How to start a home care agency in South Dakota and reach your first client faster
South Dakota has no state license for nonmedical home care, so new owners think they can simply open. For private pay families that is close to true. Medicaid clients are different: an LTSS enrollment request with a full policy manual, an onsite review, South Dakota Medicaid enrollment, a signed contract, fingerprint checks and EVV all come before the first HOPE Waiver referral. Home health and hospice depend on Medicare. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
- One fixed price, agreed in writing
- You own 100%. No franchise fees or royalties
Get your free South Dakota launch plan
A 30 minute call. No obligation.
- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to South Dakota rulesthe LTSS In-Home Services Provider Provisions and South Dakota Medicaid billing manuals
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what South Dakota requires.
Nonmedical home care for HOPE Waiver and state plan personal care clients
- State license
- None for nonmedical care; an LTSS Purchase of Services Agreement and South Dakota Medicaid enrollment instead
- Who you deal with
- DHS Division of Long Term Services and Supports (LTSS) and South Dakota Medicaid (Department of Social Services)
- Must haves
- LTSS HCBS Provider Enrollment Request with required policies, onsite review, Medicaid enrollment, W-9 and certificates of insurance, signed contract, fingerprint checks, monthly OIG and SAM checks, Therap account, EVV
- Realistic time to first client
- Several months
Orientation for South Dakota only. We confirm your exact path on the free call.
Three places new South Dakota agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
No license, but a full rulebook
With no state license, owners assume Medicaid work is just a form. LTSS asks you to upload the policies its In-Home Services Provider Provisions require with your very first enrollment request: intake, documentation, personnel, training, abuse reporting, incidents, emergencies, confidentiality, participant rights, quality assurance, grievances, gifts and medication. Missing policies come back as corrective actions.
What it costs: Weeks lost to corrective actions, and a restart if you miss the 30 day response window.
A chain of approvals before the first referral
LTSS reviews your request and visits your office, South Dakota Medicaid enrolls your agency, you send a W-9 and certificates of insurance, sign a Purchase of Services Agreement, then get a Therap account. Only then can participants choose you and LTSS send a service authorization. Agencies that hire first and apply later carry payroll with no clients.
What it costs: Months of rent, insurance and wages paid from your reserve while the chain completes.
A clinical door that is temporarily closed
South Dakota has no state home health license, so Medicare certification is the only route, and South Dakota Medicaid pays home health only to Medicare certified agencies. Since May 13, 2026 a CMS moratorium has stopped new Medicare enrollment of home health agencies and hospices, and accreditation does not grant deemed status to a new agency while it lasts.
What it costs: Clinical payroll and leases signed for an agency that cannot bill Medicare or Medicaid yet.
What does a delay cost your agency?
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Home care vs home health vs hospice in South Dakota
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Personal care, homemaker, adult companion, chore and respite | Skilled nursing plus at least one other service, such as therapy or home health aide care, under a physician's plan of treatment | Palliative and supportive care for people who are terminally ill, and their families |
| State license | None | None; Medicare certification instead | None for in home hospice; inpatient and residential hospice facilities are licensed under SDCL 34-12 |
| Certificate of Need | No | No Certificate of Need step | No Certificate of Need step |
| Main payers | Private pay, HOPE Waiver, state plan personal care, LTSS in home services funded by the Older Americans Act | Medicare, South Dakota Medicaid (Medicare certified agencies only), commercial insurance | Medicare hospice benefit, South Dakota Medicaid |
| Medicare | Not covered | State survey or accreditation, then Medicare enrollment; new enrollment paused since May 13, 2026 | State survey or accreditation, then Medicare enrollment; new enrollment paused since May 13, 2026 |
| Key staff | Owner or manager who runs staff oversight and unannounced visits; in home aides; a licensed nurse if you offer nursing | Administrator, clinical manager, RNs and therapists, home health aides trained under 42 CFR 484.80 | Administrator, physician medical director, RN, interdisciplinary team |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks (private pay) to months (LTSS and Medicaid) | Longest: survey and Medicare enrollment, after the moratorium | Longest: survey and Medicare enrollment, after the moratorium |
Most South Dakota owners start with nonmedical care, because it needs no state license and LTSS contracts open Medicaid referrals once the paperwork is right. Home health and hospice can follow later, once CMS accepts new Medicare enrollments again. We plan both from day one so your policies, hiring and records grow with you instead of being rewritten.
South Dakota requirements at a glance
| Nonmedical home care license | None. The Department of Health says nonmedical in home providers are not regulated by the department. HB 1138 (2026) would have created a license; the governor vetoed it and the override failed. |
|---|---|
| Home health licensing | No state license. The Department of Health states South Dakota does not require state licensure for certified home health agencies; agencies certify with Medicare. |
| Hospice licensing | SDCL 34-12 licenses inpatient and residential hospice facilities (ARSD 44:79 and 44:80). In home hospice programs certify with Medicare. |
| Medicaid in home route | DHS Division of Long Term Services and Supports (LTSS) Purchase of Services Agreement plus South Dakota Medicaid enrollment (Department of Social Services) |
| Medicaid programs | HOPE Waiver (age 65 and older, or 18 and older with a qualifying disability, at nursing facility level of care) and state plan personal care (ARSD 67:16:24, up to 500 hours a plan year for adults) |
| Caregiver training (Medicaid) | New employee orientation before any unsupervised visit and at least six hours of training a year, including abuse reporting, restraint and seclusion, and Medicaid fraud reporting |
| Background screening (Medicaid) | South Dakota fingerprint background check or an LTSS approved alternative, minimum age 16, OIG and SAM exclusion checks every month |
| Electronic visit verification | Required for HOPE Waiver in home services and state plan personal care since 2021, and for home health since January 1, 2024; Therap is offered at no cost |
| Certificate of Need | None for home health or hospice; South Dakota's Certificate of Need chapter (SDCL 34-7A) was repealed |
| Entity filing | South Dakota Secretary of State; reemployment assistance tax with the Department of Labor and Regulation |
Summary of South Dakota requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in South Dakota
The order matters. Your policy manual has to exist before step 6, because LTSS wants it uploaded with the enrollment request, and fingerprint checks should start before the contract is signed so you can staff the first referral.
Form the business with the Secretary of State
File your corporation or LLC through the Secretary of State's online business system, get an EIN, and register with the Department of Labor and Regulation for reemployment assistance tax. Ask the Department of Revenue whether your service mix needs a sales tax license.
You do this; we give you the checklistDecide your payer mix
Private pay, LTSS Medicaid clients through the HOPE Waiver and state plan personal care, or both. Decide which counties you will cover, because LTSS can refer any participant in the counties you list. Use the path finder above.
Decided on your free consultationSet up insurance and employment basics
Arrange workers' compensation, general and professional liability, and auto coverage for caregivers who drive clients. LTSS asks for certificates of insurance and a W-9 before it will issue a contract.
You do this; we specify what is requiredWrite policies to the LTSS provider provisions
The LTSS In-Home Services Provider Provisions list the policies you must have: intake, documentation and EVV, personnel, staff training, OIG and SAM checks, abuse and neglect, incident reporting, emergency response, health and safety, confidentiality, participant rights, quality assurance, grievances, gifting and medication administration, plus a discharge policy.
We write this for youBuild the caregiver pipeline
Hire in home aides aged 16 or older, run a South Dakota fingerprint background check or an approved alternative, check the OIG and SAM exclusion lists every month, give orientation before any unsupervised visit, and log at least six hours of training a year. Check every nurse's license with the Board of Nursing.
We set up the system and trackerSubmit the LTSS HCBS Provider Enrollment Request
Apply online with your required policies attached. LTSS reviews the request, sends corrective actions within about 10 days, gives you 30 days to respond, and visits your office to confirm your location before approving.
We prepare the applicationEnroll with South Dakota Medicaid and sign the contract
Get your NPI, enroll through the South Dakota Medicaid Provider Enrollment Portal under the in home taxonomy (253Z00000X), complete the Dakota at Home inclusion form, send your W-9 and certificates of insurance, and sign the LTSS Purchase of Services Agreement.
We prepare and manage itSet up Therap and electronic visit verification
LTSS opens your Therap account and Therap trains your staff. Use Therap's free EVV or get approval for another system, acknowledge each service authorization within seven business days, and start services within seven business days.
We walk you through setup
Caregiver screening and training for Medicaid work
South Dakota sets no caregiver rules for private pay nonmedical care. For LTSS clients, the In-Home Services Provider Provisions set the minimum standards for every in home aide, and LTSS checks them at enrollment and at its annual quality review. Most agencies use one standard for every caregiver so anyone can be scheduled to any client.
- Who can be hired: In home aides must be 16 or older, employed by an enrolled Medicaid provider and pass a fingerprint background check.
- Background check: A South Dakota fingerprint background check of everyone hired to work in participants' homes, or an alternative check LTSS has approved that verifies identity with two IDs and reports criminal history.
- Disqualifying convictions: Crimes of violence under SDCL 22-1-2, sex crimes under SDCL 22-24B-1 and related chapters, and Class A or B felonies bar hiring. Other felonies and financial crimes are left to your judgment.
- Exclusion lists: Check every new hire and current employee against the OIG List of Excluded Individuals and Entities and the SAM exclusions database at least once a month, and keep proof in each file.
- Orientation and yearly training: Orientation before an aide enters a home unsupervised, then at least six hours of training a year, covering mandatory abuse reporting, the ban on restraint and seclusion, and how to report Medicaid fraud.
- Supervision: The agency oversees all staff, including relatives it hires, with unannounced visits to each worker's assigned site, documented for review.
- Nursing tasks: Nursing is done by or under a licensed RN or LPN. Some tasks cannot be delegated under ARSD 20:48:04.01:07, and delegated tasks are paid as personal care.
- Home health aides: Medicare certified agencies need aides who complete at least 75 hours of training and a competency evaluation, or who are on the state nurse aide registry in good standing (42 CFR 484.80).
Six mistakes that slow South Dakota agencies down
We look for every one of these in the first week of an engagement.
Assuming no license means no rules
- What it costs
- LTSS returns enrollment requests without the required policies as corrective actions, and missing the 30 day window ends the request.
- How we prevent it
- We write your policy manual to the LTSS In-Home Services Provider Provisions before you apply.
Starting care before the Therap authorization
- What it costs
- Services not authorized and acknowledged in Therap before the visit are denied, and units above the authorization are recouped.
- How we prevent it
- A simple intake rule: no visit until the service authorization is checked and acknowledged.
Setting a private pay rate below the LTSS rate
- What it costs
- LTSS will not pay more than your private pay rate, so a low private price lowers every Medicaid payment too.
- How we prevent it
- We set your private pay rate with the LTSS fee schedule in view before you attest to it.
Letting aides drift into nursing tasks
- What it costs
- Exposure under the Nurse Practice Act (SDCL Chapter 36-9) and recoupment of services that were not delivered by qualified staff.
- How we prevent it
- Clear task lists for aides, and nurse delegation set up within ARSD 20:48:04.01.
Treating EVV as optional
- What it costs
- LTSS expects compliant EVV for at least 75% of EVV services, and manually entered visits do not count.
- How we prevent it
- Caregivers trained to check in and out of each service on the Therap app from the first visit.
Skipping the monthly exclusion checks
- What it costs
- Payments for work by an excluded person must be reported and returned.
- How we prevent it
- A tracker that runs OIG and SAM checks for every employee each month and stores the proof.
In a free 30 minute call we confirm your South Dakota path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
South Dakota launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- South Dakota path and a dated launch plan
- Policy and procedure manual written to the LTSS In-Home Services Provider Provisions and South Dakota Medicaid billing manuals
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
HOPE Waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to HOPE Waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for the DHS Division of Long Term Services and Supports (LTSS)
- Survey and audit readiness
- South Dakota city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to SD DOH rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what South Dakota requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to the LTSS In-Home Services Provider Provisions and South Dakota Medicaid billing manuals |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for the DHS Division of Long Term Services and Supports (LTSS) prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The South Dakota home care startup checklist
Every South Dakota step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type, payer mix and the counties you will serve
- Form your corporation or LLC with the South Dakota Secretary of State
- Get an EIN and register for reemployment assistance tax with the Department of Labor and Regulation
- Ask the Department of Revenue whether you need a sales tax license
- Buy workers' compensation, general and professional liability, and auto coverage
- and 15 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for South Dakota
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The South Dakota cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, HOPE Waiver, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in South Dakota
| Item | Notes |
|---|---|
| State license | None for nonmedical care, home health or in home hospice, so no state license fee. |
| Entity formation and annual report | Secretary of State filing and annual report fees; check current amounts on the Secretary of State's site. |
| Fingerprint background checks | Per caregiver fingerprinting and processing fees for Medicaid staff, or the cost of an approved alternative check. |
| EVV and scheduling software | Therap is offered at no cost for LTSS services; another EVV system is at your own cost and needs approval. |
| Insurance | Workers' compensation, general and professional liability, auto coverage |
| Nursing time | A licensed nurse for nursing services and for tasks that cannot be delegated to aides |
| Medicare enrollment (home health, hospice) | CMS application fee of $750 for institutional providers in calendar year 2026, plus survey readiness or accreditation costs. |
| Operating reserve | Covers payroll, rent and insurance while LTSS enrollment, Medicaid enrollment or Medicare certification is pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in South Dakota
Weeks, once the business, insurance and hiring process are in place.
Several months: LTSS review and onsite visit, corrective actions, South Dakota Medicaid enrollment, the contract and Therap setup, then referrals as participants choose you.
Longest: Medicare certification and enrollment, which CMS paused for new agencies on May 13, 2026. Plan around the moratorium's end before you commit to clinical payroll.
South Dakota families searching for care are spread between Sioux Falls, Rapid City and many small towns, so the counties you agree to cover matter. LTSS contracts let you choose your county coverage area, and any participant living there may be referred to you, so an agency that can reliably staff rural routes stands out with case management specialists. Many people searching are adult children arranging care for a parent, sometimes from out of state, which makes a complete Google Business Profile and clear pages for each county or town you serve important.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in South Dakota?
No. The South Dakota Department of Health says nonmedical in home providers, such as those helping with bathing, light housekeeping or meals, are not regulated by the department. You still need business, tax and payroll registrations, and Medicaid work requires an LTSS contract and South Dakota Medicaid enrollment.
What happened to South Dakota's home care licensing bill?
House Bill 1138 (2026) would have required nonmedical home care agencies to be licensed by the Department of Health, with eight hours of aide training, background checks and a yearly fee of up to $100. The legislature passed it, the governor vetoed it, and the House vote to override failed on March 30, 2026. A similar bill could return in a future session.
Does South Dakota license home health agencies?
No. The Department of Health states that South Dakota does not require state licensure for certified home health agencies. Agencies certify with Medicare through a Department of Health survey or an approved accrediting organization, and South Dakota Medicaid pays only Medicare certified home health agencies.
Does South Dakota license hospices?
SDCL Chapter 34-12 licenses inpatient hospice and residential hospice facilities, with rules in ARSD 44:79 and 44:80. A hospice that serves patients in their own homes certifies with Medicare, and South Dakota Medicaid requires Medicare enrollment for hospice providers.
Does South Dakota require a Certificate of Need for home health or hospice?
No. South Dakota's Certificate of Need chapter (SDCL 34-7A) was repealed, and there is no need review for home health agencies or hospices.
How do South Dakota home care agencies get Medicaid clients?
By contracting with the DHS Division of Long Term Services and Supports and enrolling with South Dakota Medicaid. LTSS case management specialists assess participants for state plan personal care and the HOPE Waiver, participants choose a provider, and LTSS sends a service authorization through Therap. There are no health plans to credential with.
What do caregivers need to serve LTSS clients?
They must be at least 16, pass a South Dakota fingerprint background check or an approved alternative, clear monthly OIG and SAM exclusion checks, complete orientation before working alone, and receive at least six hours of training a year. Tasks reserved for nurses under SDCL Chapter 36-9 need a licensed nurse.
Can I open a Medicare certified home health agency or hospice in South Dakota right now?
CMS put a nationwide moratorium on new Medicare enrollment of home health agencies and hospices from May 13, 2026, for six months, so it was due to run out around November 13, 2026. It may have ended or been extended by the time you read this. You can still build your team and policies, then apply once new applications are accepted.
How much does South Dakota home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, LTSS and Medicaid, or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and you own 100% of your agency.
Do you only work in South Dakota?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team.
Sources checked for this guide (32)
- SD Department of Health: Home Health Agencies (nonmedical providers not regulated; no state licensure for certified HHAs)
- SD Department of Health: Hospice (certified, inpatient and residential hospice)
- SD Department of Health: Health Facility Licensure
- SDCL 34-12-1.1, health care facility definitions (inpatient and residential hospice)
- SDCL 34-12-2, license required to operate a health care facility
- SDCL 34-7A, Certificate of Need for health care facilities (repealed)
- 2026 House Bill 1138, licensure of nonmedical home care agencies (action log: vetoed, override failed 36 to 27 on March 30, 2026)
- HB 1138 enrolled text
- ARSD 67:16:24, personal care services (Medicaid)
- SD Medicaid Billing and Policy Manual: Personal Care Agency Services (updated March 2026)
- SD Medicaid Billing and Policy Manual: HOPE Waiver (updated April 2025)
- SD Medicaid Billing and Policy Manual: Electronic Visit Verification (updated February 2024)
- SD Medicaid Billing and Policy Manual: Home Health Agency Services (updated December 2025)
- SD Medicaid Billing and Policy Manual: Hospice Services (updated September 2024)
- SD Medicaid provider communications (2026 notices reviewed)
- DHS LTSS In-Home Services Provider Provisions, effective 6/01/2024 (Internet Archive copy)
- DHS LTSS HCBS Provider Enrollment Manual, effective 05/15/2023 (Internet Archive copy)
- SDCL 10-45-12.1, services exempt from sales tax
- SD Department of Revenue: Sales and Use Tax
- SD Department of Labor and Regulation: Reemployment Assistance employer registration
- SD Secretary of State: Business Services
- Dakota at Home resource directory
- Federal Register 2026-09717: nationwide moratorium on Medicare enrollment of home health agencies (govinfo)
- Federal Register 2026-09718: nationwide moratorium on Medicare enrollment of hospices
- CMS QSO-26-11-HHA & Hospice, six month national moratoria (May 20, 2026)
- CMS Provider Enrollment Moratoria page
- Federal Register 2025-21877: CY 2026 provider enrollment application fee ($750)
- 42 CFR 484.80, home health aide training and competency (eCFR)
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- CMS-855A Medicare enrollment application, institutional providers
- Dakota News Now: governor vetoes home care regulation bill (secondary, veto date pointer only)
This guide is general information and reflects South Dakota requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the South Dakota Department of Human Services, South Dakota Medicaid, the South Dakota Department of Health and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.