South Carolina Medicaid Waiver Waiting List: January 2025 Numbers and How to Register

The Scale of South Carolina's Waitlist Problem

South Carolina maintains one of the longest Home and Community-Based Services waiver waitlists in the United States. As of January 2025, the combined numbers across the two primary intellectual and developmental disability waivers tell the story:

• ID/RD Waiver (Intellectual Disability/Related Disabilities): 19,822 individuals waiting, with typical wait times of 5 to 10 years
• Community Supports Waiver: 16,129 individuals waiting, with typical wait times of 3 to 7 years

These lists are managed by the Office of Intellectual and Developmental Disabilities (OIDD), which operates under the newly created Department of Behavioral Health and Developmental Disabilities (BHDD). BHDD consolidated the former Department of Disabilities and Special Needs (DDSN), the Department of Mental Health, and the Department of Alcohol and Other Drug Abuse Services into a single cabinet-level agency as of April 2025.

The numbers mean that registering early — years before school services end — is the single most impactful step a family can take.

How the Two Waivers Differ

The ID/RD Waiver is the comprehensive option. It covers residential habilitation, day services, personal care, behavior support, assistive technology, and more. There is no annual service cost cap. To qualify, the individual must meet the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care, which requires documented intellectual disability or a related developmental disability that originated before age 22.

The Community Supports Waiver offers a capped package of services including behavior support, in-home care, respite, environmental modifications, and day programs. It is designed for individuals who live with family and need moderate support. The annual service cost limit distinguishes it from the comprehensive waiver, but the wait is still measured in years.

An individual can register on both waitlists simultaneously but can only be enrolled in one waiver at a time.

How to Register

The intake process begins with a single phone call:

1. Call BHDD-OIDD at 1-800-289-7012. Provide demographic information and general details about the applicant's disability.
2. Select intake service providers. The caller chooses three providers from a list read over the phone. OIDD forwards the referral to the chosen provider.
3. Clinical eligibility determination. The intake provider contacts the family within two weeks to collect medical, psychological, and educational records. These are submitted to OIDD to determine whether the applicant meets clinical eligibility criteria.
4. Waitlist placement. Once determined eligible, the individual is placed on the appropriate priority list. OIDD records a "date of request" and sends a letter confirming placement and position.

The date of request is everything. It establishes priority — the list operates on a date-of-request basis. Families should initiate intake as early as possible, ideally during childhood, to accumulate years of waitlist seniority before school services end.

Reserved Capacity: Bypassing the Waitlist

Under specific circumstances, an individual can bypass the ID/RD waiver waiting list and receive a priority slot through OIDD's Reserved Capacity rules. There are six qualifying situations:

1. Discharge from an ICF/IID facility — individuals transitioning from institutional to community settings
2. Foster care — children or youth in South Carolina DSS custody who need ID/RD waiver services
3. Changed circumstances for Community Supports participants — active CS Waiver participants whose needs now exceed the CS cost cap
4. Serious and imminent harm — individuals who need immediate waiver services to prevent harm, particularly those who have recently lost or are about to lose their primary caregiver
5. DDSN community-based housing — individuals approved for community-based housing sponsored, licensed, or certified by DDSN who are on the approved residential needs list
6. Military families — eligible dependents of active-duty service members maintaining South Carolina residence

The "serious and imminent harm" category is the most commonly relevant for transitioning families. If the primary caregiver becomes unable to provide care due to their own health crisis, the assigned waiver case manager can submit a formal "Request for Review of Reserved Capacity Waiver Slot" to BHDD-OIDD's central office.

What Happens When Your Turn Comes

When an individual nears the top of the list, their status changes to "processing" and enrollment activities begin. The process from that point:

• Active case management is approved for a 45-day period
• A Level of Care assessment is completed
• A service plan is developed
• A waiver slot is formally allocated

To keep the slot, the individual must receive at least two waiver services within the first 60 days of enrollment. Missing this requirement risks losing the allocation after years of waiting.

What to Do While Waiting

Years on a waitlist doesn't mean years without any support. Families should:

• Maintain SSI eligibility — SSI approval automatically triggers Healthy Connections Medicaid enrollment under South Carolina's Section 1634 agreement, which provides healthcare coverage independent of waiver services
• Use SCVRD services — the South Carolina Vocational Rehabilitation Department provides Pre-Employment Transition Services to students aged 13–21 and full VR services to eligible adults, regardless of waiver status
• Explore Palmetto ABLE — tax-free savings accounts protect assets without affecting SSI eligibility (first $100,000 is exempt from the resource limit)
• Keep eligibility records current — keep contact information current and respond promptly to OIDD correspondence

The South Carolina SSI at 18 & Adult Disability Benefits Guide includes a waiver tracking worksheet that logs your date of request, intake provider contact information, and annual status check documentation so nothing falls through during the multi-year wait.

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