South Dakota CHOICES Waiver
What the CHOICES Waiver Covers
CHOICES — Community, Hope, Opportunity, Independence, Careers, Empowerment, Success — is South Dakota's comprehensive Medicaid waiver for individuals with intellectual and developmental disabilities who need intensive, ongoing support. Unlike Family Support 360 (the state's self-directed waiver), CHOICES is agency-directed: licensed Community Support Providers (CSPs) deliver services under the coordination of Conflict-Free Case Management (CFCM) agencies.
The waiver funds residential habilitation (group homes and shared living host homes), day services, supported employment, career exploration, assistive technology, and specialized medical equipment. The projected annual expenditure per participant is approximately $89,647, reflecting the high-intensity nature of the program.
CHOICES currently serves 2,690 individuals and does not maintain an active waitlist. However, enrollment is capped by state legislative appropriations, and the state retains the right to implement enrollment limits if budget constraints require it.
Who Is Eligible
CHOICES eligibility has two components: clinical and financial.
The clinical requirement is a qualifying developmental disability with onset before age 22, confirmed through a comprehensive psychological evaluation and the ICAP (Inventory for Client and Agency Planning) functional assessment. The ICAP must demonstrate substantial functional limitations in at least three of seven domains — self-care, language, cognitive competence, mobility, self-direction, independent living capacity, and economic self-sufficiency.
The financial requirement sets the individual's monthly income below $2,982 (300% of the 2026 Federal Benefit Rate) and countable resources below $2,000. Parental income is waived — only the applicant's own income and assets count.
Active Medicaid enrollment is required. For most SSI recipients in South Dakota, Medicaid is automatic under the state's 1634 agreement. Others must apply through the Department of Social Services.
How CHOICES Differs from Family Support 360
The two waivers serve different levels of support need with fundamentally different operating models.
CHOICES is designed for individuals who require structured, agency-directed supports — often 24-hour residential services or intensive day programming. The CSP organization manages staffing, scheduling, and service delivery. The case manager from a CFCM agency coordinates the overall plan.
Family Support 360 is self-directed. The individual and family control their own budget, hire their own staff, and determine when and how services are delivered. It covers personal care, companion services, respite, environmental adaptations, and specialized equipment — but not residential group homes. The projected annual expenditure is approximately $4,200 per person.
The key practical differences: CHOICES provides housing solutions and intensive staffing. Family Support 360 provides flexible supplemental funding for families who provide the primary support. Many families start on FS 360 while the young adult lives at home, then transition to CHOICES when the family can no longer provide daily care or when the individual's support needs increase.
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Community Support Providers
CSPs are the licensed organizations that deliver CHOICES services. They operate group homes, shared living arrangements, day programs, and supported employment services across South Dakota.
Provider capacity is the real constraint — even without a waiver waitlist, finding a specific residential opening or day program slot depends on which CSPs serve your area and whether they have staffing to take new participants. Rural South Dakota faces particular challenges with provider availability.
When you receive your CHOICES waiver assignment, your CFCM case manager will help identify CSPs in your region. Families can also contact providers directly to ask about availability, philosophy, and services offered. The DDD maintains a directory of licensed CSPs on the Department of Human Services website.
Getting Started
All waiver applications start with Dakota at Home (1-833-663-9673, Option 2). There is no separate CHOICES application — the DDD intake process determines which waiver best fits the individual's assessed needs. After the ICAP assessment and eligibility determination, DDD assigns participants to CHOICES or Family Support 360 based on the level of support required.
For families navigating the full transition from school services to adult waivers, the South Dakota SSI at 18 & Adult Disability Benefits Guide includes a Waiver Application Preparation Worksheet with a decision table comparing CHOICES and Family Support 360 side by side.
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