How to Set Up a Medicaid Income Trust in South Dakota: Step by Step
South Dakota does not publish a fill-in Qualified Income Trust form. To meet its requirements, an attorney (or, where permitted, you) drafts the trust to satisfy DSS's own published policy, names a trustee, opens a dedicated trust bank account, and funds it with the applicant's income in the same calendar month you want coverage to begin. The trust diverts income above South Dakota's $2,982/month long-term-care Medicaid cap (effective January 2026) so the applicant qualifies. For complex estates, consult a South Dakota-licensed elder-law attorney. This guide is informational only and is not legal advice — we explain what DSS's policy requires; we do not draft the trust or provide sample trust language.
What usually happens
South Dakota doesn't publish a fill-in form, so the trust has to be drafted to DSS's requirements, and an elder-law attorney quotes $1,000–$2,500 to research and draft it. Once it's signed, you take it to the bank, where the branch has never opened one of these and says no.
Meanwhile the month is running out. In South Dakota, coverage can't start before the month the trust is funded, so a month that slips is another month of private-pay nursing care at $9,444–$10,190.
This applies when the person who needs care has gross monthly income over South Dakota's income cap of $2,982, whether you're their child, their spouse, or a professional helping them.
Free: the questions to ask a South Dakota bank before your first visit
7 questions for a five-minute phone call, so you find out whether a branch knows how to open this account before you make the drive. Emailed now, then 4 short follow-ups over the next 10 days — then we stop.
South Dakota does not publish a fill-in Miller Trust form, so the trust is drafted — by an attorney, or by you where permitted — to meet South Dakota Department of Social Services (DSS) -- the Division of Economic Assistance administers Medicaid LTC eligibility (state-administered, not county); the Department of Human Services (DHS), Division of Long Term Services and Supports (LTSS), operates the HOPE Waiver.'s own published requirements. Here is the full sequence, with the DSS fact behind each step.
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Confirm the applicant's income is over the South Dakota cap
A Qualified Income Trust only helps when monthly countable income exceeds South Dakota's long-term-care Medicaid limit — $2,982/month single (effective January 2026). If income is under the cap, a trust usually is not needed.
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Get the required-provisions checklist
South Dakota does not publish a fill-in QIT form. DSS's own published policy (ARSD 67:46:05:33.01 ("Medicaid income trust")) instead lists exactly what a compliant trust must contain — the checklist tells you what to bring to an attorney or verify in a draft.
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Have the trust drafted
South Dakota requires a license from the Supreme Court and active State Bar membership to practice law (SDCL 16-16-1); no South Dakota case, Attorney General opinion, or bar ethics opinion addressing generic self-help legal-form kits, Medicaid planning, or Medicaid income trusts specifically was found, and South Dakota has no Certified/Licensed Legal Document Preparer safe harbor for nonlawyers. Because DSS publishes no fill-in trust form, producing a compliant Medicaid income trust from the requirements below means drafting an original legal document, which for most people falls on the attorney side of that line. This guide never drafts or reviews your trust language -- it tells you what South Dakota's own rule requires the finished document to contain, so an attorney engagement is efficient and so you can check what they draft against the same list.
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Name a trustee
South Dakota's Medicaid income trust rule, ARSD 67:46:05:33.01, does not name who may or may not serve as trustee -- a genuine, confirmed silence in the state's own regulation, not an oversight in this guide's research.
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Open the dedicated trust bank account
Open a dedicated bank account titled to the trust once it is signed. Branches commonly hesitate to open this account type, so know what to say before you go.
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Fund the trust in the same calendar month
Deposit enough of the applicant's income into the trust account to bring remaining countable income below $2,982 — in the same calendar month you want coverage to start. DSS does not back-date, so the month you fund is the earliest month eligibility can begin.
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Distribute monthly and keep records
Each month the trustee pays out only the allowed items and keeps records. Staying inside DSS's rules each month is what keeps benefits from being pulled.
The two steps families get stuck on are opening the bank account in South Dakota and funding the trust before the calendar month closes — see how long setting up a South Dakota Miller Trust takes for the timing rules.
What your South Dakota trust must contain
South Dakota does not publish a fill-in Qualified Income Trust form. South Dakota's Department of Social Services (DSS) publishes no fill-in Medicaid income trust instrument -- its Forms & Publications library lists only application forms and unrelated brochures, and a third-party Medicaid-planning resource states DSS will not accept a DIY-drafted trust document. The governing rule, ARSD 67:46:05:33.01 ("Medicaid income trust"), sets out in four numbered requirements exactly what a compliant trust must do, plus a closing anti-overfunding provision. The checklist below is drawn directly from that rule, read in full from the primary source, so you or your attorney can draft -- or verify a draft against -- a trust that satisfies what South Dakota requires.
The step that isn't really paperwork
Opening the bank account is where families actually lose time — most branches have never opened this kind of trust account before. Free one-pager: the questions to ask before you drive to a branch, emailed now. Then 4 more short emails over the next 10 days — then we stop. No ongoing newsletter.