Starting a care business in South Dakota

For home daycares, the question is who pays, not how many children come. A home caring for up to 12 children, counting your own under 6, must hold a family day care registration only if any care is paid directly or indirectly with public funds, which in practice usually means Child Care Assistance (CCA). A home paid only privately needs no registration, though it may register voluntarily, and no one convicted of child abuse, a sex offense or a felony in the past five years may run one. A registration certificate lasts two years, covers one address and cannot be transferred. DSS pays the background check fees, and it must decide within 60 days of a complete application.

Head count takes over at 13 children, whatever the funding. Care for 13 to 20 children is licensed as a group family day care home, and care for 21 or more, even in a private house, needs a day care center license. Both come from DSS under ARSD 67:42:17, and both start with floor plan review: DSS will not accept the application until your plans are approved, and it sends them to the Department of Health and the State Fire Marshal. That review has no published timeframe and depends on those offices' queue. A center license stays in effect until it is revoked or suspended, while a group family day care home license must be renewed every year. Neither the statute nor the rules set a license fee.

On the adult side, any place that gives personal care beyond food, shelter and laundry needs an assisted living center license from the DOH Office of Health Facilities Licensure and Certification. The law sets no minimum number of residents, but 16 beds is the line that changes the rules: at 16 or fewer the annual fee is $150, DOH may approve rule modifications, and small centers can ask for one-person staffing. DOH must approve construction plans before you build and sets your bed capacity. Two smaller licenses cap a home at four adults. An adult foster care home must be run by an owner who lives there, and SDCL 34-12-6 lists no fee for it. A community living home serves one to four unrelated adults who receive at least one regularly scheduled health-related service, may be owned by an organization, and has a $150 annual fee; the adult foster care guide compares the two. A home giving only room, meals and daily living services, with no health care, to two or more unrelated elderly or disabled people registers with DOH each year at no charge instead. Running an unlicensed facility is a Class 1 misdemeanor, and an unlicensed facility cannot be paid with state or federal funds that pass through the state treasury.

A DOH license does not by itself bring Medicaid payment. Assisted living centers and community living homes can bill through the HOPE waiver, but only after DHS's Division of Long Term Services and Supports (LTSS) enrolls them: the DOH license comes first, then the LTSS policy review and contract, then SD Medicaid enrollment. The HOPE waiver services list does not name adult foster care, and no official source reviewed shows a South Dakota Medicaid program paying adult foster care homes.

Three types have no guide because the state does not license them. No state adult day license was found; programs that bill the HOPE waiver or Title III follow DHS's Adult Day Services provider provisions, including at least one staff member per six participants (one per four when many are severely impaired), and a licensed assisted living center may run adult day care as a nonresident program. DOH states that it does not regulate non-medical in-home help such as bathing, light housekeeping or meal preparation. DOH also says South Dakota does not require state licensure for certified home health agencies; an agency that wants to bill Medicare goes through Medicare certification, with CGS Administrators as the state's Medicare contractor. The official pages checked did not say whether a certificate of need applies to home health, so confirm that with DOH before you open.