South Dakota State Plan Personal Care: Can Family Be Paid?

South Dakota's State Plan personal care benefit pays for an agency worker, never a spouse, to help a South Dakota Medicaid member with bathing and dressing at home.1 South Dakota's rule says the State Plan personal care worker can't be a member of the recipient's family, but its definitions don't define family and it doesn't name an adult child, and two other South Dakota programs can pay family, and one, for adults with quadriplegia, can pay a spouse.1,2,3

Can You Be the Paid Personal Care Worker?

It's hard to hear no when you're already the one helping with every bath. For a spouse, South Dakota's answer is clear: the South Dakota Medicaid personal care manual says services "cannot be provided by a recipient's legally responsible person," which "includes parents of minor children or a spouse."1

For other relatives, the sources don't settle it. South Dakota's rule, Administrative Rules of South Dakota (ARSD) 67:16:24:01, says the State Plan personal care worker "is not a member of the recipient's family," but the rule's definitions don't define family, and neither the rule nor the manual names an adult child. South Dakota State Plan personal care comes through an agency incorporated in South Dakota that has a contract with the state.1 Ask Dakota at Home or the agency before you plan around a paycheck.

Who Qualifies for South Dakota State Plan Personal Care?

Under South Dakota's rule and the South Dakota Medicaid personal care manual, State Plan personal care requires full South Dakota Medicaid or Children's Health Insurance Program (CHIP) coverage, a needs assessment showing a need for services, and a new assessment at least every twelve months. A person must also meet one of these tests:

• Under age 60: South Dakota State Plan personal care requires another person's help with at least two activities of daily living.
• Age 60 or older: South Dakota State Plan personal care requires help with three or more activities of daily living or instrumental activities of daily living, in any combination.
• Nursing need: someone needing physician-ordered nursing at least monthly to avoid a hospital or institution qualifies for South Dakota State Plan personal care, but gets only that nursing.1

Since July 1, 2024, South Dakota has applied these State Plan personal care tests to people already getting personal care too, so someone who no longer meets them at a reassessment will be discontinued.1 Losing an aide your family counts on is a real worry, so go into each reassessment ready to describe every task your family member can't do alone, and check any notice you get for how to appeal (see below).

South Dakota's manual describes State Plan personal care as being for South Dakota Medicaid members with a medical necessity, while the HOPE Waiver offers more services to adults with disabilities and people 65 or older who meet a nursing facility level of care.1 For income and asset rules, see South Dakota Medicaid eligibility and income limits.

What South Dakota State Plan Personal Care Covers, and How Hours and Pay Are Set

South Dakota State Plan personal care covers hands-on help: bathing, dressing, grooming, toileting needs, medications the person usually takes on their own, meals and household tasks tied to a medical need, and physician-prescribed maintenance nursing. South Dakota State Plan personal care is provided at home, and South Dakota's rule and manual say home doesn't include a hospital, nursing facility, assisted living center, or other group setting.1

South Dakota's Department of Human Services, not the family, sets the hours through its needs assessment and service plan. South Dakota State Plan personal care is limited to 500 hours a plan year (July 1 to June 30); the limit doesn't apply to people 20 or younger. If someone eligible for a South Dakota home and community-based services waiver has an assessed need for more than 500 hours, additional hours may be authorized under that waiver.1

South Dakota Medicaid pays the State Plan personal care agency the lesser of its usual charge or the state fee schedule; that's a payment to the agency, and the rule and manual don't state a wage for the worker.1 As a rough benchmark, home health and personal 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's an estimate based on home care aide wages, not a program rate.4

How to Apply

The Department of Human Services' Personal Care Services page says a case manager will meet with you to assess needs and determine eligibility, and to contact Dakota at Home at 833-663-9673; the page doesn't say whether it means State Plan personal care, HOPE Waiver personal care, or both.1 When you call, ask whether your family member fits State Plan personal care or the HOPE Waiver, and whether the agency could hire you.

Where a Family Member Can Be Paid Instead

Two other South Dakota programs can pay family. The HOPE Waiver's Structured Family Caregiving service pays a stipend, through a provider agency, to a related family member who lives with the person and provides their daily care; see Structured Family Caregiving in South Dakota.2 For an adult 18 or older who has quadriplegia (or four limbs absent) and needs a nursing facility level of care, South Dakota's Assistive Daily Living Services (ADLS) Waiver rule lets a spouse, parent, or adult child be paid as the attendant when the rule's requirements are met; see the South Dakota ADLS Waiver guide.3 For spouse routes, see getting paid to care for your spouse in South Dakota.

Learn More

Find personalized help sorting out South Dakota's paid family caregiver options 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.