If you are caring for an aging parent or spouse in South Dakota and running on empty, funded respite care can give you a real break without draining your savings.

Caregiving takes a quiet toll on your own health. Federal health data, including from the U.S. Centers for Disease Control and Prevention (CDC), show that nearly 1 in 5 family caregivers reports fair or poor health, and depressive symptoms are roughly twice as common among caregivers as in the general population. Respite is not stepping away from the person you love. It can be what makes it possible to keep caring for them at home.

In South Dakota, funded respite for family caregivers can come from three programs: the Medicaid HOPE Waiver, which covers in-home respite, adult day services, and residential respite (a short stay in an assisted living or nursing facility for a participant who lives with an unpaid caregiver), for those who meet all of its tests, including a nursing-facility level of care and the state's financial test; the National Family Caregiver Support Program (NFCSP), delivered through Area Agencies on Aging; and the Department of Veterans Affairs (VA) for veterans' families.,, Medicare covers respite in two narrower settings, the hospice benefit and the GUIDE dementia care model, explained in the FAQ below., When none of those fits, adult day or a short facility stay can be paid privately.

A good first call is Dakota at Home, South Dakota's aging and disability resource center, a free phone and online referral service you can also email at DakotaAtHome@state.sd.us.

In This Guide

Does South Dakota Medicaid Pay for Respite Care?

Yes, through the HOPE Waiver, for people who qualify. The HOPE Waiver (Home and Community Based Options and Person-Centered Excellence) is operated by the Department of Human Services (DHS) Division of Long Term Services and Supports, while the Department of Social Services (DSS) Division of Economic Assistance determines financial eligibility. Its services include in-home respite care, residential respite care, adult day services, homemaker, personal care, meals, and structured family caregiving.

To qualify, a person must meet all of these tests: be 65 or older, or 18 or older with a qualifying disability; meet the Nursing Facility Level of Care as determined by the department; show a need for services on the state's standardized Home Care Assessment and be expected to need at least one HOPE Waiver service at least once a month; not live in a hospital, a nursing facility, or an intermediate care facility for individuals with intellectual disabilities; and meet DSS financial eligibility, where the maximum gross income is 300 percent of the SSI standard for the year. A participant may owe a care plan cost share. Someone living in one of those facilities now may be eligible for the Home Again Program, which helps people move to a less restrictive setting.

The HOPE Waiver's billing and policy manual states no dementia-specific eligibility pathway, so a person with Alzheimer's or a related dementia reaches waiver services through the same level-of-care, residence, and financial tests as any other applicant.

Medicaid State Plan personal care also helps with daily activities at home, but it is capped: HOPE Waiver personal care begins only once 500 hours of State Plan personal care, homemaker, and nursing are used up, and personal care may not be authorized for someone living in assisted living.

A related family member or non-relative fictive kin may be the paid principal caregiver under the HOPE Waiver's structured family caregiving service, but only if that person lives in the same home as the participant. That caregiver receives education, ongoing coaching, and a stipend from a structured family caregiving provider agency rather than an hourly Medicaid wage; the agency sets the stipend, which must equal at least 50 percent of the established rate tier., South Dakota's HOPE manual and structured family caregiving provider rules never mention a spouse, so ask the LTSS case manager, who assesses needs and eligibility for services, whether a spouse can qualify before planning around it.

Funded Respite Options in South Dakota

Funding path Who it is for What it covers Income test?
Medicaid HOPE Waiver People 65 and older, or 18 and older with a qualifying disability, who meet a nursing-facility level of care and all of the waiver's other tests In-home respite, residential respite (a short assisted living or nursing facility stay for participants who live with an unpaid caregiver), adult day, homemaker, personal care, structured family caregiving Yes: DSS financial eligibility, with gross income up to 300% of the SSI standard
NFCSP (via Area Agency on Aging) Family caregivers of adults 60 and older, or of people of any age with Alzheimer's disease and related disorders; some relatives 55 and older Respite (for caregivers of older adults, only when the person cared for is frail), counseling, training, help finding services Ask your local agency
VA respite and PCAFC Enrolled veterans who meet VA's clinical criteria for respite, where it is available; PCAFC adds respite for approved Primary Family Caregivers of veterans who meet all of its conditions, not enrollment alone In-home respite, adult day health care, nursing home respite; at least 30 days of respite a year for PCAFC caregivers PCAFC turns on VA's listed requirements; a copay for other VA respite may be charged based on the veteran's service-connected disability status and financial information
Adult day or short-term facility Any family that needs a planned or emergency break Daytime care or a short facility stay Private pay, unless a program covers it

1. Medicaid HOPE Waiver Respite

If your loved one may qualify for South Dakota Medicaid, start with the HOPE Waiver. It covers in-home respite care, adult day services, homemaker, and personal care. Residential respite care is short-term care and supervision in an assisted living or nursing facility for a participant who lives with an unpaid caregiver and cannot care for themselves while that caregiver is away or needs relief. The billing manual describes it as less than 30 consecutive days, and it is not covered in an adult day setting. A participant who already lives in assisted living cannot get respite as a separate added service, because respite is an integral part of the assisted living service.

How much you get: Services are based on assessed need as identified in the person-centered Individual Support Plan, with a threshold equal to the average cost of nursing facility care; services over that threshold are subject to an exception process.

How to access: Call Dakota at Home for free information and referral. Financial eligibility is decided by the DSS Division of Economic Assistance; for questions about waiver services such as respite, adult day, or structured family caregiving, contact the HOPE Waiver at the DHS Division of Long Term Services and Supports, which operates it.,

Best for: South Dakota families who meet the waiver's level-of-care and financial tests and want scheduled in-home or adult day breaks.

2. NFCSP Through South Dakota's Area Agencies on Aging

You do not have to be on Medicaid to ask for help here. The National Family Caregiver Support Program (NFCSP), funded under Title III-E of the Older Americans Act, makes grants to states, and its services are provided by an area agency on aging or an entity the agency contracts with. Every state program must include 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.

Who qualifies: Adult family members or other informal caregivers of people 60 and older; caregivers of people of any age with Alzheimer's disease and related disorders; older relatives (not parents) age 55 and older caring for children under 18; and older relatives, including parents, age 55 and older caring for adults ages 18 to 59 with disabilities. For a caregiver of an older adult, respite and supplemental services carry one more condition: the person cared for must be frail, meaning unable to perform at least two activities of daily living without substantial human assistance, or needing substantial supervision because a cognitive or other mental impairment makes their behavior a serious health or safety hazard. An older relative caregiver must also live with, and be the primary caregiver for, the child or adult with a disability.

How much you get: NFCSP services, including respite, are provided by an area agency on aging or an entity it contracts with, so ask your local agency what respite it can fund and whether there is a wait.

How to access: Call or text the Eldercare Locator at 1-800-677-1116, Monday through Friday, 8 a.m. to 9 p.m. ET, to reach your local Area Agency on Aging.

Best for: South Dakota caregivers whose loved one does not qualify for the HOPE Waiver, and anyone waiting on a HOPE Waiver decision.

3. Adult Day Services and Short-Term Facility Respite

If what you need back is reliable time during the day, adult day may be the answer. Adult day health care services provide supervision, engagement, and structured daytime support, which can hand you predictable time to work, rest, or manage the rest of life.

Short-term facility respite is a brief stay for your loved one in an assisted living community or nursing facility. Ask facilities in your area whether they offer short stays and what they charge.

Who pays: The South Dakota HOPE Waiver covers adult day services, and residential respite in an assisted living or nursing facility, for participants who qualify. NFCSP respite comes through your local area agency on aging, so ask which settings it can fund. Private pay is the fallback.,

Finding programs: Call Dakota at Home or the Eldercare Locator at 1-800-677-1116 for referrals near you.,

Best for: Caregivers who need dependable daytime coverage a few days a week.

4. VA Respite for Veterans

If you are caring for a veteran, start here, because VA offers several kinds of respite. All enrolled veterans are eligible for VA respite care if they meet the clinical criteria for the service and it is available. VA offers in-home respite, adult day health care, and nursing home respite in a VA Community Living Center or a community nursing home. If the respite is provided by a community agency, an adult day health care center, or a nursing home, the veteran also needs to meet community care eligibility, and a copay may be charged based on the veteran's service-connected disability status and financial information.

PCAFC respite: An approved Primary Family Caregiver in the Program of Comprehensive Assistance for Family Caregivers (PCAFC) receives at least 30 days of respite care per year as part of the benefit, along with caregiver education and training and mental health counseling. A spouse can serve as the caregiver. Approval requires the veteran to meet all of VA's requirements, and you and the veteran apply together.

How to access: Call the VA Caregiver Support Line at 1-855-260-3274, Monday through Friday, 8 a.m. to 8 p.m. ET, for help, support, and referrals. It is not a crisis line: anyone in crisis can call 988 and press 1, or text 838255, at any hour.

Best for: Families of veterans enrolled in VA health care.

What Respite Care Costs in South Dakota

When no program covers the break, you can still hire help and pay privately, and it helps to know the going rate before you call around. For adult day health care, the CareScout 2025 Cost of Care Survey put the national median daily rate at $95, which the survey annualises to $24,700 at five days a week. That is a provider rate, not your family's net cost, and actual expenses vary with care needs, provider availability, and local market conditions, so confirm the daily rate with programs near you.

Hiring an in-home aide privately runs high in South Dakota. In the CareScout 2025 Cost of Care Survey, a non-medical in-home caregiver in South Dakota had a median cost of about $44 an hour, roughly $101,244 a year at 44 hours a week, well above the national figure. Facility care is more affordable here: assisted living runs about $4,900 a month ($58,800 a year) in South Dakota, among the lowest in the country and below the national median of about $6,200 a month. Ask each facility for its short-stay rate, since these medians are not respite prices. These are industry-survey medians, not fixed rates, and they rise as care needs grow.

Knowing these numbers is exactly why the funded options above matter. A few hours of paid respite each week adds up quickly, and the Medicaid, NFCSP, and VA paths can keep the cost from falling entirely on your family.

When Funded Help Is Capped or Waitlisted

The funded routes are not unlimited. NFCSP respite comes through your area agency on aging or a provider it contracts with, so ask your local agency what respite it can fund and whether there is a wait. HOPE Waiver services follow the assessed need written into the Individual Support Plan. Do not wait empty-handed while that plays out.,

Three bridges can cover the gap. First, search for respite providers with the ARCH National Respite Network's "Find a Respite Provider" locator at archrespite.org; the federal Lifespan Respite Care Program gives competitive grants to state agencies to build coordinated respite systems, and its purpose is to expand access to respite, not to be the sole payer for it. Second, Dakota at Home, South Dakota's aging and disability resource center, gives free, unbiased information, referral, and assistance. Third, paying privately for adult day or in-home help can bridge the time until HOPE Waiver or NFCSP help starts; the cost medians above are a starting point, not a quote.

How to Start in South Dakota

1
Step 1

Contact Dakota at Home at 1-833-663-9673, through its online referral form, or by email at DakotaAtHome@state.sd.us

South Dakota's aging and disability resource center gives free, unbiased information, referral, and assistance, regardless of age, disability, income, or resources.

2
Step 2

Reach your Area Agency on Aging through the Eldercare Locator at 1-800-677-1116

Ask what NFCSP respite, counseling, or training it offers and whether there is a wait.

3
Step 3

Ask about the HOPE Waiver if your loved one may need a nursing-facility level of care

DSS decides financial eligibility; ask the DHS Division of Long Term Services and Supports, which operates the waiver, about services such as respite, adult day, or structured family caregiving.

4
Step 4

Call the VA Caregiver Support Line at 1-855-260-3274 first if your loved one is a veteran

Ask about VA respite and eligibility for the Program of Comprehensive Assistance for Family Caregivers.

Dakota at Home Email: DakotaAtHome@state.sd.us South Dakota's aging and disability resource center: a free phone and online referral service. 1-833-663-9673 dhs.sd.gov/en/ltss/dakota-at-home
South Dakota HOPE Waiver Operated by the Department of Human Services Division of Long Term Services and Supports; DSS Economic Assistance determines financial eligibility. dhs.sd.gov/en/ltss/hope-waiver
Eldercare Locator Free, nationwide federal service that connects you to services in your community, including your local Area Agency on Aging, which provides NFCSP services or contracts for them., 1-800-677-1116 eldercare.acl.gov
VA Caregiver Support Line Help, support, and referrals for family caregivers of veterans, Monday through Friday, 8 a.m. to 8 p.m. ET. 1-855-260-3274 caregiver.va.gov
Your next step Contact Dakota at Home through dhs.sd.gov/en/ltss/dakota-at-home and ask which respite options fit your family this month.

Frequently Asked Questions

Does South Dakota Medicaid cover respite care?

Yes, through the HOPE Waiver, for people who meet all of its tests: age 65 or older (or 18 or older with a qualifying disability), a nursing-facility level of care, an expected need for at least one waiver service a month, not living in a hospital, nursing facility, or intermediate care facility, and DSS financial eligibility. It covers in-home respite, adult day services, and residential respite, a stay of less than 30 consecutive days in an assisted living or nursing facility for a participant who lives with an unpaid caregiver, based on the person's Individual Support Plan.

Can I get respite in South Dakota without Medicaid?

Possibly, through the NFCSP. Area agencies on aging, or providers they contract with, offer respite to eligible family caregivers, but for a caregiver of an older adult the person cared for must be frail. Ask what your local agency can offer. Call the Eldercare Locator at 1-800-677-1116 to reach it.,

Can a family member be the paid respite worker in South Dakota?

Under the South Dakota HOPE Waiver's structured family caregiving service, a related family member or non-relative fictive kin who lives with the participant may be the paid principal caregiver, receiving a stipend through a provider agency rather than an hourly wage., The state's HOPE manual and provider rules do not address spouses, so ask the LTSS case manager whether a spouse can qualify.

Does Medicare pay for respite care in South Dakota?

Only in limited cases. Medicare does not cover custodial care when it is the only care a person needs. The hospice benefit includes short-term inpatient respite care for a person who has elected hospice, and you pay 5% of the Medicare-approved amount for that stay. Medicare's GUIDE dementia care model also pays participating providers for respite, up to $2,625 per eligible patient in the performance year that began July 1, 2026. A patient must have dementia and be aligned to a participating program: enrolled in Parts A and B with Medicare as primary payer, not in Medicare Advantage, not in hospice, not a long-term nursing home resident, and living in a private residence or a CMS-approved partner residential care community (not a memory care unit). GUIDE respite itself is limited to moderate- or high-complexity patients with an unpaid primary caregiver who do not live in a residential care community, so ask your provider whether it participates. Otherwise, look to Medicaid, NFCSP, or the VA for funded respite.

How does a veteran family in South Dakota access VA respite?

Enrolled veterans can get VA respite care if they meet the clinical criteria and it is available; respite from a community agency, adult day center, or nursing home also needs community care eligibility, and a copay may apply. An approved Primary Family Caregiver in PCAFC receives at least 30 days of respite care a year. Call the VA Caregiver Support Line at 1-855-260-3274, weekdays 8 a.m. to 8 p.m. ET, to start.,,

What does adult day care cost in South Dakota?

The national median daily rate for adult day health care was $95 in the CareScout 2025 Cost of Care Survey, which annualises it to $24,700 at five days a week. That is a provider rate, and actual costs vary with care needs and local market conditions; the HOPE Waiver covers adult day services for those who qualify. Call Dakota at Home for programs near you.,,

Learn More

CaregiverRespite Care for Family Caregivers: The 50-State GuideWhat respite care is and how to pay for it in 2026: the main types, NFCSP respite with no income test, Medicaid and VA respite, and every state guide. CaregiverHow to Get Paid as a Family Caregiver in South DakotaSouth Dakota's HOPE Waiver structured family caregiving stipend, the ADLS Waiver and VA programs can pay a family caregiver. Who qualifies for each route. CaregiverCaregiver Burnout: Signs, Stages, and How to Get 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. VA BenefitsVA Aid and Attendance in South DakotaVA Aid and Attendance in South Dakota for 2026: who qualifies, ceilings up to $34,488 a year, how to apply, and free help from SDDVA and county officers. Care TypesThe Cost 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. 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.

Find personalized help navigating respite care options 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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