This page provides a plain-English summary of key elder care and estate planning information specific to South Dakota residents. It covers South Dakota Medicaid limits, estate tax rules, advance directive information, and links to important South Dakota agencies and resources.
Information on this page is updated periodically but laws and limits change frequently. Always verify current figures with the relevant agency or a licensed attorney.
South Dakota Medicaid — 2026 Eligibility Limits for Long Term Care
South Dakota’s Medicaid program is administered by the South Dakota Department of Social Services — DSS. South Dakota expanded Medicaid under the Affordable Care Act through a voter-approved initiative in 2022 providing coverage to adults up to 138 percent of the federal poverty level. Note that a Constitutional Amendment — Amendment I — is on the November 2026 ballot that would condition continued Medicaid expansion on federal funding remaining at 90 percent or above. Families should monitor this development.
Income limit — single applicant The income limit for a single South Dakota nursing home Medicaid applicant is $2,982 per month in 2026. South Dakota is an income cap state meaning applicants whose income exceeds this limit must establish a Qualified Income Trust — also called a Miller Trust or QIT — to qualify.
Asset limit — single applicant A single applicant must have $2,000 or less in countable assets. Exempt assets include the primary residence with equity up to $752,000 if the applicant intends to return home, one vehicle, personal belongings and household furnishings, irrevocable funeral trusts, and Medicaid-compliant annuities. Note that IRAs and 401(k)s are counted as countable assets in South Dakota.
Home and community based care — HOPE Waiver South Dakota’s primary HCBS program for seniors is the Home and Community Based Services — HOPE — Waiver which provides home and community based services for South Dakota residents who need nursing facility level care but want to remain at home. The asset limit is $2,000 for a single applicant and the income limit is $2,982 per month. Services include personal care homemaker services adult day services respite care assistive technology and home modifications.
South Dakota also offers a State Plan Personal Care Services program South Dakota’s State Plan Personal Care Services — PCS — program provides in-home personal care assistance for eligible Medicaid members who do not require nursing facility level of care. The PCS program does not trigger the 60-month look-back period making it more accessible for some applicants. The income limit for PCS is $1,491 per month for a single applicant — lower than the HOPE Waiver limit.
Unique Quadriplegia Waiver South Dakota maintains a specialized Medicaid waiver exclusively for people with quadriplegia who live independently in their own homes — one of only a few such state-specific programs in the country. Applicants must be aged 18 or older have quadriplegia meet the income and asset limits and require specialized in-home services that allow them to avoid nursing home placement. The income limit is $2,982 per month in 2026.
Married couples — one spouse applying When only one spouse applies for South Dakota Medicaid the community spouse — the spouse who remains at home — may retain 50 percent of the couple’s combined countable assets up to a maximum of $162,660. If 50 percent of the couple’s assets is less than $32,532 the community spouse may retain up to $32,532. The applicant spouse retains $2,000.
Monthly Maintenance Needs Allowance The minimum Monthly Maintenance Needs Allowance for the community spouse is $2,643.75 per month in 2026. The maximum is $4,066.50 per month for community spouses with high housing costs.
Personal needs allowance — lowest in the country South Dakota nursing home Medicaid recipients are allowed to keep only $30 per month as a personal needs allowance — the lowest personal needs allowance in the country. The remainder of income is applied toward the cost of care.
Look-back period and divestment penalty South Dakota has a 60-month — five year — look-back period for nursing home Medicaid and HOPE Waiver applications. The look-back period does not apply to the State Plan PCS program. Asset transfers made within 60 months of applying that were for less than fair market value may result in a penalty period of ineligibility. The 2026 divestment penalty divisor in South Dakota is based on the statewide average monthly cost of nursing facility care.
Estate recovery South Dakota requires Medicaid estate recovery. After a South Dakota Medicaid recipient dies the state seeks reimbursement from the estate for long term care costs paid. Planning with an elder law attorney can help protect assets from estate recovery.
How to apply for South Dakota Medicaid Applications can be submitted online through the South Dakota Medicaid portal at dss.sd.gov, by phone at 1-888-828-0059, or in person at your local South Dakota DSS office.
South Dakota Medicaid administering agency South Dakota Department of Social Services — dss.sd.gov
South Dakota Estate Tax — 2026
South Dakota is one of the most tax-friendly states in the country — ranking second on the Tax Foundation’s 2026 State Tax Competitiveness Index. South Dakota has no state income tax no estate tax no inheritance tax and its trust laws are among the most favorable in the world.
No South Dakota state estate tax South Dakota does not impose a state estate tax. No South Dakota estate tax applies to any estate regardless of size.
No South Dakota inheritance tax South Dakota voters repealed the state inheritance tax effective July 1 2001. South Dakota does not impose an inheritance tax. Beneficiaries who receive assets from a South Dakota decedent owe no South Dakota inheritance tax regardless of the size of the inheritance or their relationship to the deceased.
Federal estate tax South Dakota residents may be subject to the federal estate tax. The federal estate tax exemption is $15,000,000 per person in 2026 following enactment of the One Big Beautiful Bill Act. The exemption is portable between spouses meaning a married couple can protect up to $30,000,000 from federal estate tax with proper planning. The top federal estate tax rate is 40 percent on amounts above the exemption.
No South Dakota income tax South Dakota has no state income tax of any kind — no tax on wages salaries Social Security benefits pension income IRA distributions or any other personal income. This makes South Dakota one of only nine states with no income tax and one of the most attractive states in the country for retirees and high earners.
No South Dakota gift tax South Dakota does not impose a state gift tax. Federal gift tax rules apply — the annual gift tax exclusion is $19,000 per recipient in 2026.
South Dakota as a premier dynasty trust jurisdiction South Dakota has built itself into one of the world’s premier trust jurisdictions — attracting not just domestic high-net-worth individuals but also wealthy foreign families seeking to establish US-based trusts. Key features include perpetual dynasty trusts with no rule against perpetuities domestic asset protection trusts directed trusts quiet trusts decanting without court approval and no state income tax on trust income. South Dakota’s combination of no income tax no estate tax and pioneering trust legislation makes it a destination of choice for sophisticated estate planning structures across the country and around the world.
South Dakota property taxes South Dakota has a moderate effective property tax rate of approximately 1.10 percent. Property tax rates vary by county and municipality.
Step-up in basis Inherited assets in South Dakota receive a stepped-up tax basis to fair market value at the date of the original owner’s death. This can significantly reduce capital gains taxes when beneficiaries later sell inherited property including South Dakota farmland and ranchland.
South Dakota Advance Directives
South Dakota law recognizes the following advance directive documents:
South Dakota Durable Power of Attorney for Health Care Names a healthcare agent to make medical decisions on your behalf when you are unable to do so. Must be signed and witnessed by two adults or notarized.
South Dakota Living Will — Declaration Documents your wishes regarding life-sustaining treatment when you have a terminal condition or are in a persistent vegetative state. Must be signed and witnessed by two adults.
South Dakota POLST — Physician Orders for Life-Sustaining Treatment South Dakota uses a POLST form for seriously ill patients that documents specific medical orders regarding CPR hospitalization and artificial nutrition. Must be signed by a physician or nurse practitioner.
South Dakota Do Not Resuscitate Order A physician order directing emergency personnel not to perform CPR. South Dakota has standardized out-of-hospital DNR protocols.
South Dakota Advance Directive Registry South Dakota does not maintain a statewide advance directive registry. Copies of your advance directive should be given to your healthcare agent physician and any hospital or care facility where you receive care.
Free South Dakota advance directive forms Free South Dakota-specific advance directive forms are available at caringinfo.org and from the South Dakota State Medical Association at sdsma.org.
South Dakota Key Agencies and Resources
South Dakota Department of Social Services — DSS Administers South Dakota Medicaid including long term care programs. Website: dss.sd.gov Phone: 1-888-828-0059
South Dakota Division of Long Term Services and Supports — LTSS Coordinates programs and services for older South Dakotans including home care nutrition programs caregiver support and the South Dakota SHIINE program for free Medicare counseling. Website: dss.sd.gov/elderlyservices Phone: 1-605-773-3656 South Dakota SHIINE — free Medicare counseling: 1-800-536-8197
South Dakota Area Agencies on Aging South Dakota is served by Area Agencies on Aging that coordinate local services for older adults and caregivers. Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov
South Dakota Long Term Care Ombudsman Program Advocates for the rights of residents of nursing homes and assisted living facilities. Investigates complaints and helps resolve problems free of charge. Website: dss.sd.gov/elderlyservices/ombudsman Phone: 1-605-773-3656
State Bar of South Dakota Lawyer Referral Service Connects South Dakotans with attorneys including those who specialize in elder law and estate planning. Website: statebarofsouthdakota.com Phone: 1-605-224-7554
East River Legal Services and Dakota Plains Legal Services Provides free civil legal services to low income South Dakotans including seniors on issues related to Medicaid benefits housing and elder law. East River Legal Services: erlservices.org — 1-605-336-9230 Dakota Plains Legal Services: dakotaplains.org — 1-800-696-1520
South Dakota Veterans Resources
South Dakota Department of Veterans Affairs — SDDVA Provides services and benefits to South Dakota veterans and their families including free VA claims assistance and connections to South Dakota veterans resources. Website: vetaffairs.sd.gov Phone: 1-605-773-3269
South Dakota Veterans Homes South Dakota operates veterans homes providing long term care to eligible veterans and their spouses. Facilities are located in Hot Springs and Sioux Falls. Website: vetaffairs.sd.gov/veterans-homes
South Dakota Senior Property Tax Benefits
Sales and Property Tax Refund for Senior and Disabled Citizens South Dakota offers an annual refund on either sales taxes paid or property taxes paid — whichever is higher — for qualifying residents aged 65 and older or disabled individuals. To qualify residents must have lived in South Dakota for the full calendar year and meet income limits — $17,215 for a single person or $23,265 for a household in 2026. Apply through the South Dakota Department of Revenue.
Property Tax Freeze for Elderly and Disabled South Dakota homeowners aged 70 and older or disabled and meeting income requirements may qualify to have the assessed value of their home frozen for property tax purposes. Contact your county director of equalization for details.
Disabled Veteran Property Tax Exemption South Dakota veterans who are rated 100 percent service-connected disabled qualify for a property tax exemption on their primary residence. Apply through your county director of equalization.
Finding Elder Law and Estate Planning Attorneys in South Dakota
The following resources can help you find a qualified elder law or estate planning attorney in South Dakota:
- National Academy of Elder Law Attorneys — NAELA — naela.org — searchable directory by location
- State Bar of South Dakota Lawyer Referral Service — statebarofsouthdakota.com — 1-605-224-7554
- South Dakota Chapter of NAELA — South Dakota has an active NAELA chapter with members throughout the state
- East River Legal Services — erlservices.org — free legal assistance for income-qualifying seniors — 1-605-336-9230
The information on this page is for general informational purposes only and does not constitute legal or financial advice. South Dakota Medicaid rules and other figures change frequently. The November 2026 ballot measure regarding Medicaid expansion could affect eligibility for some South Dakotans. Always verify current information with the relevant agency or a licensed attorney. Laws vary and individual circumstances differ significantly.
Last updated: May 2026