I/DD Waivers in South Carolina

All states: Medicaid disability services map

South Carolina I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in South Carolina?

Two state agencies share the work. The South Carolina Department of Health and Human Services (SCDHHS) is the Medicaid agency and keeps final authority over the waivers. The Office of Intellectual and Developmental Disabilities (OIDD), inside the Department of Behavioral Health and Developmental Disabilities (BHDD), runs the I/DD waivers day to day under a contract with SCDHHS. County Disabilities and Special Needs (DSN) boards and private agencies deliver the services.

• SCDHHS: the Medicaid agency. It sets waiver rates, enrolls Medicaid providers and pays claims.
• BHDD OIDD: operates the ID/RD, Community Supports and HASCI waivers, decides eligibility for OIDD services, licenses day programs and residential homes, and qualifies providers.
• A new agency name: BHDD was created by a law signed April 28, 2025 that merged the Department of Disabilities and Special Needs (SCDDSN or DDSN), the Department of Mental Health and the Department of Alcohol and Other Drug Abuse Services. Older forms and manuals still say SCDDSN or DDSN.
• Front door: people age 3 and older call BHDD OIDD at 1-800-289-7012. Children under 3 apply through BabyNet (1-866-512-8881).
• Case management: Waiver Case Management is provided by qualified case management providers, including county DSN boards and private agencies qualified by OIDD. Waiver case managers complete assessments and service plans and monitor services, up to 10 hours a month.

What Medicaid waivers and programs serve people with I/DD in South Carolina?

South Carolina has two 1915(c) waivers for people with intellectual or related disabilities: the Intellectual Disability/Related Disabilities (ID/RD) Waiver and the Community Supports (CS) Waiver. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. Both serve people of all ages who meet the level of care for an intermediate care facility for individuals with intellectual disabilities (ICF/IID). ID/RD is the larger waiver and includes residential services. Community Supports has no residential services and a yearly cost limit.

• ID/RD Waiver (1915(c), control number SC.0237): operating since 1991. Services include Residential Habilitation, day services (Day Activity, Career Preparation, Community Services and Support Center), individual and group Employment Services, Independent Living Skills, Adult Attendant Care, Adult Companion and Personal Care, Respite, Adult Day Health Care, Behavior Support, nursing, waiver case management, home and vehicle modifications, medical equipment, assistive technology and personal emergency response systems (PERS). Adult Attendant Care, Adult Companion and Personal Care for adults are limited to 34 combined hours a week, and Respite to 68 hours a month unless an exception is approved. SCDHHS reported 8,558 people enrolled in January 2026.
• Community Supports Waiver (1915(c), control number SC.0676): operating since July 1, 2009. Services include In-Home Support, Respite, the same day and employment services, Adult Day Health Care, Behavior Support, personal care, assistive technology, modifications, incontinence supplies, PERS and waiver case management. Each person's services must fit within an individual cost limit of $44,042 in waiver year 5 (up from $39,000 in year 1), not counting case management, according to the approved amendment. Short-term urgent needs may go up to $1,000 over the limit in state funds, and people with lasting higher needs may move to ID/RD without waiting on the ID/RD list. SCDHHS reported 2,590 people enrolled in January 2026.

To keep a slot in either waiver, a participant must receive at least two waiver services every calendar month. OIDD also runs the Head and Spinal Cord Injury (HASCI) Waiver, a related program for traumatic brain injury, spinal cord injury and similar disabilities rather than I/DD. Intermediate care facilities for individuals with intellectual disabilities (ICF/IID), including OIDD regional centers and community ICF/IIDs, remain the institutional option that the waivers are an alternative to.

Does South Carolina pay for I/DD services through managed care?

No. Both I/DD waivers are paid fee-for-service by SCDHHS, the Medicaid agency, according to the waiver documents. There are no health plans in between: providers bill Medicaid directly, and OIDD runs the waivers under contract with SCDHHS.

• Who delivers services: county DSN boards and private providers qualified by OIDD.
• Who coordinates services: waiver case managers from qualified case management providers write and monitor each service plan.
• How claims are sent: the SCDHHS HCBS Provider Manual says claims for these waivers can go through the Medicaid Web Tool or on a CMS-1500 form, and they are compared with prior authorizations.

Is there a waiting list for I/DD services in South Carolina?

Yes, and it is long. SCDHHS reported 21,671 people waiting for the ID/RD waiver and 18,244 waiting for Community Supports in January 2026. People can be on more than one list, so the two numbers should not be added together. Reserved capacity is filled first, and other slots go first come, first served by application date.

• Latest counts: the January 2026 SCDHHS waiver summary chart showed 21,671 waiting for ID/RD, 18,244 for Community Supports and 312 for HASCI. A year earlier, in January 2025, the lists were 19,822 for ID/RD and 16,129 for Community Supports, so each I/DD list grew by about 2,000.
• No newer count: the September 2026 chart no longer has a waiting list row. We did not find a newer published count.
• Changes to how lists work: an OIDD memo dated January 20, 2026 says SCDHHS is working to streamline waiting list processes across all its waivers. We did not find a description of the new process.
• Reserved capacity: the draft ID/RD renewal proposes setting aside slots each year for 20 people leaving ICF/IIDs, 50 people at risk of serious and imminent harm and 130 people entering OIDD-sponsored community housing. Community Supports reserves capacity for people in state-funded day services, ID/RD participants who choose Community Supports, and military families living in South Carolina.

For a person's place on a list, families can ask their case manager or call BHDD OIDD at 1-800-289-7012.

How do people apply for I/DD services in South Carolina, and how are budgets set?

People age 3 and older call BHDD OIDD at 1-800-289-7012, and children under 3 apply through BabyNet. After a screening, the family chooses an Intake provider who helps complete the eligibility process. The OIDD Eligibility Division then decides eligibility for OIDD services and ICF/IID level of care. South Carolina does not publish the name of the assessment tool it uses.

• Waiver eligibility: an intellectual disability or related disability that began before age 22 with substantial limits in three or more major life areas, Medicaid eligibility, ICF/IID level of care, a choice of community services over an institution, and an allocated waiver slot.
• People already in services: they ask their case manager or early interventionist to request a waiver slot.
• Assessment: a psychologist completes the initial level of care evaluation using a standardized instrument that the waiver does not name. Waiver case managers then do the initial and annual service assessments and the service plan. We did not find whether a named tool sets residential tiers, so ask OIDD.
• Budgets and limits: Community Supports has an individual cost limit ($44,042 in waiver year 5). ID/RD has no overall dollar limit in the research we reviewed, but some services have hour caps, such as 34 combined hours a week of attendant care, companion and personal care for adults.

What day and residential services can I/DD providers offer in South Carolina?

Providers can offer five day and employment services in both I/DD waivers, plus Adult Day Health Care, all paid on the SCDHHS fee schedule effective November 1, 2025. Most day services are billed in half-day units of 2 to 3 hours from facilities that OIDD licenses. Residential Habilitation is offered only in the ID/RD waiver, in several home types paid at daily rates tiered by need.

Day and employment services

• Day Activity: supports in a nonresidential setting to build, keep or slow the loss of personal care, social or adaptive skills. The facility is licensed by OIDD as an Adult Activity Center, Work Activity Center or Unclassified Program. Billed per half day ($41.63), with transportation included.
• Career Preparation: time-limited prevocational services that prepare people for competitive jobs at or above minimum wage. Same OIDD day facility license. Billed per half day ($41.63), with transportation included.
• Community Services: builds community participation, self-advocacy and social connections, provided from state-licensed facilities. Billed per half day ($41.63) for group or individual.
• Support Center: non-medical care and supervision in a group setting outside the home for people who cannot supervise themselves, provided in or from OIDD-licensed facilities. Billed per half day ($35.26). The research did not find a published ratio.
• Employment Services: supports to get and keep competitive, customized or self-employment. Individual job supports are billed in 15-minute units ($27.90), without transportation. Group services, such as mobile work crews and enclaves, are billed per half day ($41.63) with transportation. The research did not find a published ratio.
• Adult Day Health Care: health and social services for adults 18 and older for 5 or more hours a day, in a center licensed by the Department of Public Health and enrolled with SCDHHS. Staffing is at least 1 direct care staff for every 8 participants. Billed per day ($80.00), with ADHC Nursing at $15.00 a day.

Staff ratios: OIDD's day licensing standards set a minimum participant to staff ratio of 7:1 for Adult Activity and Work Activity Centers and 10:1 for Unclassified Programs, applied program-wide. These ratios apply to Day Activity, Career Preparation and Community Services.

Residential services (ID/RD only)

• Community Training Home II (CTH II) and Community Residential Care Facility (CRCF): staffed homes in the community. CTH II homes have no more than four residents, and CRCFs serve up to twelve. Daily rates run from $278.77 (Tier 1) to $386.55 (Tier 3 Intensive Support), and $536.86 for Tier 4 (forensic) and High Management (up to three people with dual diagnosis or extreme behaviors). Homes are licensed or certified under OIDD residential standards.
• Community Training Home I (CTH I): a foster care model where the person lives with a trained private family. Homes meet State Fire Marshal foster home rules and OIDD licensing. Paid daily at $91.76 (Tier 1) or $125.62 (Tier 2).
• Supervised Living Program II (SLP II): for people who need intermittent supervision, usually in an apartment with staff on site or within 15 minutes, 24 hours a day. SLP II settings are licensed. Paid $108.78 a day.
• Supported Living Program I (SLP I): occasional support in the person's own apartment or house, with staff available by phone 24 hours. Paid $21.49 per 15 minutes.
• Community Integrated Residential Services (CIRS): a step from 24-hour supervised living toward semi-independent living, where participants choose their providers, housemates and housing under a lease support agreement. We did not find who licenses CIRS settings.

Details on each home type are on BHDD's residential habilitation page.

How are I/DD provider rates set and how do agencies enroll in South Carolina?

SCDHHS sets the rates and publishes them in one HCBS waiver fee schedule, the current one effective November 1, 2025. To become a provider, an agency must first be qualified or verified by BHDD OIDD for each service, then enroll as a Medicaid provider with SCDHHS. EVV is not required for the I/DD waivers today.

• Rate method: for OIDD services, SCDHHS starts from provider cost reports (base year state fiscal year 2019), trends them forward with the Medicare Economic Index, and adds the direct care worker salary increases given from state fiscal year 2020 through 2026. The rates are tested against market or border state rates. New services and Residential Habilitation use rate models built by an outside consultant, according to the draft ID/RD renewal.
• Latest rate change: the November 1, 2025 schedule says it contains new rates as of that date, for example Day Activity at $41.63 per half day and a four-person Tier 1 residential home at $278.77 per day. The schedule does not mark which rates changed.
• Enrollment: BHDD's qualified provider application page explains the two steps. Services such as case management, day services, employment, residential habilitation and home supports need OIDD qualification. Services such as behavior support and modifications need OIDD verification. Each service needs its own application, and then the agency enrolls with SCDHHS.
• EVV: the SCDHHS HCBS Provider Manual says the ID/RD, Community Supports and HASCI waivers do not require the EVV billing system. A planned December 2022 launch on AuthentiCare for these waivers was postponed.

What is changing next for I/DD services in South Carolina?

As of October 23, 2026, we did not find a final, approved change with a set date for South Carolina's I/DD waivers. SCDHHS has proposed renewing the ID/RD waiver for five years, and it plans a new EVV system. Both are proposals or plans, not final decisions.

• ID/RD waiver renewal: the current ID/RD waiver expires December 31, 2026. SCDHHS posted a proposed renewal with a target start of January 1, 2027, pending federal approval. The listed changes are mostly technical: removing retired service titles (Personal Care I and II, nursing levels and ADHC transportation) and updating rates, billing, cost neutrality and quality sections. Public comments closed in September 2026.
• New EVV vendor: SCDHHS has awarded a new EVV contract to HHAeXchange and says the new system will expand EVV to all required services. We did not find whether or when this will include I/DD waiver services.
• Other renewals ahead: the Community Supports waiver expires June 30, 2027, with its next renewal due July 1, 2027. The HASCI waiver expires June 30, 2028.
• Waiting list process: SCDHHS is working to streamline waiting lists across all waivers. We did not find details or a date.

South Carolina I/DD sources

• BHDD Office of Intellectual and Developmental Disabilities: Waivers
• BHDD OIDD: ID/RD Waiver
• BHDD OIDD: Community Supports Waiver
• SCDHHS: Waiver Summary Chart (January 2026)
• OIDD memo: Update on Waiver Waiting List Additions (January 20, 2026)
• SCDHHS: Draft ID/RD Waiver Renewal Application (proposed January 1, 2027)
• SCDHHS: Approved Community Supports Waiver Amendment
• SCDHHS: HCBS Waiver Fee Schedule (effective November 1, 2025)
• BHDD: OIDD Qualified Provider Application
• SCDHHS: HCBS Provider Manual

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Developmental Disabilities vs. Mental Health: Key Differences
• Disability Services DayHab has a dilemma - how to solve it
• I/DD services in every state (map)
• South Carolina EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.