South Dakota Medicaid for seniors and long-term care

Last verified: June 2026

What South Dakota Medicaid covers for seniors and people needing long-term care

South Dakota Medicaid covers nursing facility care and home and community-based services for eligible seniors and adults with disabilities. Per DSS, Medicaid helps cover long-term care "whether at home, in your community, or in a care facility." DSS also administers the HomeAgainSD program, which supports transitions from nursing facilities back to home-based care for eligible members.

• Skilled nursing facility (nursing home) care
• Personal care services at home
• Home health aide services
• Home and Community Based Services (HCBS) waiver programs
• Adult Day Services
• Respite care for family caregivers
• HomeAgainSD — nursing facility transition assistance
• Long Term Care Partnership Program — asset protection for partnership policyholders
• Hospice care
• Non-emergency medical transportation

Source: South Dakota DSS medical eligibility page; DSS Long Term Care program descriptions; HomeAgainSD program (homeagain.sd.gov).

Financial eligibility for South Dakota long-term care Medicaid

South Dakota long-term care Medicaid uses non-MAGI eligibility rules. Asset limits and income limits apply. The asset limit for a single applicant is $2,000.

Source: Federal SSI FBR 2026; federal spousal impoverishment rules (42 U.S.C. § 1396r-5). Verify current South Dakota-specific figures with DSS or a South Dakota elder law attorney before proceeding.

South Dakota Long Term Care Partnership Program

South Dakota participates in the Long Term Care Partnership Program (available at ltcpartnership.sd.gov). This program lets South Dakotans who purchase a qualifying long-term care insurance policy protect an amount of assets equal to the insurance benefits paid — reducing the amount they must spend down to qualify for Medicaid.

For example: if a qualifying LTC insurance policy pays out $200,000 in benefits before the policyholder applies for Medicaid LTC, the policyholder can keep $200,000 in assets that would otherwise need to be spent down to the $2,000 limit. This is a federally supported program available in most states, and South Dakota's participation is part of DSS's broader long-term care planning infrastructure.

South Dakota Medicaid estate recovery

South Dakota operates an estate recovery program. DSS may seek reimbursement from the estates of members who received nursing facility care or HCBS waiver services at age 55 or older. The home is generally exempt during the lifetime of a surviving spouse or dependent child. South Dakota enforces the federal 60-month (5-year) lookback period for asset transfers. Consult a South Dakota elder law attorney before making asset transfers if a family member may need Medicaid long-term care.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. South Dakota's share of that population is administered through South Dakota Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

South Dakota Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, South Dakota may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether South Dakota uses this approach with South Dakota Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through South Dakota Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact South Dakota Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult South Dakota Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. South Dakota's current CSRA is set by South Dakota Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments