Updated September 4, 2026. Quick answer: yes, through HOPE Waiver: Home and Community Based Options and Person-Centered Excellence (SD.0189). Medicaid does not pay the facility’s room and board either way; only the care and service component.
What South Dakota covers
| Waiver / state plan option | HOPE Waiver: Home and Community Based Options and Person-Centered Excellence (SD.0189) |
|---|---|
| Covers an assisted living setting? | Yes: “Assisted living is a covered service. Assisted living includes homemaker, personal care, chore, and meal preparation for participants who reside in a homelike, non-institutional setting that includes 24-hour on-site response capability to meet scheduled or unpredictable participant needs and to provide supervision, safety, and security.” |
| Room and board | Never covered by Medicaid, in South Dakota or any state; see below. |
The room-and-board split
Federal law is the floor every state builds on: “The Secretary may by waiver provide that a State plan approved under this subchapter may include as “medical assistance” under such plan payment for part or all of the cost of home or community-based services (other than room and board) approved by the Secretary” (42 U.S.C. §1396n(c)(1), Social Security Act §1915(c)). The words in parentheses do the work: whatever a state’s waiver pays for inside an assisted living community, it is not the rent, the meals, or the room itself. That portion stays the resident’s own to fund, out of income, savings, or a family contribution; the waiver only ever reaches the care and service layer on top of it. South Dakota’s own materials say the same thing directly: “Room and board, items of comfort or convenience, cost of facility upkeep, maintenance, etc. are not covered. Room and board and items of comfort and convenience are the participant’s responsibility.” (SD Medicaid HOPE Waiver Billing and Policy Manual (dss.sd.gov), “Assisted Living Services (T2031)” section).
The waitlist
Not published by the state in the materials reviewed this session.
What you get to keep: the personal needs allowance
Not published in the materials reviewed this session. This is the amount of a waiver participant’s own income the state lets them keep for personal spending after the rest goes toward the cost of their care; it varies by state because each state sets its own figure inside the federal floor.
What this doesn’t answer
The HOPE waiver (SD’s aged/disabled 1915(c) waiver) explicitly names assisted living as a covered service and explicitly excludes room and board, both read directly from the state’s own billing manual. Personal needs allowance is unverified as a fixed dollar figure: the manual defines a ‘standard needs allowance’ as a formula (300% of the SSI standard) rather than stating a dollar amount, so we report the formula rather than guess a number. Waitlist status is unverified: no primary source read this session stated an open/closed waiting-list status for the HOPE waiver.
Sources
- SD Medicaid HOPE Waiver Billing and Policy Manual, updated April 2025
- SD DSS: Medicaid Home and Community Based Services overview
Read September 4, 2026.
Same question, other states: Tennessee · Texas.
Related: what assisted living actually costs · assisted living vs. staying home vs. a CCRC · why home care has a waitlist and a nursing home doesn’t.
General information drawn from each state’s own Medicaid agency and federal statute, not legal, tax or financial advice. Medicaid is administered state by state; waiver names, coverage decisions, waitlists and allowance amounts change by state budget and legislative action. This page cannot see your own state’s current caseload. 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.
Related: South Dakota’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.