Long-Term Care Medicaid in South Dakota: 2026 Guide
In South Dakota, Medicaid eligibility is handled by the Department of Social Services (DSS), and long-term services and supports are run by the Department of Human Services (DHS) through Dakota at Home. Long-Term Care Medicaid can pay for nursing facility care and for care at home through the HOPE Waiver. This guide explains the rules in plain language.
At a glance: South Dakota 2026 figures
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month (300% of the SSI rate) |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $752,000 |
| Spouse at home: resource allowance (CSRA) | Half the couple’s assets, minimum $32,532 / maximum $162,660 |
| Spouse at home: monthly income allowance | Minimum $2,705 (from July 1, 2026) / maximum $4,066.50 |
| Personal needs allowance (nursing home) | $100 a month |
| Look-back period | 60 months (5 years) |
| Penalty divisor | $9,749.92 a month ($320.55 a day) |
Figures last updated for 2026. Sources are listed at the end of this page.
Figures change periodically. Double-check current amounts with the South Dakota Department of Social Services before relying on them.
What Long-Term Care Medicaid covers in South Dakota
Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.
HOPE Waiver. For adults 65 and older, or 18 and older with a qualifying disability, who need a nursing facility level of care, meet the financial rules, live at home or in an approved community setting and need at least one service each month. Services can include in-home care, respite, meals, adult day services and assisted living.
Other programs.
How Medicare fits in. Medicare Part A covers skilled nursing facility care only for a limited time. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first (time under observation or in the emergency room does not count), and you must need daily skilled nursing or therapy. In 2026, Medicare charges nothing for days 1 to 20 after the Part A deductible ($1,736) is met, $217 a day for days 21 to 100, and nothing after day 100, when you pay all costs. Medicare limits this coverage to 100 days in each benefit period. Medicaid can be a way to pay for long-term nursing home care after Medicare coverage ends.
Who qualifies
A person generally must:
- be 65 or older, or blind or disabled;
- live in South Dakota and be a U.S. citizen or qualified non-citizen;
- meet a nursing facility level of care, based on an assessment arranged through Dakota at Home;
- meet the income and asset rules below, as decided by SD DSS.
Income rules
In 2026, the income limit is 300% of the SSI rate, $2,982 a month.
Once you are on Medicaid in a nursing facility, most of your income goes to the facility. You keep a personal needs allowance of $100 a month, and money can be set aside for a spouse at home and for health insurance premiums.
Asset rules
A single applicant can have up to $2,000 in countable resources. For a couple who both need care, the limit is $3,000.
Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.
Usually exempt:
- Your home if you live there or plan to return, or a spouse or dependent relative lives there
- One vehicle
- Household goods and personal belongings
- Burial plots and limited burial funds, within SD DSS rules
Spousal protections
- Assets: The spouse at home can keep a share of the couple’s assets within federal limits, plus the home, one car and belongings.
- Income: The spouse at home keeps their own income, and part of the applicant’s income can be set aside if their income is low.
Look-back and penalties
When you apply, South Dakota looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.
Common examples of transfers that can cause a problem:
- Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
- Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
- Selling a house or car to a relative for much less than it is worth.
- Paying a family member for care without a written agreement made at the time.
Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.
How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($9,749.92 a month ($320.55 a day)).
Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $9,749.92 is about 5.1 months without Medicaid payment for long-term care.
The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.
Estate recovery in South Dakota
South Dakota’s estate recovery program is run by DSS.
- What is recovered: Medicaid paid for long-term care and related services received at age 55 or older, and for some people of any age in a nursing facility.
- When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
- Hardship waivers: the state must have a way to waive recovery when it would cause undue hardship. Ask SD DSS for the current rules.
- Family members and personal representatives can contact SD DSS with questions.
How to apply
- For Medicaid: apply with DSS.
- For the HOPE Waiver: contact Dakota at Home, which leads to an assessment and a support plan.
Applying for a spouse or parent. If you are applying for someone else, you may need legal authority to act for them, or you can be named as an authorized representative on the application. Gather statements for every account, not just the main one, and write down when the person’s care needs began. If the person is already in a nursing home, ask the facility’s business office or social worker which Medicaid forms they need from you and when, and tell the agency if any requested document is hard to get, since agencies can often give extra time when you ask before the deadline.
After you apply. SD DSS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.
Gather what you can before you apply. The caseworker may ask for:
- Photo ID, Social Security card and Medicare card
- Proof of age and of U.S. citizenship or immigration status
- Proof that you live in the state (for example, a utility bill or lease)
- Proof of all income: Social Security award letter, pension statements, annuity statements
- Bank, credit union and investment statements (often for the full 60-month look-back period)
- Deeds, property tax bills and the value of any real estate
- Life insurance policies (showing cash value) and prepaid funeral or burial contracts
- Vehicle titles
- Health insurance cards and long-term care insurance policies
- Power of attorney or guardianship papers, if someone is applying for you
- For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start
If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.
Free public help in South Dakota
- SD DSS: Medicaid applications and eligibility.
- Dakota at Home (DHS): information and referrals for long-term services and supports.
- SHIP (State Health Insurance Assistance Program): free Medicare counseling.
- Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and other long-term care settings.
Recent and upcoming changes
A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including South Dakota:
- Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
- Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). South Dakota’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect South Dakota’s limit.
The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.
State programs
Each program below has its own page with who qualifies, services, how to apply and waiting lists:
Frequently asked questions
What is the HOPE Waiver? South Dakota’s Medicaid waiver for care at home or in approved community settings for adults who need a nursing facility level of care.
How do I start? Contact Dakota at Home for the waiver, and apply for Medicaid with DSS.
What is the personal needs allowance? $100 a month for a nursing facility resident.
How long is the penalty for a gift? South Dakota divides the gift by its statewide average private-pay cost of long-term care.
Will the state take my home after I die? SD DSS can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.
Figures change periodically. Double-check current amounts with the South Dakota Department of Social Services before relying on them.
Sources
- SD DSS, Medical programs
- ARSD 67:46:06:05 (PNA)
- SD DHS, HOPE Waiver
- SD DHS, Dakota at Home
- Medicare.gov, Skilled nursing facility care
- CMS, 2026 SSI and spousal impoverishment standards
- Public Law 119-21 (2025)
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.