South Carolina ICF/IID Level of Care for Waiver Eligibility

What the ICF/IID Level of Care Standard Means

Before South Carolina will enroll anyone in the ID/RD Waiver or Community Supports Waiver, the individual must meet the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care standard. This is the clinical gatekeeping step that determines whether someone qualifies for BHDD-OIDD waiver services.

The term sounds institutional, and it is — by design. Medicaid HCBS waivers exist as alternatives to institutional care. The federal government only funds waiver slots for people who would otherwise require the level of care provided in an ICF/IID facility. So to access community-based waiver services, an applicant must first demonstrate that they need institutional-level support, even though the whole point is keeping them out of an institution.

What BHDD-OIDD Reviews

BHDD-OIDD's ICF/IID Level of Care review addresses several elements:

A qualifying diagnosis. The individual must have a documented intellectual disability, or a condition related to intellectual disability (such as autism spectrum disorder, cerebral palsy, epilepsy, or another developmental disability), that manifests substantial functional limitations. The diagnosis must have originated before age 22.

Substantial functional limitations. The individual must demonstrate significant deficits in at least three of the following major life activities: self-care, receptive and expressive language, learning, mobility, self-direction, and capacity for independent living. The intake review considers whether these limitations are ongoing.

A need for supervision. The individual must need supervision because of impaired judgment, limited capabilities, behavior problems, abusiveness or assaultiveness, drug effect, or medical monitorship.

A need for services. The individual must need services directed toward acquiring behaviors for as much self-determination and independence as possible, or toward preventing or decelerating regression or loss of current optimal functional status.

How the Assessment Works

After you call BHDD-OIDD at 1-800-289-7012 and select an intake service provider, the provider coordinates the clinical evaluation. The assessment typically involves:

A review of existing medical, psychological, and educational records. School psychoeducational evaluations, IEP documentation, adaptive behavior assessments (Vineland-3 or ABAS-3), and medical diagnoses form the foundation of the clinical record.

A clinical interview with the individual and their family or caregivers. The evaluator assesses current functioning across the six major life activity domains.

A formal Level of Care determination. The intake provider submits the compiled documentation to BHDD-OIDD, which makes the eligibility decision. If approved, the individual is placed on the appropriate waiver priority list.

Why the Diagnosis Alone Isn't Enough

A common point of confusion: having an autism diagnosis or an intellectual disability diagnosis does not automatically mean someone meets the ICF/IID Level of Care. The diagnosis is necessary but not sufficient. The Level of Care assessment focuses on functional impact — what the person can and cannot do in daily life — not on the diagnostic label itself.

This is particularly relevant for autistic individuals with average or above-average IQs. An IQ score above the intellectual disability range doesn't disqualify someone from the ID/RD Waiver if their adaptive behavior deficits in self-care, self-direction, or independent living are substantial enough to meet the three-domain threshold.

The documentation that matters most is the adaptive behavior assessment. A Vineland-3 or ABAS-3 administered by a licensed psychologist produces standardized scores across communication, daily living skills, socialization, and motor skills. Those scores help document functioning across the relevant domains, but the assessment is part of BHDD-OIDD's broader Level of Care review rather than a single-score test.

Preparing for the Assessment

Gather clinical records early. Don't wait until the intake provider contacts you. Collect the most recent school psychoeducational evaluation (triennial reevaluations are required every three years under IDEA), any private psychological evaluations, developmental history from the pediatrician, and any psychiatric or neurological assessments.

Request current adaptive-functioning evidence. If the most recent Vineland or ABAS is outdated, ask the school psychologist or a private psychologist whether an updated assessment is appropriate. The Level of Care evaluation considers current functioning, not only historical scores.

Document daily living deficits concretely. The evaluator needs to know what the individual cannot do independently, not what they can do with maximum prompting. If your child needs hand-over-hand assistance with hygiene, cannot manage medication without supervision, or cannot navigate public transportation — document those specific limitations with examples.

Bring the IEP. The IEP's present levels of academic achievement and functional performance section contains exactly the kind of functional data the Level of Care evaluation uses. If the IEP documents that the student requires one-on-one paraprofessional support throughout the school day, that's strong evidence of the need for active treatment.

After the Determination

If BHDD-OIDD determines the individual meets the ICF/IID Level of Care, they're placed on the waiver priority list with a date of request. As of January 2025, the ID/RD Waiver waitlist had 19,822 individuals and the Community Supports Waiver waitlist had 16,129.

If the determination is denied, ask BHDD-OIDD or the intake provider what reconsideration or resubmission process is available and which additional documentation it will accept. New clinical evaluations, updated adaptive behavior assessments, or medical records that were not included in the original submission may help address the reason for the denial.

Our South Carolina SSI at 18 & Adult Disability Benefits Guide tracks the entire waiver eligibility process alongside SSI redetermination, Medicaid transitions, and decision-making options — ensuring that no deadline slips while you're waiting for one agency's response before contacting the next.

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