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South Dakota Cost of Care

What long-term care actually costs in South Dakota in 2025–2026 — nursing facility care, memory care, assisted living, independent living, home health care, and Lifecare/CCRC — sourced from the CareScout 2025 Cost of Care Survey and the A Place for Mom 2026 report.

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State financial aid available for South Dakota cost of care

HOPE Waiver (Home and Community-Based Options and Person-Centered Excellence)·Contact Dakota at Home
LTSS State-Funded KIND Program·Contact Dakota at Home

* Medicare, Medicaid Eligibility Limits & Requirements

Medicare — Nursing Facility: Requires a qualifying inpatient hospital stay of at least 3 days AND a doctor-certified daily need for skilled nursing or rehabilitation care. Medicare does not pay for custodial-only nursing home stays, and coverage ends entirely after 100 days per benefit period.
Medicare — Home Health Care: Requires the patient to be doctor-certified as “homebound” and to need intermittent skilled nursing or therapy from a Medicare-certified home health agency. Ongoing non-skilled custodial help (bathing, meals, housekeeping) alone does not qualify.
Medicaid — all care types: Requires meeting South Dakota's own Medicaid income and asset limits plus a functional (level-of-care) need determination. Nursing facility Medicaid is an entitlement once eligible; assisted living, memory care, and home health Medicaid coverage is typically delivered through a Home and Community-Based Services (HCBS) waiver, which can carry its own enrollment cap and waiting list.

Assisted living and memory care have no Medicare eligibility pathway to list here — see the estimated percentage of cost each program pays in the table below.

Last updated: August 21, 2026 Jurisdiction: South Dakota

How to read this page: Two different, independently published surveys are cited here, and they are never averaged together. CareScout's 2025 Cost of Care Survey reports facility/agency list rates. The A Place for Mom, Cost of Long-Term Care & Senior Living Report (2026 edition; 2025 move-in data) reports actual 2025 move-in-based medians, which run lower in many markets because they reflect what people actually pay, not published rate cards. Figures reported monthly are also shown ×12 as an "equivalent annual" figure purely for comparison against the annual CareScout figures — that computed figure is labeled as such and is not itself a published annual rate.

What Medicare, Medicaid & State Aid Pay

Medicare's rules are federally uniform and identical in every state. South Dakota's Medicaid program sets its own nursing-facility rate and Home and Community-Based Services (HCBS) waiver coverage, which can differ sharply from other states. The figures below are what each program pays once a resident meets every eligibility requirement for that program (marked with an asterisk) — not South Dakota's full cost of care shown elsewhere on this page.

What Medicare, South Dakota Medicaid, and other state financial assistance pay toward each type of long-term care, once eligibility requirements are met
Care Type	Medicare Pays*	South Dakota Medicaid Pays*	State Financial Assistance
Nursing Facility	Days 1–20: $0 — Days 21–100: pay $217/day — Day 101+: $0 paid ^* Estimated ~27% of South Dakota's $113,333/year cost (100 of 365 days) — a days-covered ceiling; the actual dollar share is lower once the day 21–100 coinsurance is subtracted. (source)	Estimated $164.13–$334.41/day (effective 7/1/2025) ^* South Dakota Medicaid nursing facility rates. (source)	LTSS State-Funded KIND Program Eligibility and covered settings vary by program — may not apply to every care type at left. See this state's full financial-aid summary above for details.
Assisted Living	$0 toward room, board, or personal care Estimated 0% of South Dakota's $4,740/month cost — Medicare pays none of the residency. (source)	Estimated $82.08–$108.61/day by tier ^* HOPE Waiver assisted living (services only). (source)	LTSS State-Funded KIND Program Eligibility and covered settings vary by program — may not apply to every care type at left. See this state's full financial-aid summary above for details.
Memory Care	$0 toward room, board, or custodial dementia care Estimated 0% of South Dakota's $5,545/month cost — Medicare pays none of the residency. (source)	Covered ^* — no statewide dollar figure published No dedicated dementia rate line; dementia residents fall under AL Tier 1/Tier 2. (source)	LTSS State-Funded KIND Program Eligibility and covered settings vary by program — may not apply to every care type at left. See this state's full financial-aid summary above for details.
Home Health Care	$0 for covered skilled home health visits ^* (source)	Estimated $44.68/hour (in-home personal care) ^* HOPE Waiver. (source)	LTSS State-Funded KIND Program Eligibility and covered settings vary by program — may not apply to every care type at left. See this state's full financial-aid summary above for details.

Nursing Facility Care

Annual cost of skilled nursing / nursing home care in South Dakota, per CareScout's 2025 survey.

South Dakota nursing facility care, annual cost, 2025 (CareScout)
Room Type	South Dakota (Annual)	National Median (Annual)
Semi-Private Room	$113,333	$114,975
Private Room	$122,275	$129,575

Facility supply & occupancy: As of 2025, South Dakota has 96 CMS-certified nursing facilities, running at an average 83% occupancy (national: 14,742 facilities, 79% occupancy). Higher occupancy can mean fewer open beds and longer waits, especially for Medicaid-pending residents. Source: KFF State Health Facts, based on CMS certified nursing facility data.

Capacity pressure, 2025–2033: This is a bed-demand model, not a verified occupancy-rate forecast — no source we could verify publishes an actual projected occupancy percentage by state for future years. Using each state's existing ratio of occupied beds to its 65+ population and Census-based population projections, Kieslich Analytics, US Nursing Bed Demand Analysis (March 2025) estimates South Dakota will need 1,313 more occupied nursing-facility beds by 2033 just to keep pace with population aging at its current bed-to-population ratio. That would require 348 additional certified beds on top of today's supply. South Dakota's 2024 occupancy in that same dataset was 83.4% (5,804 certified beds, 4,839 occupied) — in a moderate range (75–84% occupied), which shapes how much of that added demand shows up as tighter availability versus filling already-open beds. A second, more aggressive scenario in the same report (bringing every below-average state up to the national average bed-to-population ratio) would require 1,313 more occupied beds in South Dakota. Treat both figures as a modeled projection based on population trends and current capacity, not a guarantee.

Why Medicaid and private-pay rates differ (national context): Nationally, state Medicaid programs pay nursing facilities well below what private-pay residents are charged for comparable care. AHCA/NCAL puts typical Medicaid payment rates at 70–80% of private-pay prices, and a federal HHS/ASPE analysis found the median facility's Medicaid payment covers roughly 82 cents per dollar of its actual cost of caring for Medicaid residents. Facilities commonly offset that shortfall by charging private-pay and Medicare residents more — a pattern researchers call "cost-shifting"; one frequently cited study found a statistically significant correlation (r = 0.753) between how much a facility relies on private-pay revenue and the size of the Medicaid/Medicare shortfall it is covering. How wide this gap runs varies by state: MACPAC found state Medicaid base payment rates range from 62% to 182% of the national average after adjusting for local wages and resident acuity. South Dakota's own published Medicaid nursing-facility rate is shown in the “What Medicare, Medicaid & State Aid Pay” table below — compare it against South Dakota's private-pay rate in the table above to see where this state's own gap falls; a precise state-specific ratio isn't shown here because the two surveys use different methodologies (a facility list-rate survey vs. a state case-mix-adjusted Medicaid per-diem) and dividing one by the other would overstate precision the underlying data doesn't support.

Assisted Living

Assisted living pricing varies not just by state but by level of supportive care (a private studio with minimal help vs. a shared room with daily medication management and mobility assistance), and no state-level public survey breaks pricing out by care level — individual facility quotes do that, and vary by provider. What the two national surveys below do capture consistently is the difference between a facility's list rate and what residents in South Dakota actually paid on move-in in 2025.

South Dakota assisted living, CareScout 2025 facility list rate
Methodology	South Dakota (Annual)	National Median (Annual)
CareScout facility rate	$58,800	$74,400

South Dakota assisted living, A Place for Mom 2025 actual move-in median
Methodology	South Dakota (Monthly)	National Median (Monthly)
APFM move-in-based median	$4,740/mo (≈ $56,880/yr equivalent)	$5,419/mo

Facility supply & occupancy (national context): Unlike nursing facilities, assisted living communities are licensed individually by each state rather than federally certified, so there is no single standardized facility count comparable across all 50 states and DC the way there is for nursing homes — published state-by-state counts vary by tens of percent depending on which registry or survey compiled them. What is consistently tracked nationally: the U.S. has roughly 41,465 licensed assisted living communities with nearly 1.4 million beds (AHCA/NCAL), and occupancy has been climbing as new construction stalls — averaging 88.4% in the second quarter of 2026 across the major markets NIC MAP tracks (National Investment Center for Seniors Housing & Care). Treat this as a national backdrop, not a South Dakota-specific figure — check with South Dakota's licensing agency (see the eligibility notes above) for a facility count specific to this state.

Memory Care

Dedicated memory care (dementia/Alzheimer's-specific) monthly median, South Dakota vs. national, per A Place for Mom's 2026 report (2025 move-in data).

South Dakota memory care, monthly, 2025 (A Place for Mom)
Care Type	South Dakota (Monthly)	National Median (Monthly)
Memory care (APFM 2025 median)	$5,545/mo (≈ $66,540/yr equivalent)	$6,690/mo

Facility supply & occupancy: Memory care is rarely licensed as its own facility category — in most states, including South Dakota (see the eligibility notes above for how this state's Medicaid program treats it), it is an add-on endorsement layered onto an existing assisted living or nursing facility license rather than a separately counted, separately licensed building type. That means there is no reliable standalone national or state-by-state memory-care facility count or occupancy rate to report here the way there is for nursing facilities. Industry trackers such as the National Investment Center for Seniors Housing & Care (NIC) follow memory-care performance mainly within continuing care retirement communities (CCRC) and major metro markets rather than as a standalone nationwide occupancy figure.

Independent Living

Independent living communities provide housing, meals, and activities with little or no hands-on care. Monthly median, South Dakota vs. national.

South Dakota independent living, monthly, 2025 (A Place for Mom)
Care Type	South Dakota (Monthly)	National Median (Monthly)
Independent living (APFM 2025 median)	$3,288/mo (≈ $39,456/yr equivalent)	$3,200/mo

Home Health Care: Professional vs. Personal Care

"Personal" (non-medical) caregivers help with bathing, dressing, meals, and companionship. "Professional" home care — a private-duty licensed nurse — costs substantially more and covers skilled medical tasks. Both are shown below at CareScout's 2025 annualized rate for a typical weekly schedule, alongside A Place for Mom's blended hourly starting rate.

South Dakota home health care, personal vs. professional, annual, 2025 (CareScout)
Care Type	South Dakota (Annual)	National Median (Annual)
Personal / non-medical caregiver (CareScout, annual)	$101,244	$80,080
Professional / private-duty nurse (CareScout, annual)	$4,778	$4,680

South Dakota blended home care starting hourly rate, 2025 (A Place for Mom)
Rate	South Dakota	National
Blended home care starting rate (APFM, hourly)	$44/hr	$34/hr

Related: Adult Day Health Care

A lower-cost daytime alternative to in-home or residential care, typically used to supplement family caregiving.

South Dakota adult day health care, annual, 2025 (CareScout)
Care Type	South Dakota (Annual)	National Median (Annual)
Adult day health care (CareScout, annual)	Not reported in the source data	$24,700

Lifecare & Continuing Care Retirement Communities (CCRC)

A Continuing Care Retirement Community (also called a Life Care community) is a single campus offering independent living, assisted living, and nursing care, designed so a resident can move between levels of care as needs change without having to move to a different community. Most CCRCs are funded through a large upfront entrance fee plus an ongoing monthly fee — not Medicare, Medicaid, or long-term care insurance directly, although insurance and VA benefits can help offset the monthly fee once a resident needs a higher level of care.

National entrance-fee & monthly-fee figures

CCRC entrance fees and monthly fees are not published on a state-by-state basis by any survey we could verify — contract type, unit size, and specific community matter far more than which state a CCRC is in. The figures below are national, not South Dakota-specific, and are shown alongside South Dakota's own CCRC regulatory framework, which is state-specific.

CCRCs (also called Life Care communities) charge a large upfront entrance fee plus an ongoing monthly fee, in exchange for guaranteed access to a continuum of care — independent living through nursing care — often at little or no increase in monthly cost as a resident's needs increase. No single national number captures this well, since the fee depends heavily on contract type, unit size, and location. Two dated snapshots below show the structure and the current market average; neither is a state-specific figure, since entrance-fee data is not broken out by state in either source.

Entrance-fee ranges by CCRC contract type (2009 fee data from eight selected CCRCs, GAO-10-611, June 2010) — historical context on how CCRC contracts are structured, not a current-year price quote.
Contract Type	Reported Entrance-Fee Range	What's Included
Type A — Life Care / Extensive	$160,000–$600,000	Housing, residential services, amenities, and unlimited use of health care services as residents move from independent living to assisted living or nursing care, at little or no increase in monthly fees.
Type B — Modified	$80,000–$750,000	Same housing and residential amenities as Type A, but only some health care services are included in the initial monthly fee; additional care can be charged at market or discounted rates.
Type C — Fee-for-Service	$100,000–$500,000	Same housing, residential services, and amenities as Types A and B, but residents pay market rates for health-related services as needed.
Type D — Rental	$1,800–$30,000	Generally requires no large entrance fee; guarantees access to CCRC services and health care on an essentially pay-as-you-go basis.

Current national CCRC entrance-fee and monthly-fee averages (National Investment Center for Seniors Housing & Care data, end of 2024, as reported by Where You Live Matters).
Figure	National Average	Notes
Average entrance fee (entrance-fee model)	$300,000	Typical range $50,000–$500,000, higher in high-cost urban areas
Average monthly fee — entrance-fee model	$4,166	Independent-living level, asking rate
Average monthly fee — rental model	$3,747	Independent-living level, asking rate; rental CCRCs run higher than entrance-fee CCRCs at the assisted living, memory care, and nursing care levels

South Dakota's CCRC regulatory framework

South Dakota has a CCRC-specific statutory framework: S.D. Codified Laws secs. 34-12-40 to 34-12-47 (continuing care agreements and continuing care retirement communities), with escrow oversight by the Director of the South Dakota Division of Insurance; facility licensing by the South Dakota Department of Health under SDCL ch. 34-12.

South Dakota defines a 'continuing care agreement' and 'continuing care retirement community' in SDCL 34-12-40 and 34-12-41 and requires entrance-fee deposits to be escrowed, with a copy of the escrow agreement filed with the Director of the Division of Insurance and notice to the Director both when escrowed deposits reach the level required for construction to begin and when funds are released to the provider. The underlying health care facilities on the campus (nursing facilities, assisted living centers) must be licensed by the South Dakota Department of Health under SDCL ch. 34-12. These sections do not establish a separate CCRC license, ongoing actuarial reserve requirement, or state-approved disclosure statement, so South Dakota's framework is narrower than escrow-plus-reserve states.

A Hypothetical South Dakota Case Study

CASE STUDY

Meet Percival, a 72-year-old retired pharmacist in South Dakota. This is a hypothetical scenario built entirely from South Dakota's own 2025–2026 cost-of-care figures on this page, used to illustrate how a family's financial exposure can grow as care needs progress — it does not describe a real individual. At 72, Percival started dialysis and began needing help managing daily tasks, related to chronic kidney disease alongside declining cardiac function. Over the years that followed, his care needs moved through 3 stages:

Independent living community — ages 72–75 (3 years)

Chose an independent living community to stay social after retiring.

$39,456/year × 3 yr = $118,368
In-home personal care (within independent living) — ages 75–79 (4 years)

Arranged private in-home aides to supplement the community's non-medical services.

$101,244/year × 4 yr = $404,976
Skilled nursing facility (semi-private room) — ages 79–80 (1 year)

A hospitalization led directly to a long-term skilled nursing placement.

$113,333/year × 1 yr = $113,333

$636,677

Illustrative total cost of care across 8 years (ages 72–80), computed directly from the South Dakota figures shown elsewhere on this page. Actual costs depend on the specific provider, level of care, and region within South Dakota.

If the family's income and assets fell within program limits, South Dakota's HOPE Waiver (Home and Community-Based Options and Person-Centered Excellence) and/or LTSS State-Funded KIND Program could have offset some of the community-based or residential-care costs above — see the financial-aid summary at the top of this page for eligibility details and how to apply.

This case study is a hypothetical illustration created for educational purposes only. It does not describe any real person, and it is not a prediction, guarantee, or professional recommendation about any individual's future care needs, costs, or eligibility for financial assistance. Care progression, duration, and provider pricing vary widely by individual circumstances. Consult a qualified elder-law attorney, financial advisor, or benefits counselor for guidance specific to your situation.

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