South Dakota Structured Family Caregiving: Who Can Be Paid (2026)

South Dakota structured family caregiving pays a stipend to a family member who lives with an adult on the HOPE Waiver and is that person's main caregiver. A structured family caregiving provider agency pays the stipend, and the caregiver must share a home with the HOPE Waiver participant, so an adult child living across town would need to move in, or have the parent move in, first.1

Who Can Be the Paid Caregiver?

Under the South Dakota Medicaid HOPE Waiver, structured family caregiving lets a participant live with a principal caregiver, either in the participant's own home or in the caregiver's home. South Dakota's HOPE Waiver billing manual says the structured family caregiving principal caregiver "may be a related family member or non-relative fictive kin." Fictive kin means someone who isn't related by birth, adoption, or marriage but has an emotionally significant relationship with the participant. If a structured family caregiver is neither a relative nor fictive kin, the home must also be licensed by South Dakota's Department of Health as a Community Living Home.1

South Dakota's structured family caregiving provider rules set these conditions for the principal caregiver, who must:

• live in the same qualified home as the participant
• be the main person responsible for daily care and support
• be 18 or older and pass a background check
• support no more than two people in structured family caregiving1

On spouses, none of the state documents behind this page uses the word, so ask the case manager rather than assume, and see getting paid to care for a spouse in South Dakota for routes that do address it.1

How Much Does Structured Family Caregiving Pay in South Dakota?

It's natural to want a number before you rearrange your life around this. South Dakota publishes one, but it's the agency's rate, not your paycheck. The HOPE Waiver fee schedule effective July 1, 2026 lists these daily rates for structured family caregiving, each the maximum an agency may be reimbursed:2

South Dakota's HOPE Waiver billing manual explains that the structured family caregiving rates are the daily payment to the provider agency and include both the agency's payment and the stipend paid to the caregiver. Each South Dakota structured family caregiving agency sets its own stipend amount, which must equal at least 50 percent of the participant's HOPE Waiver rate tier. The tier reflects how much support the participant needs, and the LTSS case management specialist decides it. Services must be authorized by LTSS to be paid at the state rates.2,1

You also won't be on a payroll. A South Dakota structured family caregiver isn't an employee of the provider agency and isn't covered by employee rules such as wage and hour laws, workers' compensation, and unemployment.1

For a rough sense of the going rate, home care aides in South Dakota earned a median of $18.15 an hour in May 2025, according to the BLS. The BLS figure reflects aide wages, not what any structured family caregiving agency pays as a stipend, so ask each agency what stipend it pays for your parent's tier and get the answer in writing.3

Does Your Parent Qualify for the HOPE Waiver?

Only a HOPE Waiver participant, or someone who qualifies for the waiver, can get South Dakota structured family caregiving.1 The South Dakota Department of Human Services says that to qualify for the HOPE Waiver, a person must be 65 or older, or 18 or older with a qualifying disability; meet a nursing facility level of care; take part in an assessment of needs; not live in a hospital, nursing facility, or intermediate care facility; need at least one waiver service at least once a month; and meet financial eligibility as decided by the Department of Social Services' Economic Assistance office.4

Next comes the money test. In 2026, the South Dakota HOPE Waiver's monthly income limit is $2,982 (300 percent of the Supplemental Security Income (SSI) standard benefit), and its resource limit is $2,000. The Department of Social Services says the resources that count include items such as checking and savings accounts and certificates of deposit, so ask Economic Assistance which of your parent's assets count before you assume they're over the line. A HOPE Waiver applicant must also live in South Dakota and meet certain U.S. citizenship requirements.4 The full waiver is explained in how the HOPE Waiver covers home care.

What Structured Family Caregiving Doesn't Cover Separately

In South Dakota, meals, homemaker services, and chore services aren't covered or paid separately for a HOPE Waiver participant receiving structured family caregiving, and structured family caregiving payments don't cover room and board.2

In its Spring 2026 response to public comments, South Dakota's LTSS division said adding participant self-direction to the HOPE Waiver isn't part of the waiver's renewal.1

How to Start Structured Family Caregiving in South Dakota

Is the Stipend Taxable?

Possibly not, but check before you file. Under IRS Notice 2014-7, qualified Medicaid waiver payments are excludable from federal gross income, whether or not the caregiver is related to the person receiving care. Qualified Medicaid waiver payments include payments from a certified Medicaid provider to a caregiver for nonmedical support under a plan of care. The IRS Notice 2014-7 exclusion applies only to care in the caregiver's home where the person receiving care lives, and it doesn't cover payments the person makes from their own private funds.5

Structured family caregiving requires a shared home, but we found no South Dakota or IRS document that says how the notice applies to this stipend specifically. Ask a tax professional, and see whether Medicaid waiver payments are taxable for how the home test works.1

Learn More

Find personalized help getting paid as a structured family caregiver 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.