I/DD Waivers in South Dakota

All states: Medicaid disability services map

South Dakota I/DD services at a glance

Last verified against state sources: 2026-10-28.

Who runs I/DD services in South Dakota?

The Division of Developmental Disabilities (DDD) in the South Dakota Department of Human Services (DHS) runs the state's two I/DD waivers day to day. The Department of Social Services (DSS) is the state Medicaid agency that oversees them and makes the final Medicaid financial decision. People start through Dakota at Home, the DHS front door for services.

• DDD (Department of Human Services): operates the CHOICES and Family Support 360 waivers, decides whether a person has a developmental disability and meets the level of care, and certifies the agencies that provide CHOICES services.
• Department of Social Services (DSS): the state Medicaid agency. It confirms Medicaid financial eligibility and enrolls providers in South Dakota Medicaid.
• Front door: Dakota at Home is the DHS No Wrong Door line, live since June 1, 2023. Call 833-663-9673, Option 2, or email DDDIntakeProcess@state.sd.us to reach a DDD intake specialist.
• Case management: CHOICES participants choose a conflict-free case management provider, which cannot also provide their other CHOICES services. Family Support 360 participants choose a Family Support Service Coordinator from a provider in their area.

About 6,500 people are supported across the two waivers, according to the South Dakota Council on Developmental Disabilities FFY 2025 annual report.

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

South Dakota has two 1915(c) waivers for people with intellectual or developmental disabilities: CHOICES and Family Support 360 (FS360). A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. Both are run by DDD and both require the level of care of an intermediate care facility for individuals with intellectual disabilities (ICF/IID).

• SD CHOICES Waiver (1915(c), control number 0044.R09.00): CHOICES stands for Community, Hope, Opportunity, Independence, Careers, Empowerment, Success. It is the more intensive of the two waivers and serves children and adults with supports that range from a few hours to around the clock. Services include conflict-free case management, residential habilitation (group home, supervised living, supported living and family home), shared living, day services, career exploration (prevocational services), individual and group supported employment, small group vocational support, assistive technology, and specialized medical equipment and drugs. CMS lists the current approval as effective June 1, 2023, through May 31, 2028.
• SD Family Support 360 Waiver (1915(c), control number 0338.R05.00): serves people with intellectual or developmental disabilities who live with their families or in their own homes. DDD describes it as self-directed. Services include support coordination, personal care, respite, companion care, supported employment, environmental accessibility adaptations, vehicle modifications, specialized medical adaptive equipment and supplies, nutritional supplements and specialized therapies. CMS lists the current approval as effective June 1, 2022, through May 31, 2027.

Two other South Dakota waivers, Assistive Daily Living Services (0264) and HOPE (0189), serve people with physical disabilities and older adults, not people with I/DD, so they are not counted here. We did not find any other Medicaid authority, such as a 1915(i) or 1115 program, used for I/DD services. About 160 people live in three ICF/IID settings, the state-run South Dakota Developmental Center and two private facilities for youth, which are the institutional option the waivers are an alternative to.

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

No. South Dakota pays for I/DD waiver services fee-for-service, which means the state pays enrolled providers directly for each service using published state fee schedules. No health plan sits between the state and the provider. Coordination is done by provider agencies: conflict-free case managers in CHOICES and Family Support Service Coordinators in FS360.

• CHOICES: paid from the DHS CHOICES waiver fee schedule, with each service's rate and billing unit.
• Family Support 360 Agency With Choice: families who use the Agency With Choice option, where an agency acts as co-employer of the workers the family chooses, have all been served by Consumer Direct Care Network South Dakota since May 2025, after a late 2024 waiver amendment.

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

For Family Support 360, yes. The South Dakota Council on Developmental Disabilities reported a waiting list of about 180 people with a wait of about 8 months in its FFY 2025 annual report, which covers the year ending September 2025. The CHOICES waiver has no waiting list, although individual providers may keep their own waits for openings.

• Why there is a wait: the Council report ties the FS360 list to state budget limits and a lack of provider openings.
• Priority order: under the DDD Application Guide, if a waiting list forms, DDD gives priority to people at significant risk: those whose health, welfare or safety is in jeopardy, those at imminent risk of entering an institution, and those already in one.

For a person's place on the FS360 list, families can contact Dakota at Home at 833-663-9673, Option 2.

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

A person or family contacts Dakota at Home, then sends DDD a completed DDD Services Application. DDD uses the Inventory for Client and Agency Planning (ICAP) to decide level of care, usually within 45 days of a complete application. DSS then makes the final Medicaid financial decision.

• Application: the DDD Services Application, a psychological evaluation (or a Birth to 3 assessment for children ages 0 to 3), and signed choice, rights and fair hearing forms, as listed in the DDD Application Guide.
• Level of care: the ICAP must show substantial functional limitations in three or more areas, which establishes ICF/IID level of care for both waivers.
• Financial eligibility: under ARSD 67:54:09:12, the person must receive SSI, or be aged, blind or disabled with income under 300 percent of the SSI standard benefit.
• Support levels: CHOICES group home and supervised living rates are set by support tier (1 to 6) and home size. We did not find how DDD assigns a person to a tier or how individual budgets are set. Ask DDD.

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

CHOICES pays for day services, career exploration, supported employment and several kinds of residential habilitation. All are delivered by a Community Support Provider, an agency certified by DDD and accredited by a national quality assurance organization the division designates, under ARSD 46:11:02:02. Staff ratios and billing units come from the SFY2026 CHOICES fee schedule.

Day and employment services (CHOICES)

• Day Services: support for meaningful daytime activities, relationships, independence and skill building, without paid wages. Billed by the hour. Ratios: facility basic 1:8, facility intermediate 1:5, facility enhanced 1:3, community 1:4 or 1:2, virtual 1:6, and behavioral support 1:2.
• Career Exploration (prevocational): time-limited help to find and build skills for integrated, competitive jobs. Billed by the hour, at 1:5 in a facility and 1:4 in the community.
• Supported Employment: individual supported employment helps a person get and keep a competitive job at or above minimum wage, at 1:1 and billed in 15-minute units. Group supported employment (1:4) and small group vocational support (1:8) are billed by the hour. Supported employment is also an FS360 service.

Residential services (CHOICES)

• Group Home: provider-run residential habilitation with help with daily living, cooking, cleaning and community activities. Paid daily by support tier (1 to 6) and home size (1 to 8 or more residents). DDD and DSS monitor compliance with the federal HCBS settings rule.
• Supervised Living and Supported Living: less intensive support for people in their own or leased homes. Supervised living is paid daily by tier and home size. Supported living is billed in 15-minute units for intermittent support.
• Shared Living (host home): the participant lives in a private home with a shared living provider, who may or may not be family, with up to two participants per provider, paid daily by level. A DDD-certified agency contracts with both the shared living provider and the participant, as described in the South Dakota Shared Living Guide.

For FS360 services such as personal care, respite and companion care, we did not find a published billing unit or rate in the research. Check the DSS Family Support 360 billing manual or ask DDD.

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

CHOICES rates rest on a 2021 independent rate study that built each rate from wages, benefits, administration, program support and transportation. Guidehouse reviews the rates each year and proposes benchmark rates, but the final rates depend on what the Legislature funds. Agencies need DDD certification, national accreditation and South Dakota Medicaid enrollment through DSS.

• Latest rate change: the SFY2026 CHOICES fee schedule took effect June 1, 2025, with modest increases. For example, facility basic day services rose from $9.51 to $9.73 per hour. Conflict-free case management is $16.65 per 15 minutes from July 1, 2025. The 2024 rate review had proposed an average increase of about 8 percent. We did not confirm a SFY2027 schedule.
• Certification: CHOICES Community Support Providers must be certified by DDD under ARSD chapter 46:11:02 and accredited by a national quality assurance organization DDD designates.
• Medicaid enrollment: agencies enroll through the DSS Provider Enrollment Portal and send supporting documents to SDMedicaidPE@state.sd.us within 30 days.
• EVV: FS360 personal care (billing code S5125) has required electronic visit verification (EVV) since January 1, 2021, according to the DSS EVV manual. DDD offers the FOCOS EVV system at no cost, and providers may ask for approval to use another system that meets the minimum requirements. FS360 services do not currently have to send EVV data to the state's Therap aggregator, which home health and private duty nursing must use. The manual lists no CHOICES services as EVV services.

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

Revised DDD rules take effect November 5, 2026. They cover critical incident reporting, cost report deadlines and insurance requirements, and they align CHOICES services in rule with the federally approved waiver. Separately, the Family Support 360 waiver's current federal approval ends May 31, 2027, so a renewal is due by then.

• DDD rule changes: the revised rules in ARSD chapter 46:11 were filed October 16, 2026, under rules docket 957. Providers should review the final text for the new incident reporting, cost report and insurance requirements.
• Family Support 360 renewal: as of October 28, 2026, we did not find a draft renewal or public comment period. Watch DHS and DSS notices for one.

A recent change is already in place: a December 2024 CHOICES amendment, since approved, lets CHOICES providers serve participants out of state when they are approved and in good standing in that state.

South Dakota I/DD sources

• South Dakota DHS: Division of Developmental Disabilities
• South Dakota DHS: DDD Application Guide
• CMS: SD CHOICES Waiver (0044)
• CMS: SD Family Support 360 Waiver (0338)
• CMS: South Dakota waiver fact sheet
• South Dakota Council on Developmental Disabilities: FFY 2025 annual report
• South Dakota DHS: SFY2026 CHOICES waiver rates
• South Dakota DSS: Electronic Visit Verification manual
• ARSD 46:11:02:02 (Community Support Provider certification)
• South Dakota rules docket 957 (DDD rule revisions)

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• What is Active Support in Disability Services?
• I/DD services in every state (map)
• South Dakota EVV requirements

Page history

• October 28, 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.