Can I get paid to care for my spouse in South Dakota?
Yes — South Dakota lets a spouse be paid.
South Dakota is one of the states where the person who needs care can hire their own husband or wife and have the program pay for it. You do the caring you are already doing. The state pays you for it.
What has to be true
- Your spouse lives in South Dakota and needs long-term care help at home.
- Your spouse has Medicaid, or can qualify. We check that with you for free.
- You pass a background check. No license or certificate is needed.
- The care your spouse needs is written into their plan — that is what the hours are paid against.
What South Dakota pays family caregivers
$392/week
Your exact pay is set by the program and your care plan. We'll tell you your real number before you enroll.
Source: South Dakota Medicaid program data · Updated September 2026
What South Dakota's rule actually says
yes — spouses may serve as the paid SFC caregiver; caregiver and recipient must live in the same home
The programs this runs through in South Dakota: Structured Family Caregiving (HOPE Waiver). Who runs them: South Dakota Dept. of Human Services, Division of Long-Term Services & Supports (financial eligibility via Dept. of Social Services); Dakota at Home 833-663-9673
173,800 people in South Dakota are 65 or older. Most of them are cared for at home, by a relative — usually without being paid for it.
How to start in South Dakota
Call Dakota at Home at 833-663-9673 or your local DSS office; financial eligibility goes through DSS and the LTSS functional assessment through DHS at the same time.
yes — SFC is delivered through an approved SFC provider agency (e.g. Careforth) that pays the caregiver, though the caregiver is not an agency employee; live-in required
See if you qualify →Spouse questions in South Dakota, answered
Can I get paid to care for my husband or wife in South Dakota?
Yes. South Dakota allows it. The published rule: yes — spouses may serve as the paid SFC caregiver; caregiver and recipient must live in the same home
Why do some states allow this and others don't?
Medicaid has long treated care between spouses as a family duty rather than paid work. Self-directed programs changed that in many states by making the person who needs care the employer — they choose their own worker, and in some states that can be a spouse. It is a state-by-state policy choice, not a federal rule.
How much would I earn in South Dakota?
Reported pay in South Dakota runs around $392/week, though your exact rate is set by the program and the care plan.
Does my spouse need Medicaid first?
Yes. These are Medicaid programs, so your spouse has to qualify for South Dakota Medicaid and need long-term care help. Many families assume they earn too much and never apply. The rules for long-term care are not the same as regular Medicaid — check before you rule yourself out.
Is there a waitlist in South Dakota?
capped at ~3,704 beneficiaries/year; a waitlist can form
How do we start?
Call Dakota at Home at 833-663-9673 or your local DSS office; financial eligibility goes through DSS and the LTSS functional assessment through DHS at the same time.
Sources: medicaidplanningassistance.org · medicaidplanningassistance.org · dhs.sd.gov · Updated September 2026. Rules change — always confirm with the program.
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.
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