South Dakota Medicaid Long Term Care Eligibility for 2025

South Dakota Long Term Care

South Dakota is an income cap state, meaning that to qualify for Medicaid long-term care benefits, applicants must meet a hard income limit. Unlike non-income cap states, South Dakota requires income to be under the limit at the time of application rather than allowing spend-downs to qualify.

Eligibility for 2025:

1. Residency and Citizenship – Applicants must be South Dakota residents and U.S. citizens or have proper immigration status.

2. Age/Disability – Applicants must be 65 years or older, blind, or disabled, and meet medical requirements consistent with the requested level of care. Applicants must need care for thirty (30) consecutive days.

3. Income Limitations – A single applicant’s monthly income must not exceed 300% of the Federal Benefit Rate (FBR), which is $3,021 in 2025. Income above this limit can be placed into a Qualified Income Trust to establish eligibility. South Dakota also allows a personal needs allowance of $65/month, which is excluded from countable income.

4. Asset Limitations – Assets are divided into two categories: Exempt and Available. Non-exempt assets must be liquidated to cover care costs before Medicaid eligibility is granted. South Dakota enforces a 5-year look-back period to prevent transfers of assets below market value or as gifts.

Exempt Assets in 2025 for an applicant in South Dakota include:

$2,000 or less in cash or non-exempt assets for single applicants.
One home, with an equity limit of $788,000, if the applicant plans to return or if a spouse, child under 21, or disabled dependent resides there. Proceeds from a home sale are countable assets.
One automobile, with no equity limit specified.
Irrevocable burial trust, with no limit specified.
Non-saleable property, household furnishings, clothing, and personal effects.

Spousal Rules for 2025:

Community Spouse Asset Allowance: The community spouse may retain up to $152,020 in non-exempt assets. If their assets are below $30,027, additional resources may be transferred from the institutionalized spouse.

Community Spouse Income Protection: A community spouse may retain a portion of the institutionalized spouse’s income if their monthly income is below $2,389. The maximum monthly income a community spouse may retain is $3,898.50, depending on unique living expenses.

South Dakota Long Term Care Insurance Partnership in 2025:

This partnership between the state and private insurers protects assets on a dollar-for-dollar basis. For example, a policy with a maximum payout of $165,000 exempts $165,000 in assets. Each spouse must purchase individual policies to qualify.