How Services are Funded

The primary system of funding for Community Support Provider services comes from a Medicaid program called Home and Community Based Services (HCBS). HCBS funding allows Medicaid beneficiaries to receive services in their home and community rather than institutional settings. The funding mechanism is most often referred to as an HCBS Waiver. This term is used because the program waives certain Federal regulations pertaining to Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID) programs. States can tailor HCBS Waiver programs to target specific populations (e.g. people with developmental disabilities, elderly populations, people with physical disabilities, and people with behavioral conditions) and can operate as many HCBS plans as they desire.

Funding for services is shared between the state and federal government and requires at least a 1/3 non-federal match of the reimbursement rate. Individual reimbursement rates are determined via a rate model that uses cost report data, activity logging, individual service records, and the Inventory for Client and Agency Planning (ICAP) assessment tool. The model uses a statistical method incorporating these elements to generate an individual rate. 

All 20 South Dakota Community Support Providers participate in HCBS Waiver programs. Below is a brief description of the HCBS Waiver plans that Community Support Providers utilize. 

Choices Waiver

This waiver program provides a wide range of services including residential supports (e.g. group home settings, supervised apartments, and independent living arrangements), health and medical assistance, vocational supports (e.g. pre-vocational facility based employment, group supported employment, and supported employment), and day habilitation services. It also offers the Shared Living program which is a service model delivered in the participant’s own home, family member home, or host home. This model offers a different approach to services and is administered by a local CSP. All 20 Community Support Providers offer services under the Choices Waiver with a smaller number providing Shared Living.

Family Support Waiver

This waiver program is flexible and designed for individuals to receive services from more natural or informal sources (e.g. family members, friends, community organizations, churches, neighbors etc.).  The waiver program also helps participants and families connect to more formalized services available in communities. The participant is assisted by a Family Support Coordinator and has access to a flexible pool of funds for purchasing needed services or products. 

Community Training Services (CTS)

CTS is the only funding source available for services that is strictly state general funds. It is the smallest funding program, but also the most flexible. CTS is typically utilized for individuals that need less intensive services or who do not meet the financial eligibility for ICF/IID or HCBS funded services. The three main services that are provided under the CTS program are prevocational training, community living training and expanded follow along/support.