South Dakota's home health care industry serves a predominantly rural state with a small but growing aging population. Agencies must navigate state licensing requirements, understand the HOPE and CHOICES waiver programs, and develop effective workforce strategies in a state with limited healthcare workforce availability but a moderate cost of living and a CPI-indexed minimum wage that provides predictable annual increases.

Home Health Agency Requirements in South Dakota

The South Dakota Department of Health (DOH) Office of Health Facility Licensure surveys, licenses, and recommends federal certification for healthcare facilities to ensure state and federal health and safety standards are met.

Home Health Agency Definition

Home health agencies (HHAs) in South Dakota provide skilled nursing services and at least one of the following therapeutic services in a patient's place of residence:

  • Physical therapy
  • Speech-language pathology
  • Occupational therapy
  • Medical social services
  • Home health aide services

Licensing Contact

For questions about healthcare facility licensing:

  • Office of Health Facilities Licensure & Certification
  • 600 E. Capitol Ave., Pierre, SD 57501
  • Administrator: Jennifer Maeschen

Certified Nursing Assistant (CNA) Certification

South Dakota's CNA certification is regulated by the Board of Nursing under ARSD 20:48. The South Dakota Unlicensed Assistive Personnel (SDUAP) registry maintains certification records and processes applications.

Nursing Assistant Definition

Under South Dakota's Administrative Rules, a nursing assistant is defined as "a person trained to assist a licensed nurse and function in a supportive role, regardless of title, and to whom a nursing task may be delegated."

Training Requirements

To become a CNA in South Dakota, candidates must complete a state-approved training program with the following requirements:

  • Minimum 75 hours of comprehensive instruction
  • At least 16 hours of supervised clinical practice
  • Combination of classroom learning and hands-on training
  • Program costs typically range from $1,000 to $2,500

Additional costs may include CPR certification, background checks, and state exam fees.

Eligibility Requirements

  • Minimum age of 16 years
  • Basic English language skills
  • Background check clearance

Nursing Student Waiver

Students enrolled in an LPN or RN nursing program approved by the SD Board of Nursing who have successfully completed the Fundamentals of Nursing course may receive a waiver to skip the 75-hour nurse aide training and proceed directly to the state CNA written and manual skills exams.

Certification Exam

Candidates must pass the National Nurse Aide Assessment Program (NNAAP), which includes:

  • Written knowledge test: Measures understanding of essential caregiving principles
  • Skills evaluation: Demonstrates practical abilities

A passing score on both sections is required for certification. If a candidate does not pass, they have up to two years from their training completion date to retake the exam.

Certification Renewal

CNA certification in South Dakota must be renewed every two years. Requirements include:

  • 24 hours of approved continuing education training
  • At least 12 hours of paid CNA employment in the past 24 months

Contact Information

  • SD Board of Nursing: 4305 S. Louise Ave., Suite 201, Sioux Falls, SD 57106
  • Email: [email protected]
  • Phone: (605) 362-2760

Home Health Aide (HHA) Requirements

Home health aides in South Dakota must meet training requirements established by their employing agencies and applicable federal requirements for Medicare-certified agencies. HHAs work under nurse supervision providing personal care and health-related services.

South Dakota Medicaid and Home Care Services

South Dakota's Medicaid program provides home and community-based services through both state plan benefits and four 1915(c) waivers operated by the Departments of Social Services and Human Services. Each waiver targets a specific population with a tailored menu of services.

Personal Care Services (State Plan)

South Dakota's Medicaid Personal Care Services (PCS) are available through the Regular Medicaid Plan. Key features include:

  • Entitlement program: No waiting list for eligible participants
  • Service limit: Up to 500 hours per year
  • Income limit (2025): $967 per month for individual applicants

PCS provides an important foundation of personal care services that complements waiver programs.

HOPE Waiver

The Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver—previously called the HCBS Waiver for the Elderly—is a nursing home diversion program providing services and supports in various settings including:

  • Private homes
  • Community living homes
  • Structured family caregiving homes
  • Assisted living facilities

HOPE Waiver Services

  • Adult day care
  • Private duty nursing
  • Homemaker services
  • Personal care assistance
  • Home modifications
  • Emergency response systems
  • Additional support services

CHOICES Waiver

The Community, Hope, Opportunity, Independence, Careers, Empowerment, Success (CHOICES) Waiver provides services to children and adults with intellectual and developmental disabilities. Participants must meet developmental disability criteria to qualify.

2025 Waiver Financial Eligibility

For HCBS Waivers (HOPE, CHOICES, and others):

  • Level of Care: Must require nursing home level of care
  • Income (Single): $2,901 per month (300% of SSI)
  • Assets (Single): $2,000
  • Income (Married, both applying): $5,802 per month combined
  • Assets (Married, both applying): $3,000 combined

December 2026 Renewal Changes

Starting December 2026, Medicaid beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps. Agencies should prepare clients and operational processes for more frequent eligibility verification.

Electronic Visit Verification (EVV)

South Dakota has implemented Electronic Visit Verification (EVV) for personal care services and home health care services in compliance with the 21st Century Cures Act. Providers must use approved EVV systems to capture required visit data.

Medicare Home Health in South Dakota

Medicare-certified home health agencies in South Dakota must meet federal Conditions of Participation and operate under the Patient-Driven Groupings Model (PDGM) for reimbursement.

South Dakota-Specific Considerations

South Dakota's rural geography creates significant challenges for home health agencies:

  • Long travel distances between patient homes
  • Limited workforce availability in rural areas
  • Harsh winter weather affecting travel and scheduling
  • Need for efficient routing and scheduling systems

Agencies must factor travel time and costs into their service area planning and operational budgets.

South Dakota Labor Laws for Home Care

South Dakota's minimum wage is indexed to the Consumer Price Index (CPI), providing predictable annual increases. The state follows federal FLSA standards for overtime and other employment protections.

2026 Minimum Wage

Effective January 1, 2026:

  • Non-tipped employees: $11.85 per hour
  • Tipped employees: $5.925 per hour

The 2025 rates were $11.50 for non-tipped and $5.75 for tipped employees.

CPI Indexing

South Dakota's minimum wage is adjusted annually based on the Consumer Price Index published by the U.S. Department of Labor. Key features:

  • Increases match the cost of living rate
  • Amounts rounded up to the nearest 5 cents
  • Minimum wage cannot decrease

This indexing provides predictable, gradual increases for agencies to plan around, though there is no set timeline for reaching higher minimum wage levels like $15/hour.

Payroll Timing

For hours worked in 2025 but paid in 2026, the 2025 minimum wage applies to those hours, even if the payroll check is issued after January 1, 2026.

Overtime Requirements

South Dakota follows federal FLSA overtime standards:

  • Time and a half required for hours over 40 in a workweek
  • Live-in employees are exempt from overtime requirements

Workers' Compensation

South Dakota requires workers' compensation coverage for household employees who work:

  • More than 20 hours in a calendar week, or
  • More than six weeks in any 13-week period

Paid Leave

South Dakota does not have a paid leave law that applies to household employers. There is no state-mandated paid sick leave or family leave requirement.

Workforce Challenges and Strategies

South Dakota agencies face distinct workforce challenges shaped by rural geography, small population, and competitive labor markets.

Key Challenges

  • Rural Service Areas: Large distances between clients in sparsely populated counties
  • Small Workforce Pool: Limited population means fewer potential candidates
  • Competition: Healthcare systems, nursing homes, and other employers compete for workers
  • Seasonal Factors: Harsh winters affect travel and scheduling reliability
  • Training Access: Rural areas may have limited training program options

Recruitment Strategies

  • Nursing Student Pipeline: Leverage the waiver allowing nursing students to test for CNA certification after completing Fundamentals of Nursing
  • Regional Training Partnerships: Work with community colleges and healthcare facilities offering CNA programs
  • Employer-Sponsored Training: Pay for CNA training ($1,000-$2,500) in exchange for work commitments
  • Rural Community Outreach: Target recruitment in small communities where home care jobs offer steady employment

Retention Strategies

  • Above-Minimum Wages: The $11.85 minimum allows competitive wages at modest cost increases
  • Mileage Reimbursement: Critical for extensive rural travel requirements
  • Weather Policies: Clear policies for winter weather closures and rescheduling
  • Continuing Education Support: Help workers complete the 24 hours of CE required for renewal
  • Career Advancement: Create pathways from HHA to CNA to LPN/RN
  • Flexible Scheduling: Accommodate workers in rural areas with limited schedule options

Technology Solutions

  • Route optimization software for efficient rural service delivery
  • Mobile scheduling and communication apps for distributed workforce
  • EVV systems that minimize administrative burden
  • Telehealth integration for clinical support in remote areas
  • Online training platforms for CE hour completion

Resources for South Dakota Home Care Agencies

  • SD Department of Health: Home health agency licensing and facility surveys
  • SD Board of Nursing: CNA certification and registry (ARSD 20:48)
  • SDUAP Registry: Certification applications and renewals ([email protected])
  • SD Department of Social Services: Medicaid programs and waiver information
  • SD Department of Labor and Regulation: Minimum wage and employment law guidance

The Bottom Line

Operating a home health or home care agency in South Dakota requires navigating DOH licensing, understanding the Board of Nursing's CNA certification requirements, and effectively managing HOPE and CHOICES waiver programs. The state's CPI-indexed minimum wage ($11.85 in 2026) provides predictable annual increases that agencies can plan around, while the predominantly rural geography demands efficient service delivery systems and strong travel reimbursement policies. The December 2026 eligibility renewal changes will require operational adjustments for agencies serving Medicaid beneficiaries. Success in South Dakota requires developing strong rural workforce strategies, leveraging nursing student pathways to CNA certification, and maintaining efficient operations across vast service areas. Agencies that invest in technology solutions for routing, scheduling, and training will be best positioned to thrive in this challenging but underserved market.