Hospice Medicaid Rates in South Dakota (2026)

Hospice Medicaid rates in South Dakota are a study in balance. South Dakota Medicaid pays $186.33 a day for hospice routine home care on revenue code 651, which ranks 12th of 21 states and sits just 0.2% below the $186.66 national median. On the three higher-acuity levels of care, though, South Dakota moves into the top tier, ranking 4th of 16 for continuous home care and 4th of 18 for general inpatient care.

That shape is unusual. Most states that pay well on inpatient levels also pay well on routine home care, and most states that sit at the median do so across the board. South Dakota pays a median rate for ordinary days and an above-median rate for crisis and inpatient days, and it does so against one of the lowest nursing wage markets in the country. This page explains what that combination means for a hospice and how to plan around it.

All four South Dakota hospice rates are effective 2026-10-01 and billed on revenue codes, paid through South Dakota Medicaid (fee-for-service, DSS Division of Medical Services).

For a South Dakota hospice, the table says that routine care days pay what they pay in a typical state, while each continuous care hour or inpatient day pays more than typical. A hospice with the staff and contracts to deliver those higher levels of care captures more of the state's above-median rates.

South Dakota bills hospice on three-digit institutional revenue codes: 651 for routine home care, 652 for continuous home care, 655 for inpatient respite and 656 for general inpatient care.

Daily and hourly units

Routine home care, respite and general inpatient care are paid per day. The routine rate is the same whether the hospice team visits once that day or not at all. Continuous home care is paid by the hour and is compared at the registered nurse level, because it must be predominantly nursing care.

One payer schedule

All four rates come from the fee-for-service schedule. There is no separate plan rate for hospice in South Dakota, which keeps billing and reconciliation simple.

Routine home care covers most hospice days and drives most revenue. At $186.33, South Dakota pays what a typical state pays for an ordinary day of hospice at home.

A median rate makes cost control the deciding factor. The visit-heavy days after admission and before death cost far more to deliver than a quiet day in mid-stay, yet pay the same. In a rural state, travel is often the biggest hidden cost: long drives between patients cut the number of visits each nurse and aide can make, raising the cost of every routine day without changing its payment. Grouping patients by territory and scheduling around distance protects the routine margin more than any rate change could.

Continuous home care is paid by the hour when a patient in crisis needs predominantly nursing care at home. South Dakota's $71.92 an hour compares with a national median of $66.11 and a national range from $59.29 in West Virginia to $80.47 in Oregon.

Only three states pay more: Oregon, Washington at $77.54 and New Hampshire at $74.56. South Dakota sits ahead of Massachusetts at $70.00.

The rate makes crisis care at home financially viable. The challenge in South Dakota is logistics rather than payment: a crisis in a remote area can require a nurse to drive a long distance and stay for many hours. Hospices that keep a small on-call nursing pool for crisis care, rather than pulling staff from routine visits, use the strong hourly rate most effectively.

South Dakota's general inpatient rate of $1,231.51 a day is the fourth-highest in the country, behind Oregon ($1,354.60), New York ($1,299.97) and New Jersey ($1,253.17), and ahead of Massachusetts ($1,202.36). At the bottom of that table, Kansas pays $1,057.76, Missouri $1,048.85 and Arkansas $449.54.

Inpatient respite at $545.93 a day ranks 7th of 19, 3.0% above the $530.15 median. Oregon leads respite at $629.83, and Kansas ($496.74) and Missouri ($492.74) trail just above Arkansas ($212.93).

General inpatient care pays for short-term symptom management that cannot be done at home, typically in a hospital or contracted facility. A South Dakota hospice that can secure inpatient capacity is paid well for it. Because inpatient beds can be scarce outside the larger towns, the strong rate gives a hospice room to offer a facility a competitive daily price and still cover its own nursing oversight.

South Dakota's wage profile makes its higher-acuity rates more valuable. Federal occupational wage data for May 2025:

• Registered nurse: $37.53 in South Dakota, against a US median of $46.90.
• Home health / personal care aide: $18.15, against $17.21.
• Healthcare social worker: $27.65, against $32.63.
• Chaplain: $28.78, against $29.24.

Registered nurses earn well below the US median, while the continuous home care rate is well above it. At $71.92 an hour against a state median RN wage of $37.53, continuous care hours carry more room for travel, supervision and on-call coverage in South Dakota than in most states.

Aides are the one role paid above the US median. Since routine home care pays at the median, a hospice whose daily visit mix leans on aide hours will see less of the wage advantage on routine days than on nursing-heavy crisis care.

Our data names 4 plans in South Dakota Medicaid, and they are not conventional risk-based managed care plans. The list covers PRIME primary care case management providers under the South Dakota Medicaid Primary Care Program, Care Connect health home providers, BabyReady designated providers and Delta Dental of South Dakota as the dental vendor. South Dakota's managed care rules do not classify a hospice line, so hospice is billed through the fee-for-service schedule at the published rates.

For a hospice, that means one rate schedule and no plan contracts to negotiate for Medicaid hospice days. The South Dakota managed care page shows how each service line is paid.

Patients on the South Dakota HOPE Waiver, which serves older adults and adults with physical disabilities, may elect hospice. When they do, care has to be coordinated so that waiver services and hospice services do not duplicate each other. Personal care delivered by a waiver provider and aide visits delivered by the hospice can overlap if no one draws the line.

A practical approach is to agree in writing, at the time of election, which provider delivers which services, and to record that division in the hospice plan of care. That protects both providers' claims and gives the family a clear picture of who is coming and when.

On routine home care, South Dakota at $186.33 sits a long way below New York ($317.60) and the New England cluster led by Massachusetts ($231.13), and well above Arkansas ($80.36). It is effectively the median state.

On the other three levels it is a top-tier payer, appearing among the five highest states for both continuous home care and general inpatient care. For a hospice weighing markets, South Dakota pays ordinary days like a typical state and pays crisis and inpatient care like a high-rate one, against a below-median nursing wage bill.

The practical consequence is that South Dakota rewards capability. Two hospices with identical routine census will earn similar amounts here, but the one that can staff continuous care and place patients in inpatient beds when needed will earn noticeably more, because those are the levels where the state pays above the national norm.

1. Budget by level of care. Routine days set the base; continuous and inpatient days add the upside. Project each level separately rather than using one blended daily figure.
2. Build crisis capacity. The 4th-ranked hourly rate rewards a dedicated on-call nursing pool, and the below-median nurse wage makes that pool more affordable than in most states.
3. Secure inpatient beds early. Use the strong general inpatient rate to offer facilities a fair price, and negotiate respite beds in the same agreement.
4. Map travel costs. In rural territories, measure cost per routine day including drive time, and review territory boundaries when the census shifts.
5. Plan for October. Current rates took effect 2026-10-01; load the next schedule on its effective date and check the first remittances against it.

Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document. All four hospice rates come from South Dakota Medicaid's fee-for-service schedule effective 2026-10-01.

These hospice rates are part of all 41,546 current South Dakota Medicaid rates across 146 service categories. Compare all states on the hospice industry hub, see every code on the South Dakota Medicaid rates page, read our methodology for how hospice rates are ranked, and see pricing for full dataset access.