Self-Direction and FMS in South Dakota
Self-Direction and FMS in South Dakota
All states: self-direction map
In short: Two DHS waivers are self-directed: Family Support 360 (Consumer Direct co-employer or Acumen fiscal agent) and ADLS for adults with quadriplegia.
South Dakota self-direction at a glance
| Self-directed programs | Family Support 360 Waiver and Assistive Daily Living Services (ADLS) Waiver |
|---|---|
| FMS model | Both. Family Support 360 offers Agency with Choice (co-employer) or a common-law employer option with a fiscal agent. ADLS uses provider agencies as co-employers. |
| FMS vendors | Family Support 360: Consumer Direct Care Network South Dakota (co-employer) or Acumen Fiscal Agent (common-law option). ADLS: four DHS-contracted provider agencies. |
| Who is the employer | Depends on the option. The vendor or agency is employer of record under co-employment. The person or a representative is employer of record under the common-law option. |
| Can family be paid | Yes, with limits. Family Support 360 bars a minor's parent, a spouse or partner, and the representative. ADLS allows spouses, parents and adult children. |
| EVV for self-directed workers | Partly. Only personal care (S5125) in both waivers, through the state's free FOCoS system or an approved alternative. |
| Budget authority | Yes in Family Support 360. Not confirmed for ADLS. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in South Dakota offer self-direction?
South Dakota offers self-direction in two Medicaid home and community based services waivers, both run by the Department of Human Services (DHS): the Family Support 360 Waiver and the Assistive Daily Living Services (ADLS) Waiver. Family Support 360 serves children and adults with intellectual and developmental disabilities. ADLS serves adults with quadriplegia. We did not find a statewide self-directed option for older adults.
- Family Support 360 Waiver (FS 360): serves children and adults with intellectual and developmental disabilities who live with family or on their own. It is run by the DHS Division of Developmental Disabilities (DDD), and each participant has a Family Support Coordinator. The participant, or a representative, has both employer authority and budget authority. Under the Agency with Choice option the self-directed services are Respite Care, Companion Care, Personal Care and Supported Employment. A DHS presentation from October 2025 says about 1,300 people are supported on the waiver.
- Assistive Daily Living Services (ADLS) Waiver: serves adults 18 and older with quadriplegia (a substantial functional limitation in all four limbs) who can direct their own attendants or choose a representative to do it. It is run by the DHS Division of Rehabilitation Services (DRS). Participants have employer authority: they recruit, screen, train and direct their personal attendants. The ADLS manual does not describe a participant-controlled budget, so we did not find budget authority confirmed for this waiver.
Employer authority means the person picks, trains and directs the workers. Budget authority means the person also has a say over how a set amount of money is spent on services. In Family Support 360, DHS describes an individualized budget used to self-direct services. The Family Support 360 billing manual lists monthly cost guides of about $3,500 for personal care, $3,500 for companion care, $2,500 for respite and $2,000 for supported employment, with exceptions decided case by case.
Two other South Dakota programs are sometimes confused with self-direction. The state's own waiver comparison sheet marks Family Support 360 as self-directed and the CHOICES waiver as not self-directed. The HOPE waiver has a service called Structured Family Caregiving that pays a stipend to a family caregiver, but a provider supports and trains that caregiver, so it is not a participant-directed option.
Who handles financial management services (FMS) in South Dakota?
It depends on the waiver and the option chosen. In Family Support 360, Consumer Direct Care Network South Dakota is the co-employer under Agency with Choice, and Acumen Fiscal Agent is the Financial Management Services provider under the common-law employer option. In ADLS, four provider agencies under contract with DHS act as co-employers. South Dakota does not use managed care for these services, so there is no health plan in the middle.
Family Support 360 has two employment options, and the state uses its own names for them:
- Agency with Choice (co-employer): the vendor is the employer of record, and the person or a representative is the co-employer who picks and directs the staff. DHS contracted Consumer Direct Care Network South Dakota for this role.
- Common-law employer option: the person or a representative is the employer of record. A Financial Management Services provider handles payroll, taxes and new hire paperwork on the employer's behalf. The state's posted Acumen FAQ names Acumen Fiscal Agent in this role.
DHS says Family Support 360 originally had five co-employment vendors. They gave notice to end the service after changes in federal retirement law, DHS contracted Consumer Direct Care Network South Dakota, and people moved over from June to November 2024. The DHS page also says a few people still using the Huron Area Center for Independence were to switch by May 31, 2025. That date has passed and the page has not been updated, so we could not confirm whether Consumer Direct is now the only co-employment vendor.
The state does not publish how many participants use each option. We also did not find a state document that sets out how a family moves from one option to the other. A Family Support Coordinator, or Dakota at Home at 833-663-9673 (Option 2), can explain the choices.
In ADLS the model is agency co-employment. The participant exercises employer authority as a co-employer, and the contracted provider agency carries duties such as payroll, tax withholding, background checks and labor law compliance. A DHS presentation from October 2025 says services are delivered statewide through four contracted in-home providers that serve as the employer of choice. We did not find the names of those four agencies in the state sources we read. Ask DRS at 605-773-3195 or InfoRS@state.sd.us.
Who can be a paid caregiver under self-direction in South Dakota?
Family members can be paid in both waivers, but the rules differ. In Family Support 360, a family member can be the paid provider of personal care, companion care or supported employment unless that person is a minor participant's parent, the parent's spouse or significant other, or the participant's own spouse or significant other. ADLS is more open: its manual says the waiver encourages employing spouses, parents or adult children as personal attendants.
Important: In Family Support 360, the person chosen as the participant's representative for employer tasks cannot also be employed as the participant's staff. A family that wants one relative to be paid needs a different person to act as representative.
- Family Support 360: the parent of a minor cannot be the employee. Neither can the parent's spouse or significant other, the participant's spouse or significant other, or the participant's representative. Other relatives can be paid if they meet the provider requirements. These limits come from the Family Support 360 billing manual and a DHS FAQ on the two employment options.
- ADLS: spouses, parents and adult children may be personal attendants, and the DRS program page says family or friends may be paid if they qualify. One limit applies to respite: an ADLS respite worker may not live with the participant or be the participant's primary caregiver.
Hours and pay work differently under each Family Support 360 option. Under Agency with Choice, staff may be subject to hour limits set by the co-employer's policies. Under the common-law option, the employer sets the hours. The Fair Labor Standards Act applies to both. The DHS FAQ says a self-directing employer can in some cases negotiate the wage, which must be at least minimum wage and not above a reasonable or customary wage for care providers. We did not find a published weekly hour cap for family caregivers in either waiver.
Does EVV apply to self-directed workers in South Dakota?
Partly. Electronic visit verification (EVV) applies to self-directed personal care (billing code S5125) in both Family Support 360 and ADLS, and has since January 1, 2021. It does not extend to the other self-directed services in the sources we read. South Dakota uses an open vendor model: the state offers its FOCoS system free of charge, and a provider may use another system with state approval.
- ADLS: the ADLS manual says providers must use EVV to substantiate every personal attendant claim, and each visit must be signed by the attendant. Services that are not documented are subject to recoupment on audit. Manual entries are not counted as compliant and should not exceed 25 percent.
- Family Support 360: claims are submitted electronically through FOCoS. The Family Support 360 manual, updated October 2025, has no EVV section and no rule that denies a claim for lack of EVV. The state's EVV manual is the source for EVV applying to personal care in this waiver.
- Aggregator: the state's EVV manual says the Therap Aggregator is not required for either program.
Several points could not be confirmed. We did not find a published claims edit that automatically denies an ADLS or Family Support 360 claim without a matching EVV record. The ADLS rule is that claims must be backed by EVV and can be recouped on audit. We did not find a published EVV exemption for live-in caregivers in either waiver. And while the Acumen FAQ says workers under the common-law option enter their time in Acumen's DCI portal, it does not say whether that entry is the approved EVV record for personal care or whether it feeds FOCoS. For Family Support 360 questions ask DDD through Dakota at Home at 833-663-9673 (Option 2). For ADLS ask DRS at 605-773-3195.
What is changing next for self-direction in South Dakota?
We did not find an upcoming change to self-direction in South Dakota as of the last check on October 13, 2026. No new program, vendor change or rule change with a set date appears in the state sources we read. One planned change is on hold.
DDD had planned an amendment to the Family Support 360 waiver. At a town hall in May 2025 the division said it had paused that amendment because of federal uncertainty, and that current services stay the same. We did not find a restart date or any later notice. The same presentation cited more than 150 families waiting for the waiver.
The most recent change that has already happened is the move of Family Support 360 co-employment to Consumer Direct Care Network South Dakota in 2024, described above. Anyone planning around these programs should check the Family Support 360 page for new notices, since some DHS pages have not been updated since the 2025 deadlines passed.
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Who to ask about self-direction in South Dakota
Questions about self-direction in South Dakota are best put to the state. Start with Family Support 360 (DHS Division of Developmental Disabilities). Published contact: Dakota at Home 833-663-9673, Option 2, or DDDIntakeProcess@state.sd.us (Family Support 360); 605-773-3195 or InfoRS@state.sd.us (ADLS).
South Dakota self-direction sources
- South Dakota DHS: Family Support 360
- South Dakota DHS: Agency with Choice
- South Dakota DHS: Common-Law vs. Agency with Choice FAQ (January 2022)
- South Dakota DHS: Family Support 360 Acumen FAQ
- South Dakota Medicaid: Family Support 360 billing manual (updated October 2025)
- South Dakota Medicaid: Assistive Daily Living Services billing manual (updated April 2025)
- South Dakota Medicaid: Electronic Visit Verification manual
- South Dakota DHS: Waivers presentation (October 28, 2025)
- South Dakota DHS: Family Support 360 town hall presentation (May 2025)
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
- Self-direction in every state (map)
- South Dakota EVV requirements
Page history
- October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
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Questions about EVV?
EVV is still to be implemented in most of the states with different guidelines and regulations. We’re keeping up with the updates related to EVV implementation and if there is something we haven’t included, please share with us. To learn how ankota can help in ensuring compliance, please get in touch with us.
South Dakota self-direction questions
Who is the FMS vendor for self-direction in South Dakota?
It depends on the program. In Family Support 360, Consumer Direct Care Network South Dakota is the co-employer under Agency with Choice, and Acumen Fiscal Agent is the fiscal agent under the common-law employer option. In the ADLS waiver, four provider agencies under contract with DHS act as co-employers, and the state sources we read do not name them.
Can a parent be paid to care for a child on Family Support 360?
Not for a minor child. The Family Support 360 manual says the parent of a minor participant cannot be the paid provider, and the same applies to the parent's spouse or significant other. Other family members can be paid for personal care, companion care or supported employment if they qualify.
Can a spouse be paid as a caregiver in South Dakota participant direction?
It depends on the waiver. In Family Support 360 the participant's spouse or significant other cannot be the paid provider. In ADLS the manual says the waiver encourages employing spouses, parents or adult children as personal attendants.
Who is the employer when someone self-directs in South Dakota?
In Family Support 360 it depends on the option. Under Agency with Choice the vendor is the employer of record and the person or a representative is the co-employer. Under the common-law option the person or a representative is the employer of record, and a fiscal intermediary handles payroll and taxes. In ADLS the contracted provider agency and the participant are co-employers.
Does EVV apply to self-directed workers in South Dakota?
Only for personal care. Electronic visit verification has applied to self-directed personal care (S5125) in Family Support 360 and ADLS since January 1, 2021. Providers can use the state's free FOCoS system or another system the state approves. We did not find a published exemption for live-in caregivers.
Do participants control a budget under consumer direction in South Dakota?
In Family Support 360, yes. DHS describes an individualized budget used to self-direct services, and the billing manual lists monthly cost guides for each service with exceptions decided case by case. For ADLS the manual names only employer authority, so we did not find a participant-controlled budget confirmed.
Is there a self-directed Medicaid option for older adults in South Dakota?
We did not find one. The HOPE waiver has Structured Family Caregiving, which pays a stipend to a family caregiver, but a provider supports and trains that caregiver, so it is not participant direction. The two self-directed waivers serve people with intellectual and developmental disabilities and adults with quadriplegia.
Is South Dakota changing its self-direction programs soon?
We did not find an upcoming change as of October 13, 2026. The Division of Developmental Disabilities paused a planned Family Support 360 waiver amendment in May 2025 and said current services stay the same. No restart date was found.