How to start an assisted living facility in South Dakota
South Dakota requires a Assisted living center license, with special approvals for services such as medication administration and care of cognitively impaired residents from South Dakota Department of Health, Office of Health Facilities Licensure and Certification to operate an assisted living facility.
- License required
- YesAssisted living center license, with special approvals for services such as medication administration and care of cognitively impaired residents
- Application fee
- —
- Processing time
- —
- Companion care
- $10.81per 15 min · $43.24/hr
- Organizations in the state
- 208NPPES, Sep 13, 2026
On this page
South Dakota assisted living facility license
South Dakota requires a Assisted living center license, with special approvals for services such as medication administration and care of cognitively impaired residents from South Dakota Department of Health, Office of Health Facilities Licensure and Certification to operate an assisted living facility.
- License required
- Yes
- License
- Assisted living center license, with special approvals for services such as medication administration and care of cognitively impaired residents
- Issuing agency
- South Dakota Department of Health, Office of Health Facilities Licensure and Certification
- Medicaid waiver coverage
- HHS's 2015 compendium reported that South Dakota's Medicaid 1915(c) waiver covers services in assisted living centers. SD DHS now publishes assisted living provider provisions for its LTSS programs.
- Regulation
- ARSD 44:70 (Assisted Living Centers)
Enrolling as a South Dakota Medicaid provider
- Program
- South Dakota Medicaid (Department of Social Services, Division of Medical Services)
- Enrollment portal
- South Dakota Medicaid Provider Enrollment (PE) Portal
- Application fee
- SD Medicaid's enrollment page says no application fee is charged. (Federal rule 42 CFR 455.460 allows the fee; CMS set it at $750 for 2026.)
- Fingerprinting
- Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The SD DSS enrollment page we could reach does not describe a separate state fingerprint process (its maintenance/revalidation page returned an error).
- Site visit
- Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. The SD DSS enrollment page we could reach does not describe a separate state site visit process.
- Revalidation
- Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. SD Medicaid ran a portal-wide revalidation when the PE Portal launched in 2021 (due June 7, 2021). Records that could not be revalidated were terminated, and existing providers did not have to re-sign provider agreements.
Does South Dakota require a certificate of need?
- CON program
- No
- Moratoria
- A nursing facility bed moratorium dates to 1988 and was extended indefinitely in 2005 (SDCL 34-12-35.4). The Department of Health may let a facility add beds or approve a new nursing facility only by redistributing beds from closed facilities or voluntarily surrendered beds, so the statewide total cannot exceed the 2005 level. Redistribution runs through periodic requests for proposals (held most years from 2013 to 2025), and the department reports annually to the Legislature on the need for more beds (SB 6, 2017).
South Dakota wage floor
- State minimum wage
- $11.85 an hour
- Effective
- 2026-01-01
- Scheduled increases
- Adjusted each January 1 by CPI; the state publishes the new rate by October 15. The 2027 rate was not yet found.
- HCBS 80/20 rule
- Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.
South Dakota market size
Counts from federal public files: NPPES (active organization NPIs), CMS Care Compare and CMS Medicaid enrollment.
- Assisted living facilities — active organization NPIs (NPPES)
- 208 (as of Sep 13, 2026)
- Total Medicaid and CHIP enrollment (latest reported month)
- 138,321 (as of Jun 1, 2026)
What South Dakota Medicaid pays
Home care & personal care: published South Dakota fee-for-service rates, each linked to its source.
| Service | Code | South Dakota rate | Per hour | Rank |
|---|---|---|---|---|
| Companion careAide or attendant | S5135 | $10.81per 15 min | $43.24 | 2 of 20 |
| Respite care (hourly)Agency provider | T1005 | $10.81per 15 min | $43.24 | 3 of 38 |
| Respite care (daily)Agency provider | S5150 | $302.16per day | — | 14 of 34 |
| Adult day servicesClinical nurse specialist | S5100 | $3.77per 15 min | $15.08 | — |
South Dakota HCBS waivers
Medicaid home and community-based services programs that may pay for this service.
- SD Assistive Daily Living Services Waiver (1915(c))
- SD CHOICES Waiver (1915(c))
- SD Family Support 360 Waiver (1915(c))
- SD Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver (1915(c))
Frequently asked questions
Do you need a license to start an assisted living facility in South Dakota?
South Dakota requires a Assisted living center license, with special approvals for services such as medication administration and care of cognitively impaired residents from South Dakota Department of Health, Office of Health Facilities Licensure and Certification to operate an assisted living facility.
Does South Dakota require a certificate of need for an assisted living facility?
No. South Dakota has no certificate of need program.
How do you become a Medicaid provider in South Dakota?
Enroll through South Dakota Medicaid Provider Enrollment (PE) Portal (https://dss.sd.gov/medicaid/providers/enrollment/enrollment.aspx).
What does South Dakota Medicaid pay a assisted living facility?
South Dakota Medicaid pays $10.81 per 15 min for companion care, effective Jul 1, 2026, ranking 2 of 20 states.