IDD Medicaid rates in South Dakota are among the highest in the country for the two core community services. South Dakota pays $17.32 per 15 minutes for in-home and community living supports on code T2017, or $69.28 an hour, effective June 1, 2026. That ranks 2nd of 29 states and is 98.4% above the national median of $34.92 an hour.
Supported employment ranks 6th of 39 at $73.00 an hour, and the ICF/IID rate ranks 3rd of 12. But South Dakota's day, prevocational and behavior support rates are all in the bottom third. Few states pay so differently across services within the same waiver, and that split should shape any South Dakota provider's service mix.
All rates below are agency-provider rates effective June 1, 2026, under South Dakota's CHOICES Waiver for comprehensive developmental disability services:
| Service | Code | Rate | Rank | vs median |
|---|---|---|---|---|
| In-home and community living supports | T2017 | $69.28/hour | 2 of 29 | +98.4% |
| Supported employment | T2019 (HJ) | $73.00/hour | 6 of 39 | +78.7% |
| Residential habilitation | T2016 | $292.61/day | 15 of 31 | +4.4% |
| Day habilitation | T2020 (U7) | $15.78/hour | 26 of 32 | -31.8% |
| Prevocational services | T2019 (HJ, UP) | $9.65/hour | 23 of 28 | -48.3% |
| Behavior support | T2020 (SE) | $37.93/hour | 20 of 23 | -51.4% |
The split is stark. Individual services delivered one-to-one in homes, communities and workplaces pay near the top of the country. Group-based day and prevocational services, and clinically delivered behavior support, pay near the bottom. Residential habilitation sits in the middle.
The CHOICES Waiver is South Dakota's 1915(c) waiver for comprehensive developmental disability services, administered by the Department of Human Services Division of Developmental Disabilities. A second DD waiver, Family Support 360, funds in-home supports for people who live with family. Both are paid fee-for-service: the provider bills the published rate for the authorized service, and the state pays it.
Two features of the schedule matter for billing. First, codes are shared across services and distinguished by modifiers. T2019 with HJ is supported employment; T2019 with HJ and UP is prevocational services. T2020 with U7 is day habilitation; T2020 with SE is behavior support. A modifier error can therefore move a claim from a top-ranked rate to a bottom-ranked one. Second, units differ: T2017 and supported employment are billed in 15-minute units, while day habilitation, prevocational services and behavior support are priced by the hour, and residential habilitation by the day.
At $69.28 an hour, South Dakota trails only South Carolina ($85.96) on in-home supports, ahead of Massachusetts ($68.04), Alaska ($61.84) and Maryland ($61.32). The bottom of the range is Idaho ($15.44), West Virginia ($13.52) and Louisiana ($12.40).
The economics are exceptionally strong. South Dakota's median direct support wage is $18.44 an hour, well below the national $22.08, and the loaded wage is only 36.8% of the T2017 rate. That leaves $43.78 an hour for supervision, training, travel, overhead and margin.
In a rural state, that headroom matters most for travel. In-home supports are delivered where the person lives, and in South Dakota that can mean long drives between visits that cannot be billed. A rate this far above the median gives agencies room to absorb drive time, pay mileage and still fund supervision, which is why in-home supports are usually the most sustainable IDD line for a South Dakota agency.
South Dakota's $73.00 supported employment rate sits behind New York ($141.64), Arkansas ($102.36), the District of Columbia ($97.08), Iowa ($79.82) and Missouri ($77.80). The lowest states are Tennessee ($14.96), West Virginia ($12.80) and Wyoming ($12.36), all on T2019.
Supported employment is stronger still on margin: the loaded wage is 34.9% of the $73.00 hourly rate, leaving $47.50 an hour. For employment providers, South Dakota's rate supports individualized job coaching at a level few states can match. It can fund the less visible work that makes placements last, such as job development with employers, fading plans as the person gains independence, and coordination with vocational rehabilitation.
Prevocational services sit at the other end
The same code with an added UP modifier pays $9.65 an hour for prevocational services, 23rd of 28 and 48.3% below the national median of $18.67. Prevocational work is usually delivered in groups, so the per-person rate is lower by design, but the contrast with supported employment is wide. The rates give providers a clear signal to move people toward individualized employment where it fits the person's goals.
South Dakota's ICF/IID daily rate is $926.97, 3rd of 12 and 99.4% above the national median of $464.88. Only the District of Columbia ($1,021.84) and Maine ($995.49) pay more; Louisiana ($232.14), Wisconsin ($201.04) and Oklahoma ($174.35) pay least. ICF/IID rates are facility rates that cover round-the-clock care, active treatment and the building, so they are not comparable with hourly community rates.
Community residential habilitation is closer to the middle: $292.61 a day on T2016 with modifiers U3 and US, 15th of 31 and 4.4% above the national median of $280.27. That is enough to run a group home at typical staffing ratios, but not with the cushion that in-home supports enjoy. Residential advisors in South Dakota earn $18.47 an hour against $20.31 nationally, which helps, but overnight coverage and staffing for residents with higher support needs consume the daily rate quickly.
Behavior support at $37.93 an hour on T2020 with modifier SE ranks 20th of 23, 51.4% below the national median of $78.07. Only New Jersey ($33.20), Tennessee ($27.00) and Idaho ($24.64) are lower; Maryland pays $173.04.
Behavior support is clinical work: assessment, writing a behavior support plan, training staff and monitoring data. At $37.93 an hour, the rate is close to what the state pays for a direct support hour and well below what clinicians typically earn, so behavior support in South Dakota is often provided by agencies that cross-subsidize it from better-paid services, or by clinicians who combine waiver work with other payers.
Day habilitation pays $15.78 an hour, 26th of 32 and 31.8% below the median of $23.14. Day services are usually delivered to groups, so the per-person rate is lower by design, but South Dakota's rate sits well below the national norm even so. Operators manage it through group size, attendance and transportation planning.
Federal occupational wage data for May 2025 puts South Dakota's direct support professional median at $18.44 an hour against $22.08 nationally (based on the closest comparable occupation). Residential advisors earn $18.47 against $20.31, and licensed practical nurses $25.36 against $30.96.
The outlier is personal care: home health and personal care aides earn $18.15, above the national $17.21. That is unusual. IDD agencies in South Dakota recruit from a pool where personal care work pays almost the same as direct support, so the strong T2017 and supported employment rates are best used to pay a visible premium over personal care wages, since that is the comparison a job seeker will make.
- HB 1326 (2026 session), SFY2027 General Appropriations Act. Discretionary provider inflation of 1.4% for Developmental Disabilities, effective July 1, 2026.
- CHOICES DD Waiver inflationary increases effective June 1, 2024 and June 1, 2023.
- Family Support 360 Waiver inflationary increases effective July 1, 2024 and June 1, 2023.
South Dakota has adjusted its DD rates on a steady annual inflation cycle rather than through large one-time rebases. The pattern matters for planning: rates move modestly each year, so a service that is far below the national median, such as behavior support, will not catch up without a deliberate change to its methodology. The same appropriations act applied the 1.4% discretionary inflation to Medical Services, Behavioral Health, Long Term Services and Supports and Rehabilitation Services as well.
South Dakota's Medicaid program has 4 plans and arrangements in its landscape, including PRIME primary care case management and Care Connect health homes. None of them is a capitated managed-care plan that pays IDD services. The CHOICES Waiver is run by the DHS Division of Developmental Disabilities on a fee-for-service basis, so providers bill the published waiver rate and there is no plan contract to negotiate. The South Dakota managed care page covers the details.
South Dakota's IDD codes on this page, including T2016, T2017, T2019, T2020 and T2025, carry no prior authorization rules in the state's coverage listing. In practice, the authorization that matters is the person's waiver service plan, which sets the services and units a provider can bill.
Neighbors pay very differently. Iowa ranks among the leaders on supported employment at $79.82 an hour but sits near the bottom on residential habilitation at $140.81 a day. Minnesota tops the country on residential and day habilitation. North Dakota and Nebraska publish their own DD waiver rates. For a provider working across the region, South Dakota's advantage is concentrated in in-home supports, supported employment and ICF/IID care; it is not a uniformly high-paying state.
- Service mix. Lead with in-home supports and supported employment, where margins are widest, and plan day and behavior services as smaller lines.
- Billing accuracy. Audit modifiers on T2019 and T2020 claims; the modifier decides which rate applies.
- Wage strategy. Set direct support pay with a clear premium over the $18.15 personal care median.
- Budgeting. Assume modest annual inflation adjustments like the 1.4% SFY2027 increase, not large rebases.
The South Dakota Medicaid rates hub covers all 41,546 current South Dakota Medicaid rates, including every CHOICES and Family Support 360 rate not shown here, and IDD Medicaid rates by state compares every IDD service.
Rates are compiled from official state Medicaid publications, including the CHOICES Waiver and Family Support 360 Waiver rate schedules and the South Dakota Medicaid fee schedules. Each rate in our dataset links to its source document and carries its effective date. Hourly figures convert 15-minute units by four; daily rates are shown as published. National medians and ranks compare agency-provider rates for the same service across the states that publish one. See our methodology for details.