Every answer was written and checked ahead of time, with the official document next to it. Nothing is made up on the spot.
Do I need a license to run a non-medical home care agency in South Dakota?
Not a Department of Health license, according to DHS's enrollment chart.
DHS's LTSS enrollment chart (effective May 1, 2026) marks Department of Health licensure "NO" for in-home homemaker, personal care, nursing, adult companion and chore services, and for respite. To be paid by Medicaid or LTSS, you need an LTSS contract (Purchase of Services Agreement), an onsite review and Medicaid enrollment. Assisted living centers and community living homes do need a Department of Health license. The chart is about LTSS enrollment. The licensing law's definitions (SDCL 34-12-1.1) don't name in-home care agencies, but we hold only the definitions, not the section that requires a license, so we can't confirm the answer for an agency that takes only private-pay clients.
Sources (4)
Written and checked September 23, 2026
How do I become an in-home provider for the HOPE Waiver?
Enroll with DHS LTSS first, then with Medicaid.
Submit the LTSS HCBS Provider Enrollment Request. Depending on the service, LTSS visits your office unannounced within 10 business days, then sends a self-assessment due within 30 calendar days. After approval, you send a W-9 and insurance certificates, sign the LTSS contract, enroll with South Dakota Medicaid, and get a Therap account. If you are denied, you must wait 90 days to reapply.
Sources (2)
Written and checked September 23, 2026
Which EVV system do South Dakota providers use?
Therap, free, or an approved alternative.
South Dakota uses an open vendor model. LTSS offers Therap free for HOPE Waiver and State Plan personal care; to use another system you must get approval on the alternative-system form. Medicaid offers Therap free for home health and private duty nursing; another system is at your cost and must connect to the Therap Aggregator. ADLS and Family Support 360 use FOCOS.
Sources (2)
Written and checked September 23, 2026
Do live-in caregivers have to use EVV in South Dakota?
Yes.
The EVV manual says EVV applies to the services and codes it lists when the caregiver and the recipient live together.
Written and checked September 23, 2026
How many hours of personal care will Medicaid pay for?
Up to 500 hours a plan year.
Agency personal care (homemaker, personal care and nursing combined) is limited to 500 hours a plan year, July 1 to June 30. The limit does not apply to recipients age 20 or younger. If a recipient who is eligible for a waiver has an assessed need for more, more units may be authorized under that waiver. Dakota at Home (1-833-663-9673) can help.
Sources (2)
Written and checked September 23, 2026
Can family members be paid to provide care?
Not for Medicaid personal care or home health, with one HOPE Waiver exception.
Personal care cannot be provided by a legally responsible person (a parent of a minor child, or a spouse), and the person giving it must not be a member of the recipient's family. Medicaid does not cover charges by immediate relatives or household members. For private duty nursing, Medicaid told agencies in April 2025 to make other staffing arrangements; the manual now points to a Temporary Exemption form. The exception is the HOPE Waiver's structured family caregiving service: a related family member or "fictive kin" (someone with an emotionally significant relationship to the participant) can be the principal caregiver the participant lives with, and gets a stipend (at least 50% of the daily rate) through a structured family caregiving agency.
Sources (6)
Written and checked September 23, 2026
What does South Dakota Medicaid pay for personal care?
$11.17 per 15 minutes, from July 1, 2026.
The same rate applies to homemaker. Nursing is $23.20 (RN) or $19.34 (LPN) per 15 minutes. You are paid the lower of your usual and customary charge or the fee schedule rate. The HOPE Waiver pays the same in-home rates and $10.81 for companion, chore and respite.
Sources (3)
Written and checked September 23, 2026
How long do I have to file a Medicaid claim?
6 months following the month of service.
ARSD 67:16:35:04 says Medicaid must receive the claim within 6 months following the month the services were provided. For example, January services must be received by the end of July. The limit can be waived in a few cases, such as an adjustment or void received within 3 months after the paid claim, a claim received within 3 months after a denial, or a claim within 6 months after retroactive eligibility granted on appeal.
Sources (2)
Written and checked September 23, 2026
Are there Medicaid health plans in South Dakota?
None that our documents mention.
Home care claims go to South Dakota Medicaid, and HOPE Waiver claims can go through Therap or the Medicaid Portal, paid from state fee schedules. Some recipients are in care management programs (Primary Care Provider, Care Connect and BabyReady), which can affect referrals. A 2026 law (House Bill 1006) set up a task force to study an Indian Medicaid managed care model; it reports by December 1, 2028.
Sources (4)
Written and checked September 23, 2026
What do I have to do if I sell my agency?
Give LTSS 30 days' written notice.
The seller must notify DHS LTSS in writing at least 30 days before the sale takes effect. The buyer files a new LTSS enrollment request with proof of the ownership transfer and updated business, insurance and license details. A new NPI means a new Therap account.
Written and checked September 23, 2026