DRSC Medicaid Guide

Each HCBS Waiver has different eligibility requirements. Generally, you must meet the following criteria:

• Have the disability diagnosis that the waiver requires
• Have Medicaid
• Live at home or in the community 
• Need a high level of care
• Have needs that are addressed by the waiver services
• Receive a waiver slot

Important Note: Once you receive a HCBS waiver slot, you must use a certain amount of those services on a regular basis to keep your waiver services.

If you already have a Case Manager or Early Interventionist (CM/EI), you can contact them and ask for any information they have regarding the waiver. Tell them you would like to apply for an HCBS Waiver. If you are not receiving Case Management or Early Intervention, you may contact the state agency that operates the HCBS waiver you are interested in, as listed below.

Important Note: It is important to discuss whether you or your family member may need HCBS waiver services now or later in life. Some waivers have very long waiting lists so it is important that you learn how long the wait list for that waiver may be so that you can receive the services when you need them.

In certain situations, a person might get an HCBS waiver slot faster.

For the Community Supports waiver, these situations include:

• People receiving state-funded day services
• Family members of Armed Services members who live in South Carolina

For the Intellectual Disability / Related Disability Waiver, these situations include:

• Discharge from ICF/IDD: People leaving regional centers or community-based ICF/IIDs directly into waiver funding (including people that transition directly into Home Again from the ICF/IID and then into waiver funding)
• People facing a serious and immediate risk of harm: People needing a service through the waiver that, if not provided, will likely cause serious and immediate harm, and who need immediate direct care or supervision related to their disability.
• New Housing Participants: People entering community-based housing sponsored, licensed or certified by OIDD needing waiver services.

The last category includes two types of people:

• Those needing a service through the waiver that, if not provided, will likely cause serious and immediate harm, and who need direct care or supervision related to their disability.
• Those needing a service through the waiver that, if not provided, will likely cause serious and immediate harm, and who have recently lost or are at risk of losing their primary caregiver.

If you believe you should qualify under one of these categories to receive a HCBS waiver slot more quickly, contact OIDD.

Contacts for Waiver Services

Department of Health and Human Services (DHHS)

Call the local CLTC office or submit an online referral at:

• Online referral
• List of CLTC area offices

Office of Intellectual and Developmental Disabilities (OIDD) 

• Phone: 1-800-289-7012

• OIDD Website

Intellectual Disabilities / Related Disabilities Waiver

Run By:

Office of Intellectual and Developmental Disabilities (for more information use link to: SC Department of Disabilities and Special Needs)

Serves

• People who have an intellectual disability or a related disability.
• A related disability is a severe and chronic condition either closely related to intellectual disability or that requires similar treatment.  
• Must need the level of care provided in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). An ICF/IID is a facility for people with ID/RD who also need a combination of a high level of supervision and some medical care. It is like a nursing home but is designed for people with ID/RD. OIDD operates five ICF/IIDs, which they call regional centers.   

Other Eligibility

• Receive Medicaid
• Need support to live in the community
• The cost of waiver services must be below what would be spent on an ICF/IID

Services

• Residential Habilitation
• Environmental Modifications
• Private Vehicle Modification
• Private Vehicle Assessment/Consultation
• Specialized Medical Equipment, Supplies, and Assistive Technology
• Specialized Medical Equipment, Supplies, and Assistive Technology Assessment/Consultation
• Adult Attendant Care
• Adult Companion Services (Companion Care-Individual
• Adult Day Health Care
• Adult Day Health Nursing
• Respite Care
• Personal Emergency Response System Installation
• Personal Emergency Response System Monitoring
• Home Accessibility Adaptation- Environmental Modification
• Specialized Medical Equipment, Supplies, and Assistive Technology
• Specialized Medical Equipment, Supplies, and Assistive Technology Assessment/Consultation
• Pest Control Treatment and Pest Control Bed Bugs
• Waiver Case Management
• Support Center
• Behavior Support Services

For definitions of services, see the Appendix, and for details about these services, please go to:  ID/RD Waiver Information Sheet

Maintain Services

• You must use at least two waiver services per month (excluding case management).

Community Supports Waiver

Run by

Office of Intellectual and Developmental Disabilities (See link at:  SC Department of Disabilities and Special Needs)

Serves

• People who have an intellectual disability or a related disability. A related disability is a severe and chronic condition either closely related to intellectual disability or that requires similar treatment.
• You must also require the level of care provided in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). An ICF/IID is a facility for people with ID/RD who also need a combination of a high level of supervision and some medical care. It is like a nursing home but is designed for people with ID/RD. DDSN operates 5 ICF/IIDs, which they call regional centers.

Other Eligibility

• Receive Medicaid
• Require services to live in the community
• The cost of waiver services must be below the Community Supports waiver annual funding cap of approximately $16,000

Services

• Personal Care Services
• Adult Day Health Care Services
• Adult Day Health Care Nursing
• Respite Care Services
• Environmental modifications
• Assistive Technology and Appliances
• Assistive Technology and Appliances Assessment/Consultation
• Incontinence Supplies
• Private Vehicle Modifications
• Private Vehicle Assessment/Consultation
• Behavior Support Services
• Day Activity
• Career Preparation Services
• Community Services
• Employment Services
• Support Center Services
• In-home Support Services
• Personal Emergency Response System (PERS)
• Waiver Case Management

For definitions, please go to the appendix, and for details of these services, please go to: Community Supports Waiver Information Sheet

Maintain Services

• You must use at least two waiver services per month (excluding case management).
• Important Note: The primary differences between the ID/RD Waiver and the Community Supports waiver are the services offered and the implementation of a cost cap. The ID/RD and Head and Spinal Cord Injury (HASCI) Waivers are the only waivers that fund residential habilitation.

Head and Spinal Cord Injury Waiver

Run by

Office of Intellectual and Developmental Disabilities (See link at: SC Department of Disabilities and Special Needs)

Serves

• People who have a diagnosis of Traumatic Brain Injury (TBI), Spinal Cord Injury (SCI), or a similar condition notassociated with the process of a degenerative illness, disease, dementia, or a neurological disorder related to aging.
• People must require the level of care provided in a nursing facility or an ICF/IID. An ICF/IID is a facility for people with ID/RD who also need a combination of a high level of supervision and some medical care. It is like a nursing home but is designed for people with ID/RD. OIDD operates five ICF/IIDs, which they call regional centers. If the cost of waiver services exceeds the cost of a level of care in an ICF/IID, DDSN maybe able to deny waiver services.

Other Eligibility

• Receive Medicaid
• Require services to live in the community

Services

• Career Preparation Services
• Day Activity
• Employment Services
• Attendant Care Personal Assistance Services
• Health Education for Participant – direct care
• Peer guidance for participant – direct care
• Residential habilitation
• Specialized medical equipment, supplies, and assistive technology
• Incontinence supplies
• Respite care services
• Personal emergency response system
• Physical therapy
• Occupational therapy
• Psychological services
• Behavior support services
• Nursing services
• Speech and hearing services
• Private vehicle modification assessment/consultation
• Pest control bed bugs
• Pest control treatment
• Waiver case management
• Independent living skills

For definitions of these services, please see the appendix, and for details of these services, please go to: HASCI Waiver Information Sheet

Maintain Services

You must use at least two waiver services per month (excluding case management).

Community Choices Waiver

Run by

South Carolina Department of Health and Human Services

Serves

• People with physical disabilities aged 18-64 and individuals aged 65 or above
• People must require the level of care provided in a nursing facility. This means eight or more hours of skilled nursing a day. Generally, at this level of care, people need help getting in and out of bed, toileting, bathing, taking medications, and performing other activities of daily living.

Other Eligibility

• Receive Medicaid
• Require services to live in the community.
• The cost of waiver services must be below the cost of a level of care in a nursing facility.  

Services

• Case Management
• Personal Care Services
• Attendant Care
• Companion Care-Agency
• Companion Care-Individual
• Home Delivered Meals
• Adult Day Health Care
• Adult Day Health Nursing
• Respite, Institutional
• Respite, CRCF
• Respite, In-Home
• Personal Emergency Response System Installation
• Personal Emergency Response System Monitoring
• Telemonitoring
• Home accessibility Adaptation-Environmental Modification
• Specialized Medical Equipment & Supplies
• Residential Personal Care II
• Pest Control

For definitions of these services, please go to the appendix, and for details of these services, please go to: HCBS Waiver Summary Chart (Sept 2024)

Maintain Services

You must use at least one waiver service per month (excluding case management).

HIV/AIDS Waiver

Run by

South Carolina Department of Health and Human Services

Serves

• People of any age who have a diagnosis of HIV/AIDS, a CD4 count below 500, or a history of a CD4 count below 500.
• People must need the level of care provided in a hospital.

Other Eligibility

• You must also receive Medicaid.
• Require services to live in the community.
• The cost of waiver services must be below the cost of a level of care in a nursing facility.

Services

• Case Management
• Personal Care Services
• Attendant Care
• Companion Care- agency
• Companion Care individual
• Home-delivered meals
• Pest control
• Nursing services
• Home accessibility adaptations- environmental modifications
• Specialized medical equipment and supplies

For definitions of these services, please go to the appendix, and for details of these services please go to: HCBS Waiver Summary Chart (Sept 2024)

Maintain Services

You must use at least one waiver service per month (excluding case management).

Mechanical Ventilator Waiver

Run by

South Carolina Department of Health and Human Services

Serves

• People aged 21 years or older who depend on a mechanical ventilator for breathing.
• Must need the level of care provided in a nursing facility. This means you must require 8 or more hours of skilled nursing a day.  Generally, at this level of care, people need help getting in and out of bed, toileting, bathing, taking medications, and other activities of daily living.

Other Eligibility

• Receive Medicaid
• Need services to live in the community
• The cost of waiver services must stay below the cost of a level of care in a nursing facility

Services

• Case Management
• Personal Care Services
• Attendant Care
• Nursing Services
• Specialized medical equipment and supplies
• Respite, institutional
• Respite, In-home
• Personal Emergency Response System – installation
• Personal Emergency Response System – Monitoring
• Home Accessibility Adaptations – environmental modifications
• Pest control  
• Home-delivered meals

For definitions of these services, please go to the appendix, and for details of these services, please go to: HCBS Waiver Summary Chart (Sept 2024)

Maintain Services

Individuals must use at least one waiver service per month (excluding case management) to qualify to continue receiving waiver services.

Medically Complex Children’s Waiver

Run by

South Carolina Department of Health and Human Services

Serves

• People under the age of 21 who have a chronic medical condition expected to last longer than 12 months.
• Must meet state-defined medical criteria that identify the child as dependent upon the evaluation of medications, hospitalizations, skilled nursing services, ancillary services, and specialists.
• Individuals must require the level of care provided in a nursing facility or ICF/IID. An ICF/IID is a facility for people with ID/RD who also need a combination of a high level of supervision and some medical care. It is like a nursing home but is designed for people with ID/RD. DDSN operates five ICF/IIDs, which they call regional centers.

Other Eligibility

• Must also receive Medicaid
• Need services to live in the community
• The cost of waiver services must be below the cost of a level of care in a nursing facility or an ICF/IID.

Services

• Nurse Care Coordination
• Respite
• Environmental Modifications
• Pediatric Medical Day Care

For definitions of these services, please go to the appendix, and for details of these services, please go to: HCBS Waiver Summary Chart (Sept 2024)

Maintain Services

Individuals must use at least one waiver service per month, excluding case management.

Medical Home Network (MHN)

• Provides Primary Care Case Management (PCCM), which coordinates the provision of services, including linking participants to a primary care provider.
• The goal is to provide comprehensive and uniform health care management and services.
• People will have twenty-four-hour access to a primary care physician.

In an HCBS waiver, individuals (or their representatives) can manage their own services and hire their own workers. In this model, the person can make decisions about recruiting, hiring, training, and supervising their chosen workers. A fiscal agency handles payroll for these workers. Self-direction should be discussed with an individual’s case manager. The following services have the option for self-direction in SC:

• Community Choices Waiver: Attendant Care and Companion Care
• Mechanical Ventilator Dependent Waiver: Attendant Care
• HIV/AIDS Waiver: Attendant Care and Companion Care
• ID/RD Waiver: Adult Attendant Care Services and Respite
• Community Supports Waiver: In-Home Supports and Respite Care
• HASCI Waiver: Attendant Care/Personal Assistance Services and Respite Care

Under the ID/RD and HASCI HCBS waivers Residential Habilitation Services are available. They provide care, skills training, and supervision for individuals in community-based or non-institutional settings. The type and amount of care and support are based on the person’s needs and plan. These services help with daily living activities like personal grooming, cleanliness, bed making, household chores, eating, food preparation, and developing social and adaptive skills. There are a variety of Residential Habilitation settings provided in South Carolina.

Important Note: These services do not pay room and board.