South Dakota Disability Waiver & ABA Therapy: What Families Need to Know

What Is a South Dakota Disability Waiver?

A disability waiver (also called a Home and Community-Based Services (HCBS) waiver) allows states to use Medicaid funds to provide long-term care services at home or in the community rather than in an institution. In South Dakota, the Division of Developmental Disabilities (DDD) runs several waivers specifically designed to support individuals with intellectual or developmental disabilities (IDD), including autism spectrum disorder (ASD).

These waivers cover a range of services such as respite care, personal assistance, behavior support, and - most importantly for families seeking autism treatment - Applied Behavior Analysis (ABA) therapy. ABA is an evidence-based approach that helps children develop communication, social, and daily living skills while reducing challenging behaviors.

The two most relevant South Dakota disability waivers for families of children with autism are the Family Support 360 (FS360) program and the IDD Waiver. Both are 1915(c) HCBS waivers and are administered through South Dakota Medicaid.

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Which South Dakota Disability Waivers Can Cover ABA Therapy?

Family Support 360 (FS360) Program

The Family Support 360 Program is designed to help families care for a child (birth through age 17) with a developmental disability at home. It provides a flexible package of services based on the child's needs, up to a capped annual amount (currently around $15,000-$20,000, depending on the state budget). Services include:

• Behavioral intervention and support (which can include ABA)
• Respite care
• Counseling and training for parents
• Assistive technology and environmental modifications
• Transportation

ABA therapy is often covered under the behavioral intervention category, but it must be prescribed by a doctor and delivered by a qualified provider (usually a BCBA). Not all providers accept FS360, so using a matching service like Get Started with ABA can save you time finding one that does.

IDD Waiver (Intellectual/Developmental Disabilities Waiver)

The IDD Waiver is for individuals of all ages (starting at birth) who have an intellectual or developmental disability and who need a level of care comparable to an intermediate care facility. This waiver covers more intensive services, including:

• Day habilitation
• Supported employment
• Behavioral programming (ABA)
• Case management
• Residential supports

To qualify, the individual must meet both financial eligibility (Medicaid income and asset limits) and functional eligibility (significant deficits in adaptive functioning). For a child with autism, a formal diagnosis plus documentation of need from professionals is required. Waitlists for the IDD Waiver can be years long, so it's wise to apply as early as possible.

How to Apply for a South Dakota Disability Waiver for ABA

Step 1: Get a Formal Autism Diagnosis

Your child must have a documented diagnosis of autism spectrum disorder (ASD) or a related developmental disability from a qualified professional (e.g., pediatrician, developmental pediatrician, psychologist). This diagnosis is necessary for both waiver eligibility and for the doctor's prescription or referral for ABA therapy.

Step 2: Contact the South Dakota Division of Developmental Disabilities

Start by calling the South Dakota Division of Developmental Disabilities (located within the Department of Human Services) at 605-773-3438 or visiting their website. They will guide you through the application process for the FS360 or IDD Waiver and determine which one fits your child's needs.

Step 3: Apply for Medicaid

Both waivers are part of South Dakota Medicaid. If your family is not already on Medicaid, you will need to apply. The waivers use Medicaid as the funding source, so your child must be a Medicaid beneficiary. If your income is too high for traditional Medicaid, you may still qualify through the waiver's special income rules (often up to 300% of the federal poverty level).

Step 4: Gather Supporting Documentation

Prepare medical records, school evaluations, therapy reports, and a letter of medical necessity from your child's doctor stating that ABA is needed to prevent institutionalization or to promote community living. The more detailed the better.

Step 5: Complete a Level of Care Assessment

For the IDD Waiver, you will need an assessment that confirms your child requires the level of care typically provided in an intermediate care facility. This is done by a state-designated evaluator, often from the DDD. The FS360 has a simpler application, but a needs assessment is still conducted.

Step 6: Apply to the Waiver Waiting List

Both waivers have capped enrollment, so once you are determined eligible, you may be placed on a waiting list. While you wait, you can still receive some services through the state-funded Family Support Program (non-waiver) and start ABA through other funding sources (e.g., private insurance).

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Costs and Insurance for ABA Therapy in South Dakota

One of the biggest barriers to ABA therapy is cost. A full-time ABA program can easily exceed $50,000 per year. South Dakota disability waivers help make it affordable for qualifying families. Here's how costs work under the waivers:

• FS360: Services are covered up to the annual cap; you will not have a co-pay for covered services. Once the cap is reached, you may need to wait until the next fiscal year or use other funding.
• IDD Waiver: There is no cap (beyond the individual budget determined by the state). ABA services are reimbursed at Medicaid rates. There are no co-pays for waiver services.
• Private Insurance: South Dakota requires most state-regulated health plans to cover ABA for children under 19 with an autism diagnosis (SB 152). This can be used alongside or instead of waiver funding.
• Combined Funding: Some families use waiver funds to supplement private insurance, especially if insurance has high deductibles or session limits.

Important: Not all ABA providers accept Medicaid or waivers. Before committing to a provider, confirm they are enrolled as a South Dakota Medicaid provider and familiar with waiver billing. That's where Get Started with ABA's free matching service comes in - we specifically connect you with BCBA-led providers who accept waivers and public insurance.

What to Expect When You Start ABA Through a Waiver

Once your waiver is approved and you have selected a provider, your child's ABA team will conduct an initial assessment to determine goals. Services typically include:

• One-on-one therapy sessions (often 10-30 hours per week)
• Parent training and coaching
• Ongoing data collection and progress monitoring
• Collaboration with school teams if applicable

Because waivers are person-centered, you have flexibility in where services are delivered - in your home, in the community, or at a clinic. Your case manager (assigned through DDD) will help coordinate.

It's normal for ABA to feel intensive at first. The BCBA will work with you to adjust the schedule as your child makes progress. Medicaid and waiver rules also require periodic reviews (e.g., every 6 months) to ensure the therapy is still needed and effective.

Common Pitfalls to Avoid When Seeking Waiver-Funded ABA

• Waiting too long to apply: Waiver lists can have multi-year waits. Apply as soon as your child is diagnosed, even if you're not sure you'll need it.
• Assuming your preferred provider accepts waivers: Many private ABA agencies only bill commercial insurance. Always ask upfront or use a matching service to filter for waiver-friendly providers.
• Not documenting medical necessity thoroughly: A vague letter from a doctor may not suffice. Include goals, frequency recommendations, and statements that without ABA the child may regress.
• Forgetting to renew Medicaid annually: Medicaid eligibility must be renewed each year. Missing the renewal can interrupt services.
• Overlooking other funding sources: If you're on a waiting list, look into private insurance, early intervention (Part C), or school district services.

How Get Started with ABA Can Help

Navigating waivers, Medicaid, and provider options can feel overwhelming. Get Started with ABA is a completely free service that helps families in South Dakota and across the country find a vetted, BCBA-led ABA provider that accepts your specific insurance or waiver. We match you based on your child's needs, location, and funding source - including FS360 and IDD Waiver coverage. There is no obligation, and we never recommend a clinic we haven't personally verified. Let us do the legwork so you can focus on your child's journey. Fill out our brief form to get matched today.