South Dakota ranks among the least expensive areas in the U.S. for assisted living care, which helped the state take 8th place overall in our 2022 Senior Living Report. The state’s population is growing at a healthy rate, even as others in the region decline, with close to 900,000 residents in total and 154,000 seniors as of the 2021 Census estimates. People of all ages have relatively good access to clean air and drinking water and a health care system that put South Dakota in 1st place in our report for patient satisfaction. Seniors, in particular, may benefit most from the significantly lower risk of respiratory illness and cancer from air pollutants.

The average cost for care in a South Dakota assisted living facility is $3,350 per month, according to the Genworth Financial 2020 Cost of Care Survey. Seniors who are still living in their own homes also save quite a lot on most other important costs of living, such as the savings of 28.8% on transportation and 16.2% on housing.

This guide is intended to help compare South Dakota’s assisted living costs with other areas. Medicaid and other possible sources of assistance are also explained. It also notes some local nonprofits and other government-supported organizations that help seniors. The guide has important information about the laws and regulations about South Dakota’s Assisted Living facilities.

The Cost of Assisted Living in South Dakota

As reported in the Genworth Financial 2020 Cost of Care Survey, assisted living facilities in South Dakota are priced at $3,350 per month. The U.S. average is 34% higher, at $4,500 per month, and all nearby states are more expensive than South Dakota for assisted living care. Minnesota and Montana are the least affordable, at $4,508 and $4,450 per month, respectively. Residents of Nebraska and Wyoming pay roughly $700-$800 more per month compared to those in South Dakota. The cost in North Dakota is virtually even, with the survey showing only $41 per month separating the Dakotas.


South Dakota


The United States


North Dakota









There was insufficient cost data for most cities in the state due to the relatively small populations. South Dakota’s most populous city, Sioux Falls, offers an average saving of $440 per month compared to the state overall. The monthly cost in Rapid City is significantly higher, with an average increase of $564. Even so, both surveyed cities in South Dakota are relatively affordable when comparing assisted living in the closest out-of-state cities. Assisted living costs in Cheyenne, WY, are more than $1,600 per month higher than Rapid City’s average, while Omaha, NE, has an average that’s $738 higher. Bismarck, ND, and Sioux City, IA, have monthly costs of $3,710 and $4,148, respectively.


Sioux Falls


Rapid City


Sioux City, IA


Cheyenne, WY


Bismarck, ND


Omaha, NE

Assisted living in South Dakota compares favorably to the other main types of care for seniors in terms of cost alone, at $3,350 per month. The average cost for home care and home health services is higher by more than $2,500 per month. With a monthly average cost of $2,600, adult day health care is a relatively affordable option for seniors who don’t require full-time care in their own home or facility. Nursing home care has an average cost of $7,118 per month in South Dakota, which is more than twice as expensive as assisted living facilities.


Assisted Living Facility


In-Home Care


Home Health Care


Adult Day Health Care


Nursing Home (semiprivate)

Does Medicaid Cover Assisted Living in South Dakota?

Yes, but only for South Dakota Medicaid recipients who qualify for a waiver program. The relevant program for seniors and people with disabilities is the HOPE Waiver, which is described in more detail below. Medicaid and its waiver programs are intended to help low-income residents with limited assets and, as such, the recipient may be required to spend a certain amount of their monthly income on care services before Medicaid coverage takes over.

In any case, coverage for assisted living and some other home and community-based services via Medicaid isn’t guaranteed, even for those eligible for the HOPE Waiver program. There may be a waiting list at times, for example, or the requested services may be deemed unnecessary or inappropriate for the individual.

What Assisted Living Services Are Covered by Medicaid in South Dakota

Medicaid and the HOPE Waiver provide coverage for a long list of personal care and other services, which includes many assisted living facility services in particular. The South Dakota DHS website has a detailed list of the covered services and we’ve made a brief summary of the relevant points below for assisted living residents. Ultimately, the amount and type of services covered are determined for each person based on their specific needs.

  • Homemaker and chore services
  • Personal care
  • Meals and meal preparation
  • Emergency response systems
  • Environmental accessibility adaptations
  • Supervision and security
  • Recreational programming and activities
  • Social programming
  • Community transition (moving from nursing home to assisted living)
  • Specialized medical equipment and supplies
  • Nutritional supplements

Room and board costs are never covered by South Dakota Medicaid or its waiver programs. The state limits the amount that assisted living facilities can charge for room and board, however, which is $693 per month as of 2022. This limit only applies to HOPE Waiver recipients in assisted living facilities that accept Medicaid.

Assisted Living Waiver Programs in South Dakota

HOPE Waiver

South Dakota helps eligible Medicaid recipients via waivers, which extend coverage to services that aren’t otherwise covered, such as care in assisted living facilities. The HOPE Waiver program is available to South Dakota seniors and people with disabilities who are assessed as in need of the relevant services in order to avoid being placed in a nursing home. If the individual’s care needs can be provided for in a less restrictive living environment — and one that’s less expensive — then the HOPE Waiver covers the cost of care.

How to Know if You’re Eligible for Medicaid in South Dakota

South Dakota Medicaid is designed to help people who can’t afford to pay for their required care. There are limits on the number of countable assets owned by the applicant and or a couple, as well as the maximum income allowed. These financial eligibility requirements are based on the SSI federal benefit rate, which changes each year. An individual must have income no higher than 300% of the monthly SSI payment. The income and asset limits for 2022 are listed below.

Annual Income Limits

Asset Limits

Single Applicant



Two-Person Household (Only One Person Applying)


$3,000 (spouse allowed up to $137,400)

Two-Person Household (Both People Applying)



Aside from the financial eligibility rules, applicants must meet the following requirements. Seniors who aren’t sure whether they’re eligible should ask for assistance from the agencies listed further below in this guide.

  • Be aged 65+ (or blind or disabled)
  • Must be a resident of South Dakota and planning to stay
  • Be a U.S. citizen or legally admitted with valid immigration status
  • Must have been assessed as having medical needs that meet a nursing home level of care
  • Not currently residing in a hospital, nursing home or intermediate care facility

It’s important to note that the requirement for a nursing home level of care doesn’t necessarily exclude seniors in assisted living facilities. If it’s determined that the applicant could receive that level of care in an assisted living facility, they may qualify for Medicaid coverage of the services received there.

How to Apply for Medicaid in South Dakota

Applications can be submitted by mail or in person at DSS offices throughout South Dakota. Although it’s possible to apply for other Medicaid benefits online, the form for Medicaid assistance for long-term care must be printed and taken or mailed to the Department of Social Services.

Information You Will Need

Due to the income and asset limits mentioned above, applicants for Medicaid long-term care assistance should prepare as much information as possible regarding their financial situation. The following is a general list of requirements to keep in mind.

  • Social Security number
  • Valid identification and proof of age
  • Immigration/citizenship documentation (if not a U.S. citizen)
  • Proof of South Dakota residency
  • Financial details (income, assets owned, life insurance policies, household expenses, etc.)

The financial details should include 90 days of the applicant’s most recent bank statements and bills showing the cost of large household expenses. Proof of state residency can be as simple as showing a utility bill for a South Dakota address.

How to Get Help Applying for Medicaid

South Dakota seniors and anyone acting on their behalf can contact the programs detailed below to get answers to questions and help with the application process. These services are provided at no cost.

Program Name

Contact Information

Services Available

Call (800) 305-3064 or view the map of local DSS offices on the website

The DSS is responsible for Medicaid enrollment, among other assistance programs. Staff at local offices can help in the application process for Medicaid, the HOPE Waiver program and the home and community-based services made available as a result.

East region: (605) 333-3314

Central region: (605) 494-0219

West region: (605 342-8635

The South Dakota SHIINE program provides free benefits counseling services for Medicare beneficiaries. Staff can give advice about how Medicare interacts with Medicaid and other programs and benefits. Seniors who expect to be dual-eligible for Medicare and Medicaid should contact SHIINE for help and answers.

Call (605) 773-3656 statewide or contact a regional LTSS office

LTSS is a division of the South Dakota Department of Human Services that's responsible for providing access to home and community-based care, such as assisted living and in-home services. Specialists are available to help residents apply for long-term care assistance via Medicaid at regional offices throughout the state.

Does Medicare Cover Assisted Living in South Dakota?

The short answer is that no, Medicare does not cover the cost of assisted living in South Dakota. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in South Dakota.

Other Financial Assistance Options for Assisted Living in South Dakota

Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.

How to Apply

How It Works

Aid and Attendance

Learn more and apply online at

Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.

Reverse Mortgages

Learn more about your options and how to apply at

If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.

Long-Term Care (LTC) Insurance

Learn more about Long-Term Care Insurance and how to apply for a policy at

Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in South Dakota

There are many helpful resources and services available for the elderly and people with disabilities in South Dakota. The following agencies and organizations provide free and low-cost services ranging from individualized counseling to determine long-term care options, in-home care and meal delivery, assistive technology and help qualifying for assisted living coverage.

Program Name

Contact Information

Services Available

Call 1-833-663-9673 or visit the website to find services

Dakota at Home is the designated Aging and Disability Resource Center for South Dakota. Help with many aging-related concerns is available at no cost for seniors aged 60+, people with disabilities and caregivers. In particular, staff can help develop a plan for current and future care needs with a focus on independence as well as safety.

Call 211 to speak with an operator or browse for services on the website

South Dakota 211 is a free helpline that's available 24/7 by phone and online. Operators can answer questions, make referrals and guide callers to the most appropriate local services, such as financial assistance and housing programs, health care, support groups, legal assistance and various in-home supports for seniors.

Call (605) 773-3269 with general inquiries or visit the website to find a local VSO

Veterans and their eligible dependents are served by Veterans Service Officers in each county of South Dakota. VSOs may be able to help secure additional payments from the federal VA, such as the Aid and Attendance program, which can then be used to pay for care in assisted living or other long-term care needs. Elderly veterans can also find information and get help applying for state and local assistance programs unrelated to the VA.

Apply online or call the Sioux Falls office at (605) 301-8060 or visit the website for other office locations

DPLS provides free legal services to low-income residents and anyone aged 60+ regardless of income. This nonprofit law firm has eight offices throughout South Dakota and its staff has experience dealing with issues including access to public benefits, advanced health care directives, wills and estates, housing and family law issues.

Call 1-866-854-5465 or visit the website for regional offices and contacts

The LTC Ombudsman program provides advocacy and mediation services at no cost to residents of assisted living and similar facilities, as well as anyone acting on their behalf. Ombudsmen work with government agencies, legal, social and medical service providers as needed to solve problems reported by residents and all reports are kept confidential.

COVID-19 Rules for Assisted Living in South Dakota

The following information is based on research done on several government websites, including and These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 4/25/22, 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.

Visitation Policies

Rules for South Dakota Communities

Are loved ones allowed to visit to provide emotional support?

Yes (Conditions Apply)

Are relatives allowed to visit for end-of-life care?


Are residents required to quarantine after visiting with a loved one?


Are visitors required to wear PPE (including masks) in order to visit residents?


Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?


Are visitors checked for elevated temperatures?


Are visitors required to answer questions about health, travel, and potential virus contact?


Outings & Social Activities

Rules for South Dakota Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?


Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?


Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for Arizona Communities

Are staff members regularly required to do a temperature check?


Are staff members regularly tested for COVID-19?


Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?


Are residents regularly screened for COVID-19 symptoms?


Are residents regularly checked for elevated temperatures?


Are residents regularly tested for COVID-19?


Assisted Living Laws and Regulations in South Dakota

The South Dakota Department of Health and specifically the Office of Health Facilities Licensure and Certification are tasked with licensing and inspecting assisted living and other health care facilities. The applicable state regulations must be followed by all facilities, and those that accept Medicaid and/or Medicare must also meet federal standards.


Assisted Living Service Plan Requirements

The nursing staff at assisted living facilities is responsible for providing safe and effective care for residents based on their initial assessment and a service plan that's updated regularly. This plan must include a breakdown of costs for services such as those addressing physical, mental and social needs. Management of symptoms such as pain must also be noted in the service plan.

Assisted Living Admission Requirements

Although each facility is responsible for setting its own admission requirements, it's prohibited to accept or retain a resident who needs a certain type or amount of care that can't reasonably be provided. Any facility that provides specialized services, such as Alzheimer's care, must meet additional licensing requirements relevant to those services before admitting such residents.

Assisted Living Scope of Care

Residents are provided assistance with activities of daily living, such as mobility, hygiene and dressing, as well as all meals, supervision and security. Residents must not have unstable medical conditions that require frequent nursing care.

Assisted Living Medicaid Policy

As mentioned previously in this guide, the state Medicaid program and HOPE Waiver program cover the cost of assisted living services for eligible residents and limit the amount each facility can charge for room and board. As of 2022, assisted living facilities can't charge waiver recipients more than $693 per month for room and board.

Assisted Living Facility Requirements

The capacity of each assisted living facility is determined by the Department of Health based on the physical space available and other provisions, such as resident access to bathrooms. Each living unit or bedroom must house a maximum of two people. Assisted living regulations also cover aspects such as lighting, ventilation, pest control and security.

Medication Management Regulations

The acquisition, storage, usage and disposal of all medication must be strictly controlled, with written policies and procedures available for appropriate personnel. Medication must be prescribed by qualified individuals, such as a physician or nurse practitioner, and monthly reviews of resident medication usage must be handled by a pharmacist. Residents can self-administer medications if deemed appropriate.

Staffing Requirements

South Dakota regulations state that assisted living facilities must have “adequate staff” on duty based on the number of residents as well as the amount and type of care services. The staff must be appropriately licensed and/or certified to provide applicable services.

Staff Training Requirements

All new employees must participate in an orientation program within 30 days of hire and receive ongoing education each year. The subjects must include fire prevention, safety and emergency procedures, resident rights, nutrition/hydration needs and handling of claims of abuse or neglect.

Background Checks for Assisted Living

Employees of assisted living facilities aren't required by law to submit to a background check, although many facilities do make it a requirement. The regulations simply state that the administration must not knowingly allow anyone convicted of a crime of abuse to work in the facility.

Requirements for Reporting Abuse

All personnel are required to report abuse, as defined in regulations, which includes any intentional act resulting in harm, pain, fear or mental anguish. Theft of money or property is also classified as abuse. Residents and the general public can report abuse and other issues to the Complaint Coordinator at the South Dakota DOH.

Frequently Asked Questions

How Many Assisted Living Facilities Are in South Dakota?

There are 180 assisted living facilities in South Dakota. These facilities provide seniors with a safe place to retire and assistance with activities of daily living while still allowing them to maintain independence. In South Dakota, the median monthly cost for assisted living is $3,350, which is more than $1,000 less than the U.S. national median cost of $4,500 per month, according to the 2021 Genworth Cost of Care Survey. The cost will vary based on the specific community, location within South Dakota, room type and amenities. Read More

Who Qualifies for Assisted Living Financial Assistance in South Dakota?

South Dakota residents may qualify for assisted living financial assistance with the state’s Medicaid waiver. The Home & Community-Based Options and Person Centered Excellence (HOPE) waiver provides seniors with assistance paying for services provided by an assisted living community, but it does not pay for room and board. This program also provides financial assistance to elderly or disabled individuals for help with activities of daily living and instrumental activities of daily living. Read More