South Dakota
What is South Dakota Medicaid Long-Term Care?
South Dakota Medicaid provides health coverage for individuals with limited income, including seniors aged 65 and older who require long-term care. This care may be delivered in nursing homes, assisted living facilities, community living homes, or even in the senior’s own home. Medicaid also covers non-medical supports that allow frail seniors to continue living independently.
What types of long-term care Medicaid programs are available in South Dakota?
Who qualifies for Institutional or Nursing Home Medicaid?
This is an entitlement program, meaning anyone who meets the eligibility standards will receive benefits. Services are offered only in licensed nursing home facilities.
What are Medicaid Waivers / Home and Community Based Services (HCBS)?
These programs are not entitlements—spots are limited and waiting lists may apply. They aim to help seniors remain at home or in a community setting rather than moving into nursing homes. Services may be offered in assisted living, community homes, or structured family caregiving homes.
What is Regular Medicaid for the Aged, Blind, and Disabled?
This entitlement program allows eligible seniors to access various long-term care services, such as in-home help or adult day care, based on medical need.
What are the income and asset limits for South Dakota Medicaid long-term care in 2025?
Financial and medical qualifications differ by program, marital status, and are updated annually. The chart below summarizes the 2025 limits:
2025 South Dakota Medicaid Long-Term Care Eligibility for Seniors
| Type of Medicaid | Income Limit (Single) | Asset Limit (Single) | Level of Care (Single) | Income Limit (Married – Both) | Asset Limit (Married – Both) | Level of Care (Married – Both) | Income Limit (Married – One) | Asset Limit (Married – One) | Level of Care (Married – One) |
|---|---|---|---|---|---|---|---|---|---|
| Institutional / Nursing Home Medicaid | $2,901 / month* | $2,000 | Nursing Home | $5,802 / month* | $3,000 | Nursing Home | $2,901 / month* | $2,000 (applicant) & $157,920 (non-applicant) | Nursing Home |
| Medicaid Waivers / HCBS | $2,901 / month† | $2,000 | Nursing Home | $5,802 / month† | $3,000 | Nursing Home | $2,901 / month† | $2,000 (applicant) & $157,920 (non-applicant) | Nursing Home |
| Regular Medicaid / Aged, Blind & Disabled | $967 / month | $2,000 | Help with ADLs | $1,450 / month | $3,000 | Help with ADLs | $1,450 / month | $3,000 | Help with ADLs |
*Most income must be paid to the nursing home, minus a $100 personal needs allowance and possibly a spousal allowance.
†In waiver settings, not all income may be retained.
How is income evaluated for Medicaid eligibility?
What types of income count toward the Medicaid limit?
Most income sources are counted, including wages, pensions, Social Security, and dividends. Exceptions include Holocaust restitution and VA Aid & Attendance payments.
How is income treated when only one spouse applies?
Only the applicant’s income is counted. The non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) of up to $2,643.75/month. This may increase if their housing and utility expenses exceed $793.13/month, but the maximum is $3,948/month (as of July 2025).
What if both spouses’ income is considered?
For Regular Medicaid, both spouses’ incomes are counted toward eligibility. No spousal allowance applies in this case.
How are assets evaluated under Medicaid rules?
What counts as a countable asset?
Assets like savings, investments, and property not used as a primary residence count. Exempt assets include personal belongings, one vehicle, and the primary home under certain conditions.
How are a couple’s assets handled?
Married couples’ assets are evaluated jointly. The non-applicant spouse may keep up to $157,920 (or all assets up to $31,584) through the Community Spouse Resource Allowance (CSRA).
What is the Medicaid Look-Back Period in South Dakota?
There is a five-year look-back period for Nursing Home Medicaid and Waiver applicants. Any gifting or asset transfers for less than fair market value during this time can lead to a penalty period of ineligibility.
Is the primary residence always protected under Medicaid?
When is a home exempt from Medicaid asset limits?
The home is exempt if the applicant or their spouse resides in it. If neither lives there, the applicant must intend to return, and home equity must not exceed $730,000 (2025 limit).
Is the home protected from Medicaid estate recovery?
No. While exempt during the applicant’s life, the state may recover the cost of care from the estate, including the home, after death.
What medical or functional needs must be met?
Nursing Home Medicaid and Waivers require a Nursing Home Level of Care (NHLOC). For Regular Medicaid, functional impairment in Activities of Daily Living (ADLs) is sufficient.
Can someone qualify for Medicaid even if they exceed income or asset limits?
What is a Medicaid Income Trust (QIT)?
Also called a Miller Trust, this tool allows excess income to be deposited into an irrevocable trust, making the applicant eligible for Medicaid. Funds can only be used for allowed expenses and the state must be listed as a beneficiary.
What is an Asset Spend Down?
Applicants can spend excess assets on exempt items such as home modifications, debt repayment, or funeral plans. These actions must comply with Medicaid’s rules and avoid violating the 5-year look-back period.
What is Medicaid Planning?
For those over income or asset limits, working with a Medicaid Planning Professional can help create legal pathways to eligibility and protect the home from estate recovery.
What Medicaid programs are available to help seniors live at home?
Personal Care Services (PCS)
PCS provides in-home support for daily tasks like bathing, dressing, and meal prep, helping seniors avoid nursing home placements.
HOPE Waiver
The HOPE (Home and Community-Based Options and Person Centered Excellence) Waiver offers long-term care alternatives through services like personal care, home modifications, emergency systems, and adult day care.
Money Follows the Person (MFP) program
MFP assists seniors in transitioning from nursing homes back into community or home-based settings with Medicaid support.
How do South Dakota seniors apply for Medicaid?
Applications can be submitted online, in person at a DSS office, or by mailing a completed Long Term Care Application. Call 877-999-5612 to request forms or get help. If over income or asset limits, Medicaid Planning is highly recommended before applying.
