How Medicaid Can Help Pay for Long-Term Care in South Dakota

Q: Can I hire a family member as my caregiver through South Dakota's HOPE Waiver?

No — unlike many similar HCBS programs in other states, South Dakota's HOPE Waiver does not allow participant direction of services. You cannot choose your own caregiver or hire a family member to provide care through this specific waiver.

Q: What is Structured Family Caregiving in South Dakota?

A separate program offering a shared living arrangement where a participant resides with a primary caregiver, either in the participant's own home or the caregiver's home — a distinct option from the HOPE Waiver itself.

Q: What is the cost limit for South Dakota's HOPE Waiver?

The cost of care provided through the waiver must be less than 85% of the cost of comparable nursing home care — a real ceiling built into the program's design.

Published August 28, 2026 How we keep this accurate

This page is South Dakota-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

A real restriction worth knowing upfront

South Dakota's HOPE Waiver (Home and Community-Based Options and Person Centered Excellence) is the state's primary HCBS program for seniors 65+ and disabled adults 18-64 who need nursing-facility-level care but prefer to remain at home.

Unlike many similar programs in other states, the HOPE Waiver does not allow participant direction of services. You cannot choose your own caregiver or hire a family member through this specific waiver — a real, meaningful difference from states like North Carolina, Missouri, or Wisconsin, where self-direction and family hiring are genuine options.

A separate program that does allow family involvement

Structured Family Caregiving is a distinct program from the HOPE Waiver itself — a shared living arrangement letting a participant reside with a primary caregiver, either in the participant's own home or the caregiver's home. If family-based care is important to you, ask about this specifically rather than assuming the HOPE Waiver covers it.

A built-in cost ceiling

The HOPE Waiver's design includes a real cost limit: services provided must cost less than 85% of comparable nursing home care. This isn't a technicality — it's part of why the program exists, aiming to reduce costs while still meeting real care needs.

The 2026 financial numbers

	HOPE Waiver / Nursing Home Medicaid
2026 income limit	$2,982/month (single) — spousal income not counted if only one spouse applies
2026 asset limit	$2,000 (single), $3,000 (couple, both applying)
Community Spouse Resource Allowance	$32,532 to $162,660
Spousal income allowance	$2,705 to $4,066.50/month

Source: South Dakota Department of Social Services (DSS), Division of Long Term Services and Supports; figures effective 2026.

A lower-bar alternative

Personal Care Services (PCS), part of regular Medicaid, provides help with bathing, dressing, eating, mobility, shopping, light housework, and meal preparation — without requiring the full nursing-facility-level-of-care determination the HOPE Waiver needs. Worth asking about if you need help but aren't at that higher threshold yet.

If your income is over the limit

South Dakota requires a Qualified Income Trust (QIT) for income above $2,982/month, redirecting the excess so you can still qualify.

How to actually start

Contact the Division of Long Term Services and Supports through the Department of Social Services to begin a HOPE Waiver assessment — each approved participant receives an Individual Care Plan specifying their needs and services.

If family-based caregiving is important, ask specifically about Structured Family Caregiving rather than assuming the HOPE Waiver provides this option.

Common Questions

Can I hire a family member as my caregiver through South Dakota's HOPE Waiver?

No — unlike many other states, the HOPE Waiver doesn't allow participant direction or family hiring.

What is Structured Family Caregiving in South Dakota?

A separate shared-living arrangement program, distinct from the HOPE Waiver, that does involve family or a primary caregiver.

What is the cost limit for South Dakota's HOPE Waiver?

Services must cost less than 85% of comparable nursing home care.