Nicknamed the “Mount Rushmore State” for its well-known presidential sculpture, South Dakota is one of the nation’s least populous states with approximately 895,000 residents. Seniors aged 65 and older make up 17.2% of the population.

For budget-conscious seniors, this sparsely populated state may be an ideal place to retire. South Dakota’s overall cost of living is nearly 12% lower than the national average, and at $3,350 per month, typical assisted living costs are much more affordable here than in most neighboring states. The state Medicaid plan offers one waiver that may help seniors with these costs.

This guide offers a summary of assisted living in South Dakota. Keep reading for details about average care costs, financial assistance options and free and low-cost resources that support healthy aging. 

How Much Does Assisted Living Cost in in South Dakota?

Nationwide, assisted living care costs an average of $4,500 per month, according to the 2021 Genworth Cost of Care Survey. In South Dakota, assisted living rates are about 25% lower than the national norm at just $3,350 per month. Pricing is similar in North Dakota ($3,391), but significantly higher in other nearby states. At $4,076 per month, the cost in Nebraska is nearly 22% higher than in South Dakota. Montana ($4,450) and Minnesota ($4,508) are even pricier, so seniors in these states may look to South Dakota for budget-friendly assisted living care.

The Cost of Assisted Living in South Dakota’s Top Cities

In Sioux Falls, South Dakota’s most populous city, seniors pay an average of $2,910 per month for assisted living. On the other side of the state in Rapid City, assisted living costs are significantly higher at $3,914 per month. Care costs for smaller cities in South Dakota, including the state capital of Pierre, aren’t available.

The Cost of Assisted Living vs. Other Types of Care

At $3,350 per month, assisted living is one of the more affordable types of senior care in South Dakota. Adult day health care programs, which support seniors during typical workday hours, are also relatively affordable at $2,600 per month. Other options come with higher price tags. Seniors who choose to age in place pay an average of $5,911 per month for both homemaker and home health aide services. The average cost of the around-the-clock care provided in nursing homes is even higher at $7,118 per month. 

Can You Use Medicaid to Pay for Assisted Living in South Dakota?

South Dakota Medicaid doesn’t directly cover the cost of assisted living care. The state Medicaid plan does cover some in-home assistance through its Personal Care Services program. There’s also one waiver program that may help some seniors pay for assisted living services.

The state Medicaid plan offers the Home and Community-Based Options and Person Centered Excellence Waiver. Also known as the HOPE Waiver, this program aims to help seniors receive care services in a less restrictive environment, such as their home or an assisted living community.

Medicaid’s Coverage of Assisted Living in South Dakota

South Dakota Medicaid’s HOPE Waiver may cover services received in an assisted living facility, such as personal care, meal preparation and recreational programming. The services a senior can receive through the waiver are determined based on their individual needs. 

Waiver Programs for Assisted Living in South Dakota

HOPE Waiver

The HOPE waiver covers a wide variety of home and community-based services to help seniors delay or avoid nursing home placement. Depending on a senior’s needs, these services might include in-home supports, adult day care or assisted living care. Seniors who are assessed as needing assisted living care could receive:

• Homemaker services
• Personal care
• Chore services
• Meal preparation
• Social and recreational activities
• Medication assistance

The HOPE waiver doesn’t cover room and board in an assisted living facility. It also doesn’t cover personal comfort items and services, such as the beauty and barber services provided by assisted living facilities.

Seniors may qualify for the HOPE waiver if they:

• Are aged 65 or older
• Currently living in the community, not in a hospital or nursing facility
• Require waiver services at least once per month
• Are financially eligible for Medicaid coverage

Eligibility for Medicaid in South Dakota

There are several Medicaid coverage groups in South Dakota, each with its own financial eligibility requirements. For seniors who live in assisted living facilities, nursing facilities or at home, the monthly income limit is 300% of the Supplemental Security Income standard benefit amount. In 2022, this means the income limit is $2,523 per month ($30,276 per year). The resource limit is $2,000.

When a married senior applies for Medicaid-funded long-term care services, spousal impoverishment rules help protect their spouse’s savings. A spouse who lives in the community is able to retain up to $137,400 in countable resources. When both members of a couple apply for Medicaid, each applicant’s income is considered individually and the joint asset limit is $3,000.

2022 Medicaid Income Limits for Seniors in South Dakota

	Income Limits*	Asset Limits
Single Applicant	$30,276	$2,000
Two-Person Household (Only One Person Applying)	$30,276 for the applicant	$2,000 for applicant $137,400 for non-applicant
Two-Person Household (Both People Applying)	$30,276 per applicant	$3,000

*per year

Seniors who believe their income and/or assets exceed these limits may still qualify for help with assisted living costs. That’s because some types of income and assets don’t count toward the Medicaid limits. Contact your local Medicaid office for help calculating your countable income and assets.

In addition to these income and asset limits, there are other requirements that seniors must meet to be eligible for Medicaid-funded long-term care services. They must:

• Be a South Dakota resident
• Meet U.S. citizenship requirements
• Require a nursing facility level of care

Applying for Medicaid in South Dakota

There are a few ways to apply for help with assisted living costs in South Dakota. Seniors can choose to apply through the South Dakota Department of Social Services online portal. 

Alternatively, they can download and print an application form for long-term care assistance from the department’s website. After completing the form, they can mail, fax or take it to their nearest Department of Social Services office. Local offices can also mail out application packets, on request. 

Before You Apply

The Department of Social Services may request a variety of documentation to support seniors’ Medicaid applications. Before you apply, gather the following items:

• Your Social Security number
• Proof of age, such as a driver’s license
• Proof of South Dakota residency, such as a lease
• Proof of income, such as pay stubs, pensions or Social Security statements
• Proof of assets, such as bank statements

Where to Go to Get Help

Seniors who have questions about South Dakota Medicaid, or need help applying for the program, can turn to one of the following free resources. 

Resource	Contact	Service
South Dakota Department of Social Services Website	(605) 773-3165	The South Dakota Department of Social Services offers extensive information about Medicaid on its website. Seniors can learn about the services Medicaid covers and the program’s eligibility requirements, as well as how to apply.
Sioux Falls Department of Social Services Office	(605) 367-3230	The Department of Social Services Office in South Dakota’s most populous city offers assistance with Medicaid. Seniors can call or stop by for help applying for Medicaid and the HOPE waiver. There are also DSS offices in smaller communities throughout the state.
Senior Health Information and Insurance Education Program	Contact a regional office	As South Dakota’s State Health Insurance Assistance Program, SHIINE provides one-on-one  counseling to Medicare beneficiaries. Seniors can contact SHIINE if they have questions about how South Dakota Medicaid works with Medicare.

Can You Use Medicare to Pay for Assisted Living in South Dakota?

Unfortunately, Medicare does not cover the cost of assisted living in South Dakota. Unlike nursing homes, assisted living facilities are not considered to be “clinical settings’ and so are not eligible for Medicare coverage. That being said, you can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

For more information about what Medicare visit medicare.gov.

Are There Other Financial Assistance Options for Assisted Living in South Dakota?

	How to Apply	How It Works
Aid and Attendance	Apply online at va.gov	If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse Mortgages	Research and learn about the different types at ftc.gov	If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) Insurance	Learn about how to receive LTC insurance benefits at acl.gov.	While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free and Low-Cost Resources for Seniors in South Dakota

South Dakota’s current and future assisted living residents may benefit from the state’s many free and low-cost aging resources. Seniors can contact one of the following government agencies or nonprofit organizations for assistance with finding local support services, resolving legal problems and learning about their rights as long-term care facility residents.

Resource	Contact	Service
Dakota at Home	(833) 663-9673	As the state’s Aging and Disability Resource Center, Dakota at Home helps seniors identify long-term supports in their area. Seniors can call Dakota at Home for referrals to government agencies and nonprofit organizations that can help them live as independently as possible. The ADRC also provides a statewide online resource directory.
Long-Term Care Ombudsman Program	(866) 854-5465	South Dakota’s Long-Term Care Ombudsman program works to protect the rights of the state’s assisted living residents. Ombudsmen investigate and resolve complaints from residents, educate South Dakotans about elder rights and train assisted living staff.
Dakota Plains Legal Services	Contact the local service area office	This nonprofit corporation provides free legal assistance to people in 34 counties in the Dakotas. It can help seniors with a wide variety of civil legal issues, including family law, public benefits and estates. Its services range from brief advice to full representation in court.
South Dakota Department of Veterans Affairs	(605) 773-3269	The South Dakota Department of Veterans Affairs offers benefits assistance to the nearly 56,000 veterans in the state. Senior veterans can contact the department for help accessing the state and federal benefits they’ve earned through their service.
DakotaLink	(800) 645-0673	DakotaLink is a statewide program that helps South Dakotans access the assistive technology they need to overcome the challenges of aging. Its device loan program helps older adults try out new devices. To help seniors buy devices, it offers referrals to vendors and assistance programs.
Active Generations	(605) 336-6722	This nonprofit senior center serves older adults in the Sioux Falls area. For a nominal annual fee, seniors can use its state-of-the-art fitness center or take part in a number of fun activities, such as billiards and pickleball.
Black Hills Area Retired Senior Volunteer Program	(605) 394-2507	Sponsored by the City of Rapid City, this program helps people 55 years of age and older give back to their communities. Seniors who live in the Black Hills area can be matched with rewarding volunteer opportunities, such as teaching children to read. Participants also have the opportunity to meet and socialize with the program’s approximately 500 volunteers.

COVID-19 Rules for Assisted Living in South Dakota

The following information is based on research done on several government websites, including doh.sd.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?	Yes (Conditions Apply)
Can I visit my relative in person for end-of-life compassion care?	Yes
Will my loved one be required to self-quarantine after I visit him or her?	No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?	Yes
Are Hairdressers and other non-medical contractors still allowed in senior living facilities?	Yes
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?	Yes
Are visitors being screened for elevated temperatures?	Yes
Are visitors being asked questions about health, travel, and potential virus contact?	Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?	Yes
Are residents of senior living facilities who leave and return required to self-quarantine?	No (Conditions Apply)
Are senior living facilities required to cancel all group outings?	No
Are residents still eating together in the dining hall?	Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?	Yes (Conditions Apply)

Safety Measures for Staff & Contractors

Are staff members and contractors being screened for elevated temperatures?	Yes
Are staff members and contractors being tested for Coronavirus?	Yes (Conditions Apply)
Are staff members and contractors being asked questions about health, travel, and potential virus contact?	Yes

Safety Measures for Residents

Are staff members required to regularly screen residents for coronavirus symptoms?	Yes
Are residents relied on to screen themselves and self-report potential coronavirus symptoms?	No
Are staff members required to take residents’ temperatures?	Yes
Are residents being tested for coronavirus?	Yes (Conditions Apply)

Assisted Living Laws and Regulations in South Dakota

The South Dakota Department of Health’s Office of Health Facilities Licensure and Certification licenses and inspects the state’s assisted living facilities. Each facility is required to comply with the state’s extensive rules that cover everything from food safety to staffing levels and resident care.