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Section 1915(c) of the Social Security Act enables South Carolina Department of Health and Human Services (SCDHHS) to contract with South Carolina Department of Disabilities and Special Needs (SCDDSN) to operate a Home and Community-Based (HCB) Waiver program for a limited number of people with severe physical/cognitive disabilities. It is one of several HCB Waiver programs in South Carolina that can provide some level of services to people with traumatic brain injury (TBI), spinal cord injury (SCI) or similar disability (SD).

HASCI Waiver participants can receive Medicaid-funded services and supports in their homes and other community settings instead of in a hospital, nursing facility or institution.

The aggregate cost of Medicaid HCB Waiver services must be equal to or no more than the aggregate cost if the same people received institutional care funded by Medicaid.

HASCI Waiver services are provided based on the identified needs of a participant and within limits and available funding.

HASCI Waiver Information Sheet (PDF)

Eligibility Requirements

To qualify for Head and Spinal Cord Injury (HASCI) Waiver Services, a person must:

  • receive Case Management through the BHDD OIDD Head and Spinal Cord Division
  • be eligible for Medicaid or already covered by Medicaid
  • request HASCI Waiver Services through his/her HASCI Case Manager
  • meet Nursing Facility or ICF/IID level of care
  • have urgent circumstances affecting his/her health or functional status and depend on others to provide or assist with critical health needs, basic activities of daily living or require daily monitoring or supervision to avoid institutionalization
  • need services not available from or adequate with existing resources, including family, private means and other agencies/programs to meet the basic needs of the individual to allow him/her to remain in the home
  • have adequate natural supports to live safely in a private home or other community setting with the type/amount of services available from the HASCI Waiver

The HASCI Waiver does not provide income support, emergency funds, housing, room and board, general supervision or 24-hour care.

An individual must be offered choice between institutional services or home and community-based services, must choose to receive HASCI Waiver services, must be informed of all the alternatives available in the HASCI Waiver and must choose from among qualified service providers.

Reasons HASCI Waiver Will Be Terminated

HASCI Waiver services will be terminated when a person:

  • voluntarily withdraws or no longer wishes to receive services funded by the Waiver
  • is no longer financially eligible for Medicaid as determined by the SC Department of Health and Human Services
  • is admitted to an acute care hospital for more than 30 days
  • no longer meets Nursing Facility or ICF/IID level of care
  • is admitted to a Nursing Facility or ICF/IID
  • does not receive two waiver services in a calendar month
  • moves out of the state

Applying to SCDDSN

If you have severe impairments as a result of traumatic brain injury (TBI), spinal cord injury (SCI) or similar disability (SD), you or a family member should:

  • Contact DDSN Eligibility at the phone number above to be screened for referral to DDSN Head and Spinal Cord Injury (HASCI) Division and referral to the HASCI Waiver, if requested.
  • If screened as appropriate for consideration of eligibility, you will be given opportunity to choose a qualified Intake Provider for your locality.
  • The DDSN eligibility determination process includes review of medical records and other information, including the applicant’s current functional status. The process is usually completed within 90 days.
  • An applicant found ineligible for DDSN services will be notified in writing, including reason(s) for denial. This notification will provide information on how to appeal denial of eligibility.

Eligibility Criteria

S.C. Code Ann. §44-38-370 defines eligibility for services through the DDSN Head and Spinal Cord Injury Division:

“A person is eligible for case management services under this article when at the time of determining eligibility the person has a severe chronic limitation that:

  1. Is attributed to a physical impairment, including head injury, spinal cord injury, or both, or a similar disability, regardless of the age of onset but not associated with the process of a progressive degenerative illness or dementia, or a neurological disorder related to aging;
  2. Is likely to continue without intervention;
  3. Results in substantial functional limitations in at least two of these life activities: (a) self-care; (b) receptive and expressive communication; (c) learning; (d) mobility; (e) self-direction; (f) capacity for independent living; (g) economic self-sufficiency; and
  4. Reflects the person’s need for a combination and sequence of special interdisciplinary or generic care or treatment or other services which are lifelong or extended duration and are individually planned or coordinated.”

Level of Care Criteria for HASCI Waiver

In order to be eligible for HASCI Waiver services, an individual must meet Level of Care criteria for a Nursing Facility (NF) or an Intermediate Care Facility for Individuals with Intellectual Disability (ICF/IID). The individual must be evaluated to meet Level of Care criteria within 30 days prior to enrollment in the HASCI Waiver. Level of Care is re-evaluated at least every 365 days.

Initial NF Level of Care is determined by a licensed nurse who conducts a comprehensive evaluation of an individual’s medical, psychobehavioral, and functional needs. An individual may meet NF Level of Care at the skilled or intermediate level. Both levels focus on an individual’s need for extensive assistance from another person with personal care and activities of daily living.

To be eligible for the HASCI Waiver under the ICF/IID Level of Care, an individual must be determined to meet DDSN criteria for a Related Disability (onset prior to age 22 years) with substantial impairments in adaptive functioning and require ongoing supervision and services to acquire skills or prevent regression.

DDSN Reconsideration and Medicaid Appeal

If an applicant or participant is notified of an adverse decision/action affecting eligibility for or receipt of HASCI Waiver services, within 30 days the individual (or representative) may request that DDSN reconsider and reverse the decision/action. Information on the Process for Reconsideration of SCDHHS Decisions will be provided by the HASCI Case Manager.

If the individual (or representative) fully completes the Process for Reconsideration of SCDHHS Decisions and is dissatisfied with the outcome of the Reconsideration, a Fair Hearing may be requested by the Medicaid participant to SC Department of Health and Human Services- Division of Appeals and Hearings (State Medicaid Agency) within 30 days. Information on the SCDHHS Medicaid Fair Hearing Process will be provided at the time of the adverse Reconsideration response.

You may be eligible to receive continued Medicaid benefits pending a hearing decision. If you are interested in continued benefits, you must contact your DDSN Case Manager within ten (10) calendar days of the effective date of the action. If the hearing decision is not in your favor, you may be required to repay Medicaid benefits received during the appeals process.

HASCI Waiver Services

Direct assistance with personal care and activities of daily living and/or supervision to assure health and safety.

Validated practices to identify causes of specific challenging behaviors and appropriate interventions to reduce or eliminate them.

Assistance with acquisition, retention, or improvement of self-help, socialization and adaptive skills, in a licensed day program funded by SCDDSN.

Preparation for paid or unpaid employment (but not job-specific skills) in a licensed day program funded by SCDDSN.

Intensive/extended supports in a licensed employment program funded by SCDDSN.

Adaptations to the individual’s private home to ensure health and safety or to enable greater independence.

May be provided (if not covered by State Plan Medicaid) to determine specific needs related to the participant’s disability for which supplies, equipment or assistive technology will assist the participant to function more independently.

Instruction by a registered nurse to assist an individual to manage own personal care provided by another individual.

Services intended to develop, maintain and improve the community-living skills of a waiver participant. Includes direct training from a qualified staff person.

Diapers, briefs, underpads, liners, wipes and gloves provided to participants who are at least 21 years old and who are incontinent of bowel and/or bladder care according to established medical criteria.

Services within the scope of the SC Nurse Practice Act provided by an RN or LPN.

Treatment to restore or improve fine motor functioning.

Information, advice and encouragement provided by a peer to an individual with SCI/severe physical impairment to recruit, train and supervise own caregivers.

Electronic device to enable an individual to secure help in an emergency.

Aid in maintaining an environment free of insects such as roaches and other potential disease carriers to enhance safety, sanitation and cleanliness of the participant’s home/residence.

Treatment to improve or compensate for mobility and movement dysfunction and related functional impairments.

Modifications to a vehicle driven by or routinely used to transport the individual.

Are used to determine the specific modification/equipment, any follow up inspection after modifications are complete and training in the use of equipment for a private vehicle modification.

Treatment to address affective, cognitive, and substance abuse issues.

Care, skills training and supervision in a licensed residential program funded by SCDDSN.

Short-term care and/or supervision in the absence of individuals normally providing care/supervision.

Speech therapy, audiology services and augmentative communication.

Specialized medical supplies and equipment and AT devices to better perform activities of daily living.

Service to assist waiver participants in gaining access to needed waiver services, State Plan Medicaid Services, and other, non-Medicaid Services and resources, regardless of funding source.