Get Paid to Care for Your Elderly Parent in South Dakota
South Dakota's HOPE Waiver does not offer general participant-directed care, but it does include Structured Family Caregiving, which lets a co-residing family caregiver be paid without working for a provider agency. The caregiver and care recipient must live in the same home, and pay is typically delivered as a daily stipend tied to care level.
This guide covers what South Dakota family caregivers need to know: the program structure, pay rates, who can be paid, eligibility, how to apply, and other programs that may supplement your income.
South Dakota pays family caregivers $11–$20 per hour through the Structured Family Caregiving (HOPE Waiver) option within the Home & Community-Based Options and Person-Centered Excellence (HOPE) Waiver. Your parent must meet a nursing-facility level of care but prefer to remain at home.
South Dakota's Main Program: Structured Family Caregiving (HOPE Waiver)
Structured Family Caregiving (HOPE Waiver) is a self-directed option within South Dakota's Home & Community-Based Options and Person-Centered Excellence (HOPE) Waiver, which provides home and community-based care for seniors and adults with disabilities who meet a nursing-facility level of need. Under self-direction, your parent (or you as their authorized representative) can hire, train, schedule, and supervise the personal-care attendant — and that attendant can be you, an adult child.
What the Program Pays For
Authorized self-directed services typically include:
- Personal care: bathing, grooming, dressing, oral hygiene
- Toileting assistance and incontinence care
- Mobility help: transferring, positioning, ambulation support
- Meal preparation and feeding assistance
- Light housekeeping directly related to health and safety
- Medication reminders (not administration, which requires a nurse)
- Supervision for individuals with cognitive impairment, including dementia
Pay Rates Across South Dakota
| Region | Typical Hourly Rate | Notes |
|---|---|---|
| Sioux Falls Metro | $11–$20/hr | Paid as a daily/stipend SFC rate rather than strict hourly |
| Rapid City Metro | $11–$20/hr | Caregiver must live with the participant |
| Rural South Dakota | $11–$18/hr | Effective hourly equivalent varies by care level |
Rates are set within the participant's approved plan-of-care budget and the state's limits; the figures above are typical ranges, not guarantees.
Who Can Be Paid
Adult children and other relatives can be the paid caregiver if they live in the same home as the care recipient; spouses and legal guardians are generally excluded. Always confirm the current rules with South Dakota Department of Social Services before you count on a specific arrangement.
Eligibility Requirements
Your Parent Must:
- Be enrolled in full South Dakota Medicaid (not just a savings program)
- Meet the clinical criteria for a nursing-facility level of care
- Be enrolled in the Home & Community-Based Options and Person-Centered Excellence (HOPE) Waiver (or its self-directed option)
- Live in South Dakota in a community setting (not a nursing home)
- Be able to direct their own care, or have a legal/authorized representative who can
You (the Caregiver) Must:
- Be 18 years of age or older
- Meet the program's relationship rules (see above)
- Pass a criminal background check and registry search
- Complete any required caregiver orientation and training
- Be legally authorized to work in the United States
- Submit timesheets through a financial management service
How to Apply: Step-by-Step
- Apply for South Dakota Medicaid. Apply online at apps.sd.gov/SS19SpApply or call 1-800-305-9788. Your parent must meet income and asset limits.
- Request a long-term-services assessment. Contact your local Medicaid or aging office to request a comprehensive functional assessment that determines whether your parent qualifies for the Home & Community-Based Options and Person-Centered Excellence (HOPE) Waiver.
- Enroll in the waiver. Once deemed eligible, your parent is enrolled in the Home & Community-Based Options and Person-Centered Excellence (HOPE) Waiver and assigned a case manager or care coordinator.
- Request the self-directed (SFC) option. During care planning, ask specifically for the consumer/self-directed service model and state that you, the adult child, want to be the hired caregiver.
- Enroll with a financial management service. Complete enrollment paperwork — W-4, I-9, and background authorization — so payroll, tax withholding, and timesheets are handled for you.
- Complete orientation. Finish any state-required caregiver orientation covering personal-care techniques, emergency procedures, and reporting.
- Begin care and submit timesheets. Provide care per the authorized plan and submit electronic timesheets; payroll is processed on a regular cycle with taxes withheld.
Check Your Parent's Eligibility
Our free Benefits Checker helps identify whether your parent qualifies for South Dakota's caregiver-pay programs and other benefits.
Check Eligibility NowOther Programs That May Pay South Dakota Family Caregivers
VA Veteran-Directed Care & PCAFC
If your parent is a veteran enrolled in VA healthcare, the Veteran-Directed Care program provides a monthly budget that can pay family caregivers, and the Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers a monthly stipend for eligible primary caregivers. Contact the caregiver support coordinator at your parent's VA medical center or call 1-855-260-3274.
Personal Care Agreement (Private Pay)
If your parent does not qualify for Medicaid, a formal written Personal Care Agreement lets them pay you from their own funds at fair-market rates. Drafted with an elder-law attorney, it must be prospective and reasonable — and it keeps payments from being treated as "gifts" during the Medicaid 5-year look-back.
State Respite & Caregiver Support
Through the National Family Caregiver Support Program, South Dakota's Area Agencies on Aging fund respite, training, and counseling. These rarely pay ongoing wages but reduce your out-of-pocket costs. Find your local agency through the Eldercare Locator (1-800-677-1116) or 1-833-663-9673.
Tax Implications for Family Caregivers
- W-2 wages: The financial management agency issues you a W-2; federal income tax, Social Security, and Medicare are withheld.
- IRS Notice 2014-7: If you live in the same home as your parent (the Medicaid waiver participant), your self-directed wages may be excludable from federal gross income. Consult a CPA before filing — see IRS guidance on Medicaid waiver payments.
- Earned Income Tax Credit: These wages count as earned income and may qualify you for the EITC.
Maintain daily logs of services provided — date, time in, time out, and a brief description. Medicaid audits self-directed arrangements, and accurate records protect both you and your parent.
What South Dakota Caregivers Are Actually Earning
At 30 hours per week and about $15 per hour, you would earn roughly $1,950 per month. At 40 hours per week and $20 per hour, earnings reach about $3,466 per month — around $41,600 per year before taxes.
For comparison, a nursing home costs far more per year, and agency home care runs roughly $30–$40 per hour. A self-directed arrangement lets your parent receive care from someone they trust, while you earn income that partially replaces what you may have given up to provide care.
Contact Information
- South Dakota Department of Social Services: dss.sd.gov/medicaid | 1-800-305-9788
- Apply for Medicaid: apps.sd.gov/SS19SpApply
- State aging services: dhs.sd.gov/en/ltss | 1-833-663-9673
- Eldercare Locator (find local help): eldercare.acl.gov | 1-800-677-1116
- Medicaid (federal): medicaid.gov
Frequently Asked Questions
Structured Family Caregiving under the HOPE Waiver pays the live-in caregiver a daily stipend rather than a strict hourly wage, with an effective equivalent often in roughly the $11–$20 per hour range depending on the participant's care level.
Structured Family Caregiving (SFC) is a HOPE Waiver service in which a participant lives with a principal caregiver who is paid to provide care. The caregiver does not have to be employed by a Medicaid provider agency. The package includes pay, training, coaching, and respite support.
Spouses and legal guardians are generally excluded from being the paid caregiver. Adult children and other relatives can be paid through Structured Family Caregiving, but they must live in the same home as the care recipient.
The HOPE (Home & Community-Based Options and Person-Centered Excellence) Waiver allows paid family caregiving through its Structured Family Caregiving service. The participant must be 65+ or an adult with a qualifying disability and meet nursing-facility level of care.
Call Dakota at Home at 1-833-663-9673 to start a HOPE Waiver assessment, and apply for Medicaid through your local Department of Social Services office or online. A care coordinator confirms the level of care and sets up the caregiver arrangement.
Yes. If your parent qualifies for the HOPE Waiver at a nursing-facility level of care, dementia care needs can support eligibility for Structured Family Caregiving. As an adult child you can be the paid caregiver, but you must live in the same home as your parent.
Related Guides
- How to Get Paid to Care for Your Parent (National Overview)
- How to Apply for Medicaid for an Elderly Parent
- Caregiver Tax Deductions 2026
- VA Benefits for Elderly Parents
- Power of Attorney for an Elderly Parent
- Medicaid Spend-Down Rules
This guide is general information, not legal or financial advice. Program names, pay rates, and eligibility rules change and vary by county — confirm details with South Dakota Department of Social Services. Sources: dhs.sd.gov · dss.sd.gov.