South Dakota Family Support 360 Waiver
What Family Support 360 Is
Family Support 360 (FS 360) is South Dakota's self-directed Medicaid waiver for individuals with intellectual and developmental disabilities who live in their own home or with their family. Unlike the CHOICES waiver — which provides agency-directed, intensive supports — FS 360 puts the participant and family in control of their budget, staffing, and service decisions.
The waiver funds personal care, companion services, respite care, supported employment, environmental accessibility adaptations, vehicle modifications, specialized medical equipment, and nutritional supplements. The projected annual expenditure is approximately $4,200 per person, reflecting the supplemental nature of the program — FS 360 wraps around natural family supports rather than replacing them.
FS 360 currently serves 1,420 individuals. Because demand exceeds funding, the waiver maintains an active waiting list of approximately 198 people with an average wait time of eight months.
Who Qualifies
Eligibility requires a qualifying intellectual or developmental disability with onset before age 22, demonstrated through a comprehensive psychological evaluation and the ICAP (Inventory for Client and Agency Planning) functional assessment. The ICAP must show substantial functional limitations in at least three of seven domains.
Financial eligibility caps the individual's monthly income at $2,982 (300% of the 2026 Federal Benefit Rate) and countable resources at $2,000. Parental income is not counted — only the applicant's own income and assets.
Active Medicaid enrollment is also required. SSI recipients receive Medicaid automatically in South Dakota through the 1634 agreement. Others apply through the Department of Social Services.
The Waiting List Reality
The eight-month average wait is exactly that — an average. Some families wait longer depending on when openings occur and how legislative funding cycles align with their placement on the list. Unlike CHOICES (which currently has no waitlist), FS 360 availability is strictly tied to the number of funded slots the state legislature authorizes.
Apply early. Families should initiate the DDD intake process through Dakota at Home (1-833-663-9673, Option 2) as soon as the young adult turns 18. If your child is still in school-funded transition programs through age 21, those services continue regardless of waiver status — but being on the FS 360 waiting list during the school years ensures waiver services are in place (or close to it) when school funding ends.
The intake application determines eligibility and places qualified applicants on the waitlist. You do not choose between CHOICES and FS 360 yourself — the DDD assigns a waiver based on the ICAP assessment. However, families can request FS 360 specifically if the self-directed model fits their situation and the individual's assessed needs support it.
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How Self-Direction Works
Once enrolled in FS 360, a Family Support Service Coordinator helps the family develop a Person-Centered Individual Service Plan (ISP). The ISP identifies the services, hours, and budget allocated for the year.
The family then manages that budget. You hire your own direct support professionals, arrange respite care, purchase adaptive equipment, and schedule services on your own timeline. The family acts as co-employer for hired staff — handling scheduling, supervision, and sometimes payroll through a fiscal management services agency.
This model works well for families who want control over who provides care and when. It also works for individuals whose support needs are real but do not require 24-hour agency-staffed residential services. The trade-off is administrative responsibility — the family manages the budget, tracks expenditures, and ensures services stay within the allocated hours.
FS 360 vs. CHOICES: When to Consider Switching
Many families start on FS 360 while the young adult lives at home. If support needs increase — or if the family can no longer provide daily care — transitioning to CHOICES may be appropriate. The CFCM case manager or FS 360 service coordinator can initiate a reassessment and waiver transfer.
The reverse also happens: families on CHOICES who bring their adult child home and want more control over services can request a transfer to FS 360, subject to waitlist availability.
The South Dakota SSI at 18 & Adult Disability Benefits Guide includes a Waiver Application Preparation Worksheet with a side-by-side CHOICES vs. FS 360 decision table and step-by-step instructions for the Dakota at Home intake process.
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