefit will not do it. The DSS manual says personal care cannot be provided by a recipient's legally responsible person, which includes a spouse. For an adult child, 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 it does not define family, and neither source names an adult child or a relative who lives with the recipient, so ask LTSS before you plan around it.2

How the benefit works: the Department of Human Services (DHS) Division of Long Term Services and Supports (LTSS) conducts the needs assessment and writes a service plan that sets the number of personal care hours, and the worker comes through an agency incorporated in South Dakota that has a contract with the department. A recipient is limited to 500 hours of agency-based personal care in a plan year (July 1 to June 30), and that limit does not apply to recipients age 20 or younger. If a recipient is eligible for a home and community-based services waiver and has an assessed need for more than 500 hours, additional units may be authorized under that waiver.2

HOPE Waiver Structured Family Caregiving: Pay for a Relative Who Lives With You

The Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver, operated by DHS LTSS, provides services such as adult day services, in-home respite, homemaker, in-home nursing, personal care, and structured family caregiving to people 65 and older, and to adults 18 to 64 with physical or other disabilities, who meet a nursing facility level of care. Once 500 hours of State Plan personal care (homemaker, personal care, and nursing combined) are used up, a HOPE Waiver participant can receive additional personal care through the waiver, though personal care may not be authorized for a participant living in an assisted living.9

Under the HOPE Waiver's structured family caregiving (SFC) service, the participant lives with a principal caregiver, in the participant's home or the caregiver's, and that caregiver receives education, ongoing coaching, and a financial stipend from an SFC provider agency. The principal caregiver may be a related family member, such as an adult child, or non-relative fictive kin: someone not related by birth, adoption, or marriage who has an emotionally significant relationship with the participant.1 DHS's provider rules say the principal caregiver must:

• Live in the same qualified home as the participant.1
• Be the primary person responsible for daily care and support.1
• Be at least 18 and pass a background check.1
• Support no more than two people in SFC.1

The caregiver is not the agency's employee and is not covered by employee rules such as wage and hour laws, workers' compensation, and unemployment. SFC has three rate tiers (base, U1, and U2), set by the LTSS Case Management Specialist from how much support the participant needs, and the stipend must be at least 50 percent of the participant's identified rate.1

None of those HOPE sources mentions spouses, so whether a spouse can be the SFC caregiver is not settled in writing. Ask the LTSS case manager, who meets with you to assess needs and determine eligibility for services. Outside SFC, an LTSS in-home services provider may hire a relative or legal guardian of the person receiving care, as long as that person meets all of the provider's qualifications and training requirements. If that relative lives in the same home, the provider should contact the Case Management Specialist, and a referral to structured family caregiving is required. That provider rule says relative; it does not name a spouse.1

Do we qualify? Two of the gates are financial and functional. First, financial eligibility, which DSS's Division of Economic Assistance determines.9 South Dakota's look-back reaches 60 months before the first date the person is institutionalized and applies for long-term care, and an asset transferred for less than fair market value in that window can make them ineligible for long-term care services.10 Second, a functional test: the HOPE Waiver is for people who meet the nursing facility level of care, as determined by the department.9 For the HOPE Waiver, DSS lists a monthly income limit of 300 percent of the SSI standard benefit amount ($2,982 in 2026) and a resource limit of $2,000, counting items such as checking and savings accounts and certificates of deposit.11

Here are the steps toward becoming a paid caregiver through the HOPE Waiver:

ADLS Waiver: A Spouse, Parent, or Adult Child Can Be Paid

Of the Medicaid programs on this page, the Assistive Daily Living Services (ADLS) Waiver is the one whose rules expressly let a spouse be paid. State rule ARSD 67:54:06:08 says a participant's spouse, parent, or adult child may receive reimbursement for providing personal attendant services if the chapter's requirements are met, and the DSS manual says the waiver encourages the employment of spouses, parents, or adult children. The attendant must be employed by a provider agency with a DHS contract. Participants recruit, screen, train, and direct their own attendants, so the participant must be able to direct the services or select an authorized representative. Neither source says whether a relative who lives with the participant can be the paid attendant, and several tasks, such as meal preparation, housekeeping, feeding, laundry, and bill-paying, are covered only if no one else in the home is able to do them.3

ADLS is not a general waiver for older adults. CMS's waiver factsheet describes it as serving people 65 and older and adults 18 to 64 with physical disabilities, but South Dakota's eligibility rule, ARSD 67:54:06:02, is narrower. The participant must be at least 18; have quadriplegia from a listed cause, such as an injury to the spinal cord, multiple sclerosis, cerebral palsy, or muscular dystrophy, or have four limbs absent; require a nursing facility level of care; and receive SSI or qualify for Medicaid as determined by DSS. Turning 65 does not, by itself, qualify someone for ADLS.9

If you disagree with a South Dakota Medicaid decision, see South Dakota Medicaid Appeals and Fair Hearings. For a step-by-step guide to getting paid, see How to Get Paid as a Family Caregiver in South Dakota.

Where Can You Get Respite Care in South Dakota?

If you need a break, two programs can help. The National Family Caregiver Support Program (NFCSP), funded under Title III-E of the Older Americans Act, is delivered by area agencies on aging or the entities they contract with. It funds information about services, help getting access to them, individual counseling, support groups, caregiver training, respite care, and limited supplemental services. Caregivers of adults 60 and older are among the groups it serves, as are caregivers of a person of any age with Alzheimer's disease or a related disorder.4

Respite and supplemental services carry a condition the other services do not: the older person you care for must be unable to perform at least two activities of daily living without substantial help, or, because of a cognitive or other mental impairment, need substantial supervision because their behavior poses a serious health or safety hazard.4

If your loved one is on the HOPE Waiver, its services include in-home respite care.9 It also covers residential respite: short-term care, under 30 consecutive days, in an assisted living or nursing facility for a participant who lives with an unpaid caregiver. Someone already living in assisted living cannot get respite as a separate service.9 For the full respite guide, see Respite Care in South Dakota.

What Support and Training Can Caregivers Get?

Outside Medicaid, the NFCSP, which area agencies on aging deliver, funds information, help getting access to services, counseling, support groups, and caregiver training.4 Dakota at Home, South Dakota's aging and disability resource center, is a free phone and online referral service for anyone, regardless of age, disability, income, or resources.12

What Do Veterans' Families Get in South Dakota?

If your loved one is a veteran, a second system runs alongside Medicaid. Caring for a spouse or parent who served is a heavy thing to take on.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to the veteran's designated Primary Family Caregiver. The caregiver must be at least 18 and either a family member of the veteran, such as a spouse, son, daughter, or parent, or someone who lives full time with the veteran or is willing to. Primary Family Caregivers can also receive at least 30 days of respite care a year, and the stipend is paid only once the caregiver is enrolled in direct deposit through VA's customer engagement portal.13

Veteran eligibility: VA publishes four conditions, a first screen rather than the decision, and the veteran must meet all four:5

• A VA disability rating, individual or combined, of 70 percent or higher.5
• Discharge from the U.S. military, or a date of medical discharge.5
• A need for at least six months of continuous, in-person personal care services.5
• Enrollment in VA health care.5

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above:5

• Participating in the program is in the veteran's best interest.5
• The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.5
• The veteran receives care at home, or will do so if VA designates a family caregiver.5
• The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.5

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.5

The stipend starts from the federal General Schedule (GS) grade 4, step 1 annual rate for the veteran's locality pay area, divided by 12. That monthly base is then multiplied by a factor, and 38 CFR 71.40(c)(4)(i) sets five rungs using three distinct multipliers (0.625, 1.00, and 0.25). Which one you get depends first on whether the veteran is in the current program or is a legacy participant or legacy applicant:13,5

• 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."13
• 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. That legacy schedule runs for eight years beginning October 1, 2020, so it lapses October 1, 2028.13

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 address on record.13

If your family came into PCAFC before October 2020, ask your Caregiver Support Coordinator which schedule you are being paid on.13

VA Aid and Attendance Pension

Aid and Attendance is not a caregiver wage. It adds monthly payments to the amount of a VA pension for qualified veterans and survivors, so the veteran must already get a VA pension, and must meet at least one A&A requirement, such as needing another person's help with daily activities like bathing, feeding, and dressing.5

The net worth limit is $163,699, and the calculation includes the claimant's and dependents' assets and income for VA purposes. For December 1, 2025, to November 30, 2026, VA publishes the amounts as maximum annual pension rates (MAPR) and pays the difference between the claimant's income for VA purposes and that rate: a veteran with no dependents who qualifies for Aid and Attendance has a MAPR of $29,093 a year; a veteran with one dependent, $34,488. Non-reimbursable medical expenses can reduce income for VA purposes, but only the amount above 5 percent of the MAPR counts ($872 for a veteran with no spouse or child).7

The South Dakota Department of Veterans Affairs, with a County Veterans Service Officer in every county and Tribal Veterans Service Officers on some reservations, helps veterans and their dependents prepare and file VA claims, including pension claims. VA says help from an accredited VSO representative is always free.14

How Are Caregiver Wages Taxed in South Dakota?

If the person you care for lives in your home and you are paid through a Medicaid home and community-based services waiver, those payments may be excludable from your federal gross income under IRS Notice 2014-7. The exclusion does not apply if you keep a separate home of your own.8 It is fact-specific, so talk to a tax preparer familiar with it before you file. For state tax questions, check with the South Dakota Department of Revenue or a tax preparer.

Learn More

Find personalized help choosing a South Dakota caregiver program 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.