How South Carolina pays for disability services

Waiver inventory

The Pervasive Developmental Disorder (PDD) waiver and the CHANCE waiver are listed as inactive. South Carolina has no 1915(i), 1915(b)(3) or 1915(k)/Community First Choice authority for this population in the sources retrieved. SCDHHS waivers index; CMS SC waiver factsheet

Note on agency structure: the Department of Disabilities and Special Needs (DDSN) was folded into the new Department of Behavioral Health and Developmental Disabilities (BHDD) as the Office of Intellectual and Developmental Disabilities (OIDD). Waiver amendments effective January 1, 2026 replaced DDSN references with OIDD. SCDHHS waiver amendment notice

State-only funded programs

All from the FY2024 DDSN Accountability Report, J160, which reports General / Other / Federal / Total by state-funded program number. Note that DDSN's Medicaid earnings appear in the "Other" column, not "Federal," so the General column is the closest proxy for state-only dollars.

• State-funded Residential Services: serves 226 people as of September 30, 2024 where traditional Medicaid reimbursable supports are not appropriate or not available, including people presenting after hospitalization, incarceration or psychiatric treatment. The agency requested $9,275,380 recurring general funds for FY2026 to support 48 additional people. Administering agency: OIDD (formerly DDSN). DDSN FY26 budget presentation
• In-Home Family Supports: at-home family supports to prevent institutionalization, serving 4,031 people through state-funded Individual and Family Support. FY2023 actual $41,769,299 total ($2,247,119 General, $39,522,180 Other); FY2024 projected $41,627,428.
• Autism Family Support Services: at-home family supports for people with an autism diagnosis. FY2023 actual $1,375,766 General; FY2024 projected $1,333,671.
• Autism Community Residential Program: residential services for people with an autism diagnosis. FY2023 actual $2,267,752 total ($1,373,377 General, $894,375 Other); FY2024 projected $3,028,548.
• Head and Spinal Cord Injury Family Support: at-home supports for HASCI-eligible people. FY2023 actual $7,952,492; FY2024 projected $7,997,287.
• Children's Services / Early Intervention ages 3 to 6: serving 4,398 children, to mitigate developmental disabilities. FY2023 actual $16,010,181 total ($2,542,908 General, $13,467,273 Other); FY2024 projected $16,104,716.
• State-funded Case Management: 478 people; State-funded Community Services at home: 141 people. DDSN FY26 budget presentation
• Greenwood Genetic Center: genetic and metabolic research and therapies for the IDD population. FY2023 actual $10,169,753 ($7,768,600 General); FY2024 projected $10,685,571. Plus the South Carolina Genomic Medicine Initiative at $2,000,000 per year rising to $4,000,000 projected.
• Special Olympics of South Carolina: $300,000 pass-through under Proviso 118.18. Other FY2024 pass-throughs included the Unumb Center for Neurodevelopment at $5,000,000 and the ALS Association at $500,000.

County / regional / local funding

South Carolina delivers services through 37 county Disabilities and Special Needs (DSN) Boards plus roughly 145 qualified private providers. County DSN Boards are quasi-governmental local bodies whose boards of directors are appointed by the local legislative delegation or another governmental body, with a minimum of five members serving four-year terms, authorized under S.C. Code Title 44 Chapter 20. 2023 Annual Report on County DSN Boards

Mechanism: each board's revenue is categorized as Federal (HUD, SCDOT vehicle grants, SNAP/CACFP), State Agency (Medicaid and DDSN payments for services rendered), Local (county contributions, United Way, donations), Client Revenue (room and board fees in residential settings), and Miscellaneous.

Scale: local county appropriations are a very small share. The report's per-board profiles show, for York County DSN Board in FY23, total revenue of approximately $18.2 million of which State Agency revenue was $16,602K, Local was $121K (0.7 percent), Client Revenue including SSI was $1,044K, Miscellaneous $406K and Federal $0K. The report presents these per board and does not publish a consolidated statewide local-appropriation total, so a statewide figure is not available. There is no county mill levy or dedicated local DD tax in South Carolina.

Funding scale

• Number of people DDSN-eligible: 38,923 as of September 30, 2024. Approximately 23,000 receive at least one service each month. DDSN FY26 budget presentation
• People in Medicaid HCBS waivers as of September 30, 2024: 8,416 supported at home through waivers plus 3,790 receiving residential services through waivers, roughly 12,206 total. Plus 446 in provider-operated Medicaid ICFs/IID, 535 in DDSN-operated Regional Centers (Medicaid ICFs/IID), 1,367 with Medicaid Targeted Case Management. Same source.
• Medicaid HCBS DD waiver spending: Intellectual Disability Community Residential FY2023 actual $122,827,072 (General $17,919,266, Other $104,773,971, Federal $133,835); FY2024 projected $122,946,783. Regional Centers Residential Program (state ICF/IID) FY2023 actual $95,838,049 (General $59,019,162, Other $36,818,887); FY2024 projected $105,702,696. FY2024 Accountability Report J160
• State vs federal share: the accountability report's column structure makes a clean split difficult, because Medicaid earnings post to "Other Funds" rather than "Federal Funds." For community residential, general funds were $17.9 million against $104.8 million of other funds in FY2023. For the state-operated Regional Centers, general funds were $59.0 million against $36.8 million other.
• FMAP: 69.53 percent FY2026 (69.67 percent FY2025). MACPAC Exhibit 6
• Spending per participant: not published. Not calculated here, because the waiver residential total and the residential headcount come from different reporting periods.
• Waiting list, residential: 286 people determined to need residential services as of September 30, 2024, average wait 10.6 months, with 108 people waiting more than 12 months and 24 supported in institutional respite at a Regional Center while awaiting long-term placement. By August 30, 2024 the figure had risen to 310. Of the 286, 59 percent were ID/RD eligible, 33 percent ASD, 8 percent HASCI; 80 percent had a co-occurring mental health diagnosis. DDSN FY26 budget presentation
• Waiting list, waivers: 19,295 for ID/RD and 15,511 for Community Supports as of November 2024, with HASCI at 325 and a reported wait of five or more years (secondary). SC Waiver Waiting List Fact Sheet, January 2025. These two lists overlap heavily, since people commonly sit on both.
• Aging caregivers, a leading driver of future residential demand: 4,202 people supported by a caregiver aged 55 or older, 2,274 by a caregiver 65 or older, 1,233 by a caregiver 72 or older, 879 by a caregiver 75 or older, 486 by a caregiver 80 or older, as of September 2024. Same source.

Residential funding detail

South Carolina funds residential habilitation under the ID/RD waiver in eight daily tiers plus one hourly tier, mapped to three licensed setting types. From the HCBS provider manual and the HCBS Waiver Fee Schedule effective November 1, 2025:

• CTH I (Community Training Home I), a host home / family-model setting in the support provider's own licensed home, up to three people. CTH Tier 1 $91.76 per day (T2016 U1); CTH Tier 2 $125.62 per day (T2016 U2) for people needing additional supports.
• CTH II (Community Training Home II), a provider-operated group home. Tier 1 $278.77, Tier 2 $329.61, Tier 3 $386.55, Tier 4 (forensic) $536.86, all per day for up to four people. 3-person High Management $536.86 per day for people with a dual diagnosis of intellectual disability and mental illness or extremely challenging behaviors.
• CRCF (Community Residential Care Facility), up to twelve people, used for Tiers 1, 2 and 3.
• SLP II (Supervised Living Program II), a licensed single or double-occupancy residence, $108.78 per day (T2016 U3).
• SLP I, support in the person's own apartment or home with 24-hour phone availability, billed hourly rather than daily: $21.49 per 15 minutes (T2017), set by an annual assessment of support needs.
• ICF/IID: 535 people in five DDSN/OIDD-operated Regional Centers and 446 in provider-operated facilities, as of September 2024. These are institutional, not waiver, and funded under the Regional Centers Residential Program line.
• Community Supports waiver has no residential habilitation. Its in-home analogue is In-Home Support at $16.28 per hour (T2025).

Payment structure: per diem with acuity tiers for congregate and host home settings, hourly for the least intensive supported living tier. There are no separate room and board add-ons in the rate.

Room and board is not state-funded and falls to the individual. The provider manual states plainly that "payments for Residential Habilitation are not made for room and board, the cost of facility maintenance, upkeep and improvement," except for modifications required to assure resident health and safety. The county DSN board financial reports confirm this in practice: "Client Revenue" is defined as fees charged for room and board in some residential services locations, and includes SSI. For York County alone this was $1,044K in FY23.

People receiving residential habilitation at a daily rate may not also receive Adult Companion services.

Rate structure link: HCBS Waiver Fee Schedule effective November 1, 2025

Comparable service rates

All rates from the ID/RD waiver section of the HCBS Waiver Fee Schedule, effective November 1, 2025.

Official rate schedule links

• HCBS Waiver Fee Schedule, effective November 1, 2025 (covers ID/RD, Community Supports, HASCI, Community Choices, MCC)
• HCBS Waiver Fee Schedule, effective October 1, 2025
• SCDHHS fee schedules index
• ASD Services Fee Schedule, effective July 1, 2026
• HCBS Provider Manual
• CLTC Provider Manual, October 1, 2025
• ID/RD waiver document SC.0237.R06.04

Notable features and flags

• January 1, 2026: state agency restructuring took effect in the waivers. DDSN became the Office of Intellectual and Developmental Disabilities within the new Department of Behavioral Health and Developmental Disabilities. Waiver amendments replaced all DDSN references with OIDD and all DHEC references with the Department of Public Health. SCDHHS waiver amendment notice
• November 1, 2025: waiver amendments updated reserved capacity categories and participant counts, modified waiver entrance selection policies, and refreshed point-in-time participant counts. New respite rates took effect the same date (marked "New Rates As Of 11/1/25" on the fee schedule). Same source.
• January 1, 2026: amendments revised critical incident definitions to align with the CMS Access Rule, and added language permitting remote monitoring and enabling technologies in residential habilitation, career preparation, support centers and employment services. This is a meaningful capacity lever given direct support workforce shortages. Same source.
• FY2026 budget request: DDSN sought $9,275,380 recurring general funds for state-funded residential services for 48 people, plus $17,500,000 non-recurring capital to create residential capacity for 100 people awaiting services, computed at $175,000 per person. DDSN FY26 budget presentation
• FY2027 budget request: OIDD sought $25,000,000, comprising $21,000,000 recurring for operations sustainability ($10,000,000 operational capacity, $4,500,000 ICF state match, $6,500,000 for 203 new direct support professional positions at Regional Centers) and $4,000,000 non-recurring for deferred maintenance on community-owned homes, since providers would accept 45 buildings if deferred maintenance were performed. BHDD FY27 budget presentation
• Waiting list scale is the dominant policy fact: roughly 19,295 on the ID/RD list and 15,511 on the Community Supports list as of November 2024 (secondary), against approved ID/RD capacity of 13,630. The agency's own narrower residential-need list stood at 286 in September 2024 with an average 10.6 month wait. South Carolina has no managed care carve-in for IDD long-term services and supports and no published self-direction option for the ID/RD or CS waivers in the sources retrieved.

Confidence

Solid: every rate in the comparable services table, taken verbatim from the November 1, 2025 HCBS Waiver Fee Schedule PDF; the eight-tier residential structure and its setting definitions from the HCBS provider manual; the room and board exclusion; the September 2024 headcounts (38,923 eligible, 23,000 served monthly, 8,416 at home through waivers, 3,790 in waiver residential, 226 in state-funded residential, 446 and 535 in ICF/IID); the residential waiting list of 286 with a 10.6 month average wait; the ID/RD approved capacity of 13,630 and 13,230; the FY2026 and FY2027 budget requests; the county DSN board structure and the York County revenue illustration; the FMAP. Estimated or secondary: the 19,295 and 15,511 waiver waiting list figures, which come from an advocacy fact sheet rather than SCDHHS, and are marked accordingly. Could not find: a published all-funds grand total for the agency, since the accountability report presents program rows without a total line and I did not want to publish my own sum as if it were sourced; Community Supports and HASCI waiver enrollment counts; ICF/IID per diem rates; a statewide consolidated total of county local appropriations, which the DSN board report presents only per board and largely as chart images that did not extract; the FY2026 enacted appropriation for the agency, as opposed to the request.

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