Updated September 4, 2026. Quick answer: yes, through Assistive Daily Living Services (ADLS) Waiver, Personal Attendant Services. Most adult family members can be hired and paid to provide the care. A spouse can also be the paid caregiver.
How South Dakota pays a family caregiver
| Program | Assistive Daily Living Services (ADLS) Waiver, Personal Attendant Services |
|---|---|
| Can a family member be paid? | Yes. “The waiver services are based upon participant direction. Participants utilizing personal attendant services recruit, screen, train, and direct their personal care attendants. The waiver encourages the employment of spouses, parents or adult children to provide these services.” |
| Can a spouse be paid? | Yes. “The waiver encourages the employment of spouses, parents or adult children to provide these services.” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
Not published by the state in the materials reviewed this session.
How it works
A participant enrolled in the ADLS waiver is the co-employer of their own personal care attendant: DHS-funded Consumer Preparation Services train the participant to recruit, interview, train, supervise, and schedule an attendant, who may be a spouse, parent, adult child, or other family member, while an Agency of Choice handles payroll, tax withholding, and new-hire paperwork. South Dakota also offers Structured Family Caregiving under the HOPE Waiver as a live-in stipend alternative. Claims are billed through the state’s FOCOS system, and current service unit rates are posted separately on the Department of Social Services website rather than in the policy manual itself.
What this doesn’t answer
The ADLS billing manual does not itself publish a dollar per-hour attendant rate; it only points participants to a separate DSS rate schedule that was not directly accessed this session. South Dakota’s Structured Family Caregiving option is documented in an official 2018 DHS guide that describes a daily stipend model but does not, in that document, state whether a spouse specifically may serve as the paid principal caregiver, so the Yes/Yes verdict here rests on the ADLS waiver language rather than on Structured Family Caregiving.
Sources
- South Dakota DSS: Medicaid Billing and Policy Manual, Assistive Daily Living Services (ADLS) Waiver, updated April 2025
- South Dakota DHS: Structured Family Caregiving Guide, December 2018
Read September 4, 2026.
Same question, other states: Tennessee · Texas.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.