South Dakota Adult Day Care Through Medicaid: HOPE Waiver Coverage and Costs

Your parent needs supervision during the day — they can't safely be left alone for eight hours while you're at work — but they don't need a nursing home. Adult day services fill that gap, and in South Dakota, the HOPE waiver can cover the cost entirely if your parent qualifies.

What Adult Day Services Include in South Dakota

Adult day programs provide structured daytime care in a licensed facility, typically from morning through late afternoon. Services vary by program but generally include:

• Supervision and socialization activities
• Assistance with ADLs (bathing, grooming, toileting, eating)
• Medication management and health monitoring
• Nutritious meals and snacks
• Physical activity and cognitive stimulation programs
• Transportation to and from the facility (at some locations)

The South Dakota Department of Health licenses these facilities, and they're listed in the DOH Facility Registry. Most programs operate in Sioux Falls, Rapid City, and Aberdeen — rural coverage is limited, which is one of the structural challenges families in western and central South Dakota face.

How the HOPE Waiver Covers Adult Day Services

Adult day services are a covered benefit under South Dakota's HOPE waiver, the state's primary Medicaid home and community-based services program. To qualify, your parent must meet two separate tests:

Clinical eligibility: An LTSS Specialist from the Department of Human Services conducts an in-home assessment using the InterRAI tool. Your parent must score at the nursing facility level of care (NFLOC) — meaning they need consistent, documented help with multiple activities of daily living.

Financial eligibility (2026 limits):

• Gross monthly income: $2,982 or less (single applicant)
• Countable assets: $2,000 or less
• If income exceeds $2,982, a Miller Trust (Qualified Income Trust) is required — South Dakota has no medically needy spend-down pathway

The HOPE waiver authorization then covers adult day services as part of your parent's individual care plan, developed with their LTSS Specialist. There's no separate copay for the service itself — it's billed directly to Medicaid through the provider.

Private-Pay Costs Without Medicaid

If your parent doesn't qualify for the HOPE waiver, private-pay rates for adult day services in South Dakota typically run between $1,100 and $1,500 per month, depending on the facility and hours used. That's considerably less than the statewide average of roughly $8,400 per month for full-time nonmedical home care, making adult day a cost-effective option for families who need weekday coverage but can manage evenings and weekends themselves.

Some families combine adult day services with a few hours of evening home care or the Structured Family Caregiving program, building a hybrid care schedule that keeps costs manageable without placing their parent in a facility.

How to Get Started

1. Call Dakota at Home (the state ADRC) to request an initial screening — they'll determine whether a full LTSS assessment is appropriate
2. Schedule the in-home assessment — an LTSS Specialist visits your parent's home, evaluates functional ability, and generates a RUG score
3. Complete the financial application through the Department of Social Services if clinical eligibility is confirmed
4. Select an adult day provider — your LTSS Specialist can help identify available programs in your region

The expected start timeline for adult day services is typically one to two weeks, pending assessment, though rural scheduling can add delays. If your parent is coming home from a hospital stay and needs immediate coverage, mention the timeline pressure when you call Dakota at Home and ask whether an urgent assessment can be arranged.

For families juggling work schedules and caregiving responsibilities, adult day services can be the practical middle ground between full-time home care and placement. The South Dakota Home Care Navigator walks through the full HOPE waiver application process, including how to set up a Miller Trust if your parent is over the income cap.

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