South Dakota CHOICES Waiver vs Family Support 360: Which Should You Apply For?

If you're deciding between the CHOICES waiver and the Family Support 360 waiver in South Dakota, the short answer is: CHOICES is for individuals who need intensive, agency-directed supports like group homes or 24-hour residential services, while Family Support 360 is for families who want flexible, self-directed control over a smaller budget to supplement natural supports at home. The decision depends on your child's support intensity and whether your family can manage the participant-direction responsibilities that FS 360 requires.

Both waivers are administered by the Division of Developmental Disabilities through the same Dakota at Home intake system (1-833-663-9673, Option 2), but they serve fundamentally different models of support delivery.

Side-by-Side Comparison

CHOICES Makes Sense When

Your child's support needs are intensive enough that family-based care alone won't work safely. Specifically:

• 24-hour residential support is needed: Group homes, shared living host homes, or other congregate settings where trained staff provide around-the-clock supervision and habilitation
• Day services or structured programming: Community-based day services, small group vocational support, and career exploration programs delivered by licensed providers
• The family cannot serve as primary caregivers long-term: Whether due to aging parents, caregiver health, sibling burnout, or the intensity of the individual's behavioral or medical needs
• Staffing and scheduling should be agency-managed: CHOICES uses licensed CSPs who handle hiring, training, scheduling, and compliance — the family doesn't need to recruit and manage direct support professionals

The tradeoff: CHOICES offers more intensive services but less family control over who provides them and how. Service delivery depends on local CSP capacity, and even with a waiver allocation, finding a physical placement or day service opening can involve wait times due to staffing shortages across South Dakota's provider network.

Family Support 360 Makes Sense When

Your child lives at home (or with family) and needs flexible support services that supplement what the family already provides. Specifically:

• Respite care: The number-one service families use through FS 360 — planned breaks for primary caregivers
• Personal care and companion services: Assistance with daily living activities, community participation, and social engagement
• Environmental adaptations: Home modifications (ramps, bathroom adaptations, sensory rooms) that allow the individual to live safely at home
• Vehicle modifications: Wheelchair lifts, hand controls, or other transportation adaptations
• Self-direction is a good fit: The family is comfortable managing a budget, hiring their own direct support professionals, acting as co-employer, and scheduling services

The tradeoff: FS 360's average $4,200/year budget is dramatically smaller than CHOICES. The self-directed model gives families more control but also more administrative responsibility — hiring, training, scheduling, and managing workers' compensation. And the ~8-month waitlist means clinical eligibility doesn't translate into immediate services.

The Waitlist Reality

This is the most important practical factor in the decision. CHOICES currently has no active waitlist — if your child meets clinical and financial eligibility, a case manager can begin plan development and provider matching relatively quickly (though local CSP capacity still affects how fast services actually start).

FS 360 has an active waitlist of approximately 198 individuals with an average wait of about 8 months. Both waivers are capped resources funded through annual legislative appropriations, so even CHOICES could implement enrollment limits in the future based on budgetary constraints.

Because of the FS 360 waitlist, families who know they want self-directed services should apply early — ideally before their child turns 18, during the transition planning window. The ICAP assessment and DDD eligibility determination (completed within 45 days of receiving a complete application) can happen while you're still deciding between waivers, since the clinical evaluation is the same for both.

Can You Switch Between Waivers?

Moving from FS 360 to CHOICES (or the reverse) is possible but involves a new plan development process with the appropriate case management entity. It's not a simple transfer — the service models are different enough that a new Person-Centered Individual Service Plan (ISP) must be developed.

Families who are uncertain sometimes apply for CHOICES initially (no waitlist) to begin receiving some level of support, with the understanding that they can pursue FS 360's self-directed model later if that better fits their family's situation. This isn't an officially recommended strategy — it's a practical reality that some families use to avoid the FS 360 waitlist.

The Decision Framework

The South Dakota SSI at 18 & Adult Disability Benefits Guide includes a fill-in CHOICES vs. Family Support 360 decision worksheet that walks you through the key factors systematically: support intensity, family caregiver capacity, self-direction readiness, service priorities, and timeline constraints. Instead of making the decision abstractly, the worksheet helps you evaluate each factor against your specific family situation.

For families who haven't started the DDD intake process, the guide also includes a Waiver Application Preparation Worksheet that covers the Dakota at Home intake packet checklist and the documentation you'll need for the ICAP assessment.

Who This Is For

• Families whose child is approaching 18 and needs to apply for DD waiver services through Dakota at Home
• Parents who have completed the DDD intake and need to decide which waiver to request
• Caregivers currently on the FS 360 waitlist who are evaluating whether CHOICES might better fit their child's needs
• Families planning early (ages 14–16) who want to understand the waiver landscape before the transition at 18

Who This Is NOT For

• Families outside South Dakota — each state's waiver structure, caps, and waitlists are different
• Individuals who need only standard Medicaid health coverage without long-term services — waiver services are for individuals who meet the institutional level of care standard
• Families whose child doesn't have a developmental disability diagnosis — DDD waivers serve individuals with intellectual and developmental disabilities specifically

Frequently Asked Questions

Can my child be on both waivers at the same time?

No. Each individual is enrolled in one waiver at a time. The waivers serve different models of care delivery, and the funding structures don't allow dual enrollment. You can apply while enrolled in one and transition to the other, but there's no concurrent coverage.

What happens if the CHOICES waiver gets a waitlist?

The state reserves the right to implement enrollment limits on CHOICES based on budgetary constraints or federal waiver renewal terms. If a waitlist is created, new applicants would be placed on it in the same way FS 360 currently operates. The current CHOICES waiver is authorized through May 2028.

How does the ICAP assessment work?

The Inventory for Client and Agency Planning evaluates functional limitations across seven domains: self-care, receptive/expressive language, learning/general cognitive competence, mobility, self-direction, capacity for independent living, and economic self-sufficiency. The individual must demonstrate substantial limitations in at least three of these seven areas. DDD contacts the family within seven days of receiving a complete application to schedule the ICAP, and the full eligibility determination takes up to 45 days.

What if we choose CHOICES but want respite care?

CHOICES's documented service array emphasizes residential and day services, supported employment, and specialized equipment. If respite is your family's primary need and your child lives at home, FS 360's self-directed model gives you more control over how respite is scheduled and who provides it. This is one of the key factors in the decision — whether your service priorities align more with CHOICES's intensive, agency-managed model or FS 360's flexible, family-managed model.

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