South Dakota · waiver service

Structured Family Caregiving (HOPE Waiver) in South Dakota

Structured Family Caregiving is a HOPE Waiver service where an older adult or adult with a disability lives with a principal caregiver, such as a family member or friend, who provides daily care. A Medicaid-enrolled SFC provider agency coaches the caregiver and passes part of a daily Medicaid payment to them as a stipend. The caregiver is not an agency employee.

Also called: SFC · structured family caregiving South Dakota · HOPE waiver SFC · Dakota at Home caregiver pay · HOPE waiver family caregiver

Who do you care for?

My parent →My spouse →My child →

Quick facts

Pay: $392/week
Adult children & other relatives: Yes
Spouse: Yes
Parent of a minor child: Not right now
Waitlist: possible

Who qualifies for HOPE Waiver

Age 65 or older, or 18 or older with a disability.
Eligible for South Dakota's HOPE Waiver: nursing-facility level of care, assessed by DHS Long Term Services and Supports (LTSS).
Meets Medicaid financial eligibility through the Department of Social Services.
Lives with the principal caregiver, in the participant's home or the caregiver's home.

Who can be paid as the caregiver

Adult children & other relatives Yes: the state guide says participants choose a trusted family member or friend as principal caregiver.
Spouse Yes: (secondary) — states.json and national SFC sources say a spouse may serve; the DHS SFC guide does not address spouses directly.
Parent of a minor child Not right now: HOPE serves adults only.
Living together: SFC is a shared living arrangement; the caregiver can support no more than two participants.

Who employs the caregiver: Agency. A Medicaid-enrolled SFC provider agency credentials the caregiver, checks the home, provides coaching and issues the stipend; HOPE does not offer participant-directed hiring.

Spouse rules differ by program — see spouse pay in South Dakota.

How much HOPE Waiver pays

$392/week. South Dakota Medicaid pays the SFC agency a daily rate effective July 1, 2026: $82.00 base, $102.51 Tier 1, $114.81 Tier 2 (HOPE Waiver fee schedule). The agency passes a portion to the caregiver as a stipend; a minimum 50% pass-through and ~$392/week figure are reported by secondary sources, not the fee schedule.

Hours and budget: Not hourly. The LTSS case manager assesses needs and the tier (base, 1 or 2) sets the daily rate the agency receives.

Compare with other South Dakota programs on the South Dakota caregiver pay page, or across states in pay rates by state.

Is there a waitlist?

HOPE is a capped waiver (about 3,704 people a year); a waitlist can form when full.

How to apply for HOPE Waiver

Call Dakota at Home at 833-663-9673 (or email dakotaathome@state.sd.us) to request a HOPE Waiver screening.
Apply for Medicaid long-term care through the Department of Social Services at the same time.
An LTSS specialist completes the level-of-care assessment and builds the service plan.
Choose an enrolled SFC provider agency, which assesses the caregiver and home and starts stipend payments.

Dakota at Home (SD DHS Long Term Services and Supports) · 833-663-9673 · official site

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HOPE Waiver questions

Can I get paid to care for my parent in South Dakota?

Yes, through Structured Family Caregiving on the HOPE Waiver, if your parent qualifies and lives with you (or you with them). The SFC agency pays you a stipend.

How much does SFC pay?

Medicaid pays the agency $82.00 to $114.81 per day as of July 1, 2026, depending on the care tier. The caregiver gets a share as a stipend; about $392 a week is a commonly reported figure.

Do I have to live with the person I care for?

Yes. SFC is a shared living arrangement, in either your home or theirs.

Am I an employee of the agency?

No. The state guide says the principal caregiver is not an agency employee and is not covered by wage-hour, workers' compensation or unemployment rules.

Can a spouse be the paid caregiver?

Secondary sources say yes. The state's SFC guide does not mention spouses, so confirm with Dakota at Home.

Sources: dss.sd.gov · dhs.sd.gov · dss.sd.gov · medicaidplanningassistance.org · Updated 2026-10-08. Program rules change — always confirm with the program.

Guides

Where most South Dakota caregivers are

Counties with the most residents aged 65 and older. The rules are the same everywhere in South Dakota — pick yours for the local picture.

Across the line

States that border South Dakota

Each state writes its own rules, and they differ more than people expect — a spouse who can be paid on one side of the line often cannot be on the other.