For long-term care, the South Dakota Medicaid income limit is a hard cap: $2,982 a month in 2026. State rule ARSD 67:46:04:14 makes an applicant in a nursing facility or on a waiver ineligible once gross monthly income passes that ceiling, and the route the rules provide for income above it is a Medicaid income trust, South Dakota's own name for what is elsewhere called a Miller Trust.

This guide covers the 2026 income and asset rules for South Dakota Medicaid long-term care: the income cap and how a Miller Trust clears it, the $2,000 asset limit, what a nursing-home resident keeps, and what the at-home spouse is protected from. It also separates the long-term-care rules a senior faces from the income-based Supplemental Security Income (SSI) test and the expansion path for working-age adults. South Dakota Medicaid is run by the state's social-services agency (DSS).

In This Guide

Which income test applies: ABD long-term care vs. MAGI expansion

South Dakota's Medicaid program uses two different income tests, and which one applies depends on who is asking. Online calculators often surface the wrong one, so start here.

  • The long-term-care (ABD) test. A senior who is aged, blind, or disabled and needs nursing-facility or waiver care is judged under the Supplemental Security Income (SSI) related rules: the $2,982/month income cap and a hard $2,000 asset test for a single applicant. This is the test the rest of this guide explains.,
  • The expansion (MAGI) test. South Dakota implemented Medicaid expansion on July 1, 2023, under voter-approved Constitutional Amendment D. Adults aged 19 to 64 with household income at or below 138% of the Federal Poverty Level, roughly $22,025/year (about $1,835/month) for one person in 2026, are covered if they are not eligible for or enrolled in another Medicaid category, and there is no asset test.,

The distinction matters because the asset test only bites on the long-term-care side. A working-age adult in the expansion group is measured on income alone, while a senior applying for nursing-home coverage must clear both the income cap and the $2,000 asset limit.

The South Dakota Medicaid income limit for long-term care

For long-term-care Medicaid, South Dakota sets the income limit at $2,982 per month, equal to 300% of the 2026 SSI Federal Benefit Rate of $994., That figure applies to nursing-facility coverage and to the home-and-community-based services (HCBS) waivers that pay for care outside a facility.

The cap is counted on gross income, and the rule is written as a flat bar rather than a target you whittle down. ARSD 67:46:04:14 makes an individual who is in a medical or nursing facility, or who is participating in a home- and community-based waiver program, ineligible for assistance under those rules when monthly income exceeds 300 percent of the maximum SSI standard benefit amount. So a gross income even one dollar above the $2,982 cap puts you over the line, even though that income covers a fraction of a nursing-home bill.

That sounds like a trap. What the rules provide instead is a trust.

How the Miller Trust clears the cap

South Dakota's rules call it a Medicaid income trust (ARSD 67:46:05:33.01). Elsewhere the same device goes by Qualified Income Trust or, most often, Miller Trust. Each month the income above the cap is paid into the trust, and the trustee pays the beneficiary an amount that, added to income never routed through the trust, may not exceed 300 percent of the SSI standard benefit amount, which is the $2,982 line. That is how an over-income applicant is brought within the limit.

The trust is not a loophole or a way to shelter money for heirs. The rule sets out exactly what it must do:

  • It may hold only the beneficiary's own money (pension, Social Security, or other income), and it must be established for the beneficiary's sole benefit.
  • The trustee has no option or discretion. Whatever income remains in the trust after the beneficiary's monthly payment goes to the nursing facility, HCBS, or waiver provider each month.
  • On the beneficiary's death, DSS receives all amounts left in the trust, up to the total medical assistance paid on the beneficiary's behalf after September 30, 1993.

Those requirements are exact and the trust must be a nontestamentary trust or similar legal device established after August 10, 1993, which is why this is elder-law-attorney territory, not a do-it-yourself form.

The practical takeaway: being over the income cap in South Dakota does not mean you are disqualified. It means the excess has to run through a trust that meets those requirements. A single dollar of excess income is a paperwork problem, not a dead end.

What a nursing-home resident keeps

When South Dakota Medicaid pays for nursing-facility care, the resident contributes nearly all of their monthly income toward the cost of care. What stays with them is the Personal Needs Allowance (PNA), money set aside for the resident's own small expenses like clothing, a haircut, or a phone. South Dakota sets its PNA at $100/month, plus up to the first $75 of gross earned income for a resident who works.,

That $100 is worth noticing. The federal floor has sat at $30/month since 1988, so South Dakota's $100 leaves a resident more breathing room than the federal minimum requires., (For the national picture on how the allowance works and where it gets deducted, see our explainer on the Medicaid personal needs allowance.)

The five-year look-back

South Dakota reviews asset transfers made in the 60 months before the first date on which the applicant is both institutionalized and applying for long-term-care assistance (ARSD 67:46:05:06.01)., Giving away money or property for less than fair market value during that window, such as signing a house over to a child or gifting a grandchild a down payment, can trigger a penalty period during which Medicaid will not pay for long-term-care services, even when you otherwise qualify. The penalty is calculated by dividing the value transferred by the state's average monthly private-pay cost of nursing-facility care.

Narrow exceptions exist. One is the federal caregiver child rule: transferring the home to a son or daughter who lived in it for at least the two years immediately before you were institutionalized, and who, as determined by the State, provided care that permitted you to reside at home rather than in a facility, does not trigger a transfer penalty. That "as determined by the State" clause is part of the statute, so the exception turns on a state finding rather than applying automatically. South Dakota can also waive the resulting period of ineligibility on clear and convincing evidence that you have no other means of support and that denial would deprive you of food, clothing, shelter, other necessities, or medical care (ARSD 67:46:05:10).

Anything done inside the five-year window deserves an elder-law attorney's review first. If long-term care is on the horizon for someone in your family, talk to a professional before moving assets. For the broader toolkit, see our guide to Medicaid planning strategies.

Protecting the spouse who stays home

When one spouse needs long-term care and the other stays in the community, federal spousal-impoverishment rules keep the at-home spouse from being left with nothing. South Dakota's rules set these protections by reference to the federal standards (ARSD 67:46:07:02, 67:46:07:06, and 67:46:07:12), and these are the 2026 figures.,

Protection 2026 Amount What it does
Community Spouse Resource Allowance (CSRA) Half the couple's countable assets, up to $162,660; minimum $32,532 The most in countable assets the at-home spouse may keep, separate from the applicant's own asset limit.
Monthly Maintenance Needs Allowance (MMNA) Floor of $2,705/month; combined spousal allowances capped at $4,066.50/month The income the at-home spouse is allowed. South Dakota sets the floor at 150% of the federal poverty level for two people divided by 12, and the cap can be exceeded only by court order of support or a fair-hearing finding of financial duress.
Home-equity limit $752,000 Home equity above this amount makes the applicant ineligible for long-term-care medical assistance. South Dakota applies the federal minimum, for applications received after December 31, 2023.

So a married couple stands in a very different position from a single applicant. The community spouse keeps half the couple's countable assets up to $162,660, and an income allowance that starts at $2,705 a month and cannot be pushed past $4,066.50 without a court order or a fair-hearing finding of duress., The $2,000 asset limit applies to the spouse who needs care, not to the couple's whole net worth.

The home is excluded up to $752,000 in equity while it remains the applicant's principal residence, and the equity limit does not apply at all where the applicant's spouse, or a child under 21, is blind or permanently and totally disabled and lawfully resides in the home. Above that equity figure, an applicant who has no such household member is ineligible for long-term-care medical assistance, not merely counted over the resource limit.,

After death: estate recovery

Like every state, South Dakota runs a Medicaid estate-recovery program. Under SDCL 28-6-23, what the state paid on behalf of a person 55 or older for nursing-facility, home- and community-based, intermediate-care-facility, hospital, and prescription-drug services is a debt due DSS, collected from that person's estate after death.,

The age rule cuts differently than most families expect. DSS states there is no age restriction on which estates it may reach: it may recover from the estate of any recipient who received benefits after July 1, 1994. What the 55-or-older line does is limit which service categories the claim covers, not whose estate is exposed.

DSS may not seek recovery while the recipient's spouse is still living, or while a surviving child is under 21 or is blind or disabled. Read that as a pause, not a cancellation. The surviving-spouse protection is not a permanent waiver: SDCL 28-6-23 lets DSS file a claim against the surviving spouse's own estate to satisfy the debt, and a surviving spouse may petition DSS on its form, within six months of the recipient's death, to limit that liability to the value of the surviving spouse's estate as of the recipient's date of death. Federal law also requires every state to have a procedure to waive recovery in cases of undue hardship. For how recovery works and where families have room to plan, see our Medicaid estate recovery explainer and our guide to South Dakota estate recovery.

How to apply when you are over the South Dakota Medicaid income limit

South Dakota Medicaid is administered by the state DSS. You have two main ways to apply, and a level-of-care screening confirms long-term-care applicants need nursing-facility-level services.

1
Step 1

Apply online through the DSS Economic Assistance portal

Use eaportal.sd.gov, which handles Medicaid and other assistance programs together. This is the fastest route for most families.

2
Step 2

Or apply by phone or in person through your local DSS office

Contact information is listed on the South Dakota Medicaid site. Long-term-care applicants complete a level-of-care screening as part of the process.

3
Step 3

Apply even if you think you are over the income limit

The income cap is real, but a Miller Trust clears it, and the asset rules exempt more than people expect, so many who assume they are disqualified are not.

Where to get help

South Dakota Department of Social Services (DSS) Runs South Dakota Medicaid, including long-term-care eligibility. dss.sd.gov/medicaid
DSS Economic Assistance Portal Apply online for Medicaid and other assistance programs. eaportal.sd.gov

Frequently Asked Questions

What are the South Dakota Medicaid income limits in 2026?

For long-term care (nursing facility and HCBS waivers), the 2026 income cap is $2,982/month, set at 300% of the SSI Federal Benefit Rate. ARSD 67:46:04:14 makes an applicant in a facility or on a waiver ineligible once gross monthly income exceeds it. An applicant over the cap can still qualify by routing the excess through a Medicaid income trust (Miller Trust). Working-age adults are covered on a separate expansion track at 138% of the Federal Poverty Level.

What is the South Dakota Medicaid asset limit?

$2,000 in countable assets for a single applicant, or $3,000 for a married couple when both spouses begin long-term-care services in the same month. Exempt from the count: the home (up to a $752,000 equity limit), one vehicle used for necessary transportation regardless of value, household goods and personal effects, and an irrevocable prepaid burial contract. The expansion (MAGI) group for working-age adults has no asset test at all.

Does South Dakota require a Miller Trust?

It is the route South Dakota's rules provide when your income exceeds the long-term-care cap. ARSD 67:46:05:33.01 defines a "Medicaid income trust," the state's name for a Qualified Income Trust or Miller Trust: the excess income is paid into the trust each month, the trustee pays the beneficiary an amount that keeps total income within the $2,982 limit, and the rest goes to the care provider.

How much can a spouse keep when the other goes into a nursing home?

For 2026, the at-home (community) spouse keeps half the couple's countable assets up to $162,660 (the Community Spouse Resource Allowance, minimum $32,532). The monthly income allowance starts at a $2,705 floor, which South Dakota sets at 150% of the federal poverty level for two people divided by 12, and the combined spousal allowances may not exceed $4,066.50 without a court order of support or a fair-hearing finding of financial duress. The home is generally exempt while a spouse lives there.

What does a nursing-home resident on South Dakota Medicaid keep?

A resident of a nursing or intermediate care facility is allowed a Personal Needs Allowance of $100/month, which is higher than the federal $30 floor, plus a deduction of up to the first $75 of gross earned income if the resident works, and a further deduction for court-ordered child or spousal support actually paid. The rest of the resident's monthly income goes toward the cost of care, after the allowance the rules provide for a community spouse.

Learn More

MedicaidMedicaid Income Limits by State: Which Number Applies to YouMedicaid income limits depend on your pathway: expansion adults, aged and disabled, or nursing-home care. See the 2026 figures and your state's exact limits. 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. MedicaidHow Medicaid Estate Recovery WorksMedicaid estate recovery explained: federal law, 51-state matrix, categorical protections, hardship waivers, and 2025-2026 reform updates. Verify before acting. MedicaidThe Medicaid Personal Needs Allowance, ExplainedHow the Medicaid Personal Needs Allowance works in 2026: the $30 federal floor, state figures from $30 to $200, and how patient liability is calculated. MedicaidHelp Paying Medicare Costs in South DakotaSouth Dakota Medicare Savings Programs 2026: QMB, SLMB, QI income and resource limits, what each covers, Part D Extra Help, and how to apply through SD DSS. MedicaidSouth Dakota Medicaid Spousal Impoverishment RulesSouth Dakota Medicaid spousal impoverishment in 2026: CSRA, MMMNA, Miller Trust rules, and exempt assets when one spouse needs nursing facility care. MedicaidHow South Dakota Medicaid Estate Recovery WorksSouth Dakota is an expanded-estate state: Medicaid estate recovery reaches joint tenancy, life estates, and trusts, not just probate. What DSS can recover.

Find personalized help working through South Dakota Medicaid eligibility and the Miller Trust question for your family 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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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.