Governor Larry Rhoden issued his second veto of the 2026 Session Wednesday, framing an effort to regulate non-medical home care as doing not enough and too much.
House Bill 1138 proposed a new licensure requirement, for people who earn wages by providing “non-medical home care services”, which HB 1138 defines as…
- Assistance with bathing, dressing, eating, personal grooming, or toileting;
- Assistance with the self-administration of medications;
- Companionship;
- Housekeeping or assistance with household chores;
- Meal preparation; or
- Other routine activities of daily living that are not required to be performed by a licensed health care professional.
If you provide two or more of those listed services to adult customers or if you run a business that hires people to provide such services, you would have to get a non-medical home care license from the Department of Health.
So if all you do is prepare meals, no license necessary. But if you sit and chat while the client eats (companionship) or do the dishes afterward (household chore), you need a license.
HB 1138 exempts family members, certified home health agencies, health care facilities, nursing homes, community service providers, and health care professionals who do non-medical care in conjunction with in-home health care services.
An HB 1138 license would cost up to $100 a year. That would be up to $100 to license each employee and up to $100 from any owner/operator of a home care agency that employs them. I’m assuming that a person owns a company, provides services herself, and hires a couple friends to cover more clients, that owner doesn’t have to get two licenses.
Each year, a non-medical home care license applicant would have to proof of liability insurance covering at least $250,000 per mishap. Applicants would have to attest that they and any employees have passed a criminal background check; a violent crime, sex crime, or Class A or Class B felony would disqualify any applicant from working in non-medical home care. Applicants would have to attest to completing two hours of training on basic care of clients with Alzheimer’s and dementia and six hours of training on household cleanliness, safety, nutrition, confidentiality, record-keeping, and elder abuse.
Non-medical home care providers would have to document “the type and frequency of services provided to each client”. The Department of Health would be able to take a look at those records and all documents related to the license application upon request.
HB 1138 had a rough ride to the Governor’s desk. House Health and Human Services killed it on February 10 —in part on Rep. Brandei Schaefbauer’s (R-3/Aberdeen) curious assertion that regulating everything will turn destroy interpersonal caring and turn us all into rule-following robots—and had to be smoked out to reach the House floor. Neither chamber gave HB 1138 the two-thirds approval necessary to overcome a veto…
…and Wednesday, that veto came. In his veto letter, Governor Rhoden says HB 1138 regulations are not “as limited and targeted as possible” and fail to make non-medical home care services any safer.
The Governor contends that HB 1138 subjects regular housekeepers—”anyone who is compensated for cooking meals and cleaning house for an adult” would be “subjected to the same regulatory framework designed for licensed healthcare providers.” The Governor says this burdensome licensure just creates paperwork without guaranteeing safer home care:
…the bill creates a false sense of consumer protection. The Department of Health has no authority to examine or verify the background checks. They would be limited to reviewing applications, training periods, insurance documents, and attestations that background checks were completed, and only when reasonable cause already exists to do so. Under this bill, a one-person household service provider could conduct a so-called background check on themselves, and there is no accountability for that check. If a complaint is filed against a provider, the Department’s sole recourse is to confirm that paperwork exists. This bill regulates paperwork, not care [Governor Larry Rhoden, veto letter on HB 1138, 2026.03.25].
But don’t get the idea that Governor Rhoden wants to see beefier regs on non-medical home care. The Governor says that, even without going into regular evaluations of actual in-home services, HB 1138 would drive rural providers out of business:
Home care service providers are already limited across rural South Dakota. The regulations in this bill would fall disproportionately onto the small and solo providers that rural communities depend on. The result is reduced service availability, potentially forcing seniors out of their homes and into assisted living or nursing facilities. The first rule of regulation should be to do no harm, but this bill would have major unintended consequences [Rhoden, 2026.03.25].
This veto doesn’t leave sponsor Rep. Mellissa Heermann (R-7/Brookings) much room to bring better regs next year. Easing back on license requirements would feed Rhoden’s critique that HB 1138 doesn’t enforce actual safety. Toughening the rules would feed Rhoden’s critique that license requirements would drain the provider pool. Rep. Heermann and her colleagues won’t be able to resolve that conundrum on Veto Day Monday… but they could resolve it come June or November by replacing the conundrummer with a new Governor.