Get Paid to Care for a Family Member in South Dakota

How It Works: The Structured Family Caregiving Program

South Dakota's Structured Family Caregiving (SFC) program is the primary path to getting paid as a family caregiver. It's a specialized service under the HOPE Waiver — Medicaid's home and community-based program — that pays a daily stipend to a family member who lives with and provides daily care to an aging parent or other qualifying adult.

The payment structure is straightforward: Medicaid reimburses an enrolled provider agency at a daily rate, and the agency is required to pass at least 50% of that rate directly to you as the caregiver.

Here are the 2026 daily rates:

The tier your parent qualifies for depends on their assessed level of need — how much hands-on physical help and supervision they require daily.

The money is tax-free. Under IRS Notice 2014-7, difficulty-of-care payments to caregivers who live in the same home as the care recipient are exempt from federal income tax. This makes the effective value of the stipend higher than the face amount.

Who Qualifies

Both your parent and you need to meet specific criteria:

Your parent must:

• Be enrolled in the HOPE Waiver (which requires nursing-facility level of care — meaning they need hands-on help with multiple daily activities like bathing, transferring, toileting, and medication management)
• Meet Medicaid financial eligibility: gross monthly income at or below $2,982 (a Miller Trust bridges the gap if income is higher) and countable assets at or below $2,000
• Have an approved LTSS (Long Term Services and Supports) care plan

You, the caregiver, must:

• Live in the same home as the care recipient (this can be their home or yours)
• Be willing to provide daily, hands-on personal care
• Pass a fingerprint-based criminal background check
• Complete initial and ongoing training through the enrolled provider agency
• Meet the program's caregiver eligibility requirements; spouses may qualify under certain HOPE Waiver circumstances

Family members can be potential caregivers, subject to program and provider-agency eligibility requirements.

The Step-by-Step Process

1. Contact Dakota at Home (1-833-663-9673). This starts the entire process. Tell them your parent needs an assessment for long-term care services and that you're interested in Structured Family Caregiving.

2. LTSS assessment. An LTSS Specialist will schedule an in-home visit to evaluate your parent's functional needs. They'll assess physical limitations, cognitive status, and daily living capabilities using a standardized interRAI assessment tool. The result determines whether your parent meets nursing-facility level of care.

3. Medicaid application. File a formal Medicaid application with the Department of Social Services (DSS) Economic Assistance office. You'll need five years of financial records: bank statements, investment accounts, tax returns, and property deeds. If your parent's monthly income exceeds $2,982, an elder law attorney can help establish a Miller Trust.

4. Choose a provider agency. SFC operates through enrolled provider agencies, not as a direct payment from the state. Agencies active in South Dakota include Paid.care, Modani Care, AAA Advantage Home Care, and Homecare Services. The agency handles your enrollment, training, background check, and ongoing oversight.

5. Agency onboarding. The agency conducts a home safety evaluation, verifies your credentials, runs your background check, and provides caregiver training. They'll also set up the payment schedule.

6. Start receiving the daily stipend. Once everything is in place — HOPE Waiver enrollment, Medicaid approval, agency onboarding — you begin receiving daily payments through the agency.

What to Watch Out For

The timeline is not fast. From the initial Dakota at Home call to the first stipend payment, expect 10–14 weeks minimum. The Medicaid application alone has a federally mandated review period of up to 45 days (90 days if a disability determination is required). If there's a HOPE Waiver waitlist, add potentially one to two years.

The 50% pass-through is a floor, not a ceiling. State regulations require the agency to pass at least half the daily rate to you. Some agencies pass more. When choosing an agency, ask what percentage they actually pay caregivers — and get it in writing.

The co-residency requirement is strict. You must genuinely live in the same home. If you maintain a separate residence and visit daily, that's not SFC — that's a different service model. The agency conducts home visits to verify the arrangement.

Your parent's IRA or 401(k) counts as an asset. South Dakota counts retirement accounts as countable assets even if they're in payout status. This is stricter than many other states and can disqualify middle-class parents who otherwise look eligible on income alone.

Alternatives If SFC Doesn't Fit

If SFC isn't the right fit — maybe you can't move in, or your parent doesn't yet meet nursing-facility level of care — other options exist:

• Personal services contract: You can draw up a formal contract to provide care in exchange for compensation from your parent's personal funds. This must be done at fair market rates and properly documented to avoid triggering Medicaid look-back penalties.
• Personal Care Services (PCS): The Medicaid state plan benefit that covers agency-directed home care. Family members can provide care, but only through an enrolled agency, and the income limit is just $994/month.
• VA Aid & Attendance: If your parent is a veteran, this benefit may provide additional pension income toward care without SFC's co-residency requirement.

For the complete process, including the financial worksheets and provider agency comparison tools, the South Dakota Home Care Navigator walks through SFC enrollment step by step.

See more South Dakota guides →