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South Carolina home care payment guide
Last updated: 13 September 2026
If you need help bathing, dressing, moving safely, preparing meals, or staying at home, the hardest part is often figuring out who can pay. In South Carolina, the answer depends on whether you need medical home health, long-term personal care, caregiver relief, or help returning home from a facility.
Bottom Line
For ongoing hands-on help at home, South Carolina’s main Medicaid path is the Community Choices waiver. Start with Community Long-Term Care (CLTC) at 1-888-971-1637 if the person may need nursing-home-level care but wants to remain at home. Medicare can cover skilled home health in narrower situations, but it does not generally pay for ongoing personal care when that is the only help needed.
Need Help Right Now?
Call 911 for immediate danger or a medical emergency. To report suspected abuse, neglect, or exploitation of a vulnerable adult living in the community, South Carolina Department of Social Services uses the 24-hour Adult Protective Services hotline at 1-888-227-3487 (1-888-CARE4US).
If a hospital or rehabilitation facility plans to discharge someone who cannot safely manage at home, ask for the discharge planner or social worker before leaving. For other urgent bills or basic-needs problems, see our South Carolina emergency help guide.
Start Here
- If long-term daily help is needed: call CLTC centralized intake at 1-888-971-1637 and ask for a long-term-care assessment.
- If the need is local meals, respite, transportation, or caregiver support: call the South Carolina Department on Aging at 1-800-868-9095 or use GetCareSC.
- If the need follows an illness or injury: ask the doctor whether Medicare-covered home health is medically appropriate and whether the person meets Medicare’s homebound and skilled-care rules.
Quick Reference: Which Route Fits?
| Situation | Likely first route | First action |
|---|---|---|
| Ongoing bathing, dressing, transfers, or supervision | Medicaid Community Choices | Call CLTC at 1-888-971-1637 |
| Skilled nursing or therapy after illness or injury | Medicare home health | Ask the doctor for a home-health evaluation |
| Age 55+ with nursing-home-level needs in a PACE county | PACE | Check county coverage and call a PACE provider |
| Caregiver needs respite or local supports | Area Agency on Aging | Call 1-800-868-9095 |
| Veteran needs personal care at home | VA home-based services | Ask the VA care team or social worker |
| Person is in a hospital or nursing facility and wants to return home | Home Again | Ask for a referral or call 1-888-971-1637 |
Match the Payer to the Kind of Care
“Home care” can mean very different things. A nurse changing a wound dressing is not the same service as an aide helping with bathing every morning. Payment rules change with the type of care.
- Skilled home health: nursing, therapy, and related medical services ordered for a health condition.
- Personal care: help with bathing, dressing, toileting, eating, walking, and other daily activities.
- Homemaker or companion help: supervision, meals, light household tasks, and similar support.
- Round-the-clock care: continuous supervision or hands-on help. Public programs rarely provide 24-hour care in the home.
Before applying anywhere, write down what help is needed, how often it is needed, and whether the need is medical or personal. This prevents a common mistake: asking Medicare to pay for long-term custodial care or asking an aging-services program to replace full-time nursing care.
Medicare Can Cover Skilled Home Health
Medicare home health can cover medically necessary part-time or intermittent skilled nursing, physical therapy, speech-language pathology, occupational therapy in qualifying situations, medical social services, and certain supplies or equipment. A home health aide may also be covered on a part-time or intermittent basis when the person is receiving qualifying skilled nursing or therapy at the same time.
The person generally must be under a provider’s care, need qualifying skilled services, meet Medicare’s homebound rules, and receive care from a Medicare-certified home health agency. Medicare does not pay for 24-hour care at home or for personal care such as bathing and dressing when that is the only care needed.
Helpful tip: If a Medicare Advantage plan is involved, ask which home health agencies are in the plan’s network. For free, unbiased help comparing Medicare coverage, South Carolina’s SCSHIP counselors can be reached at 1-800-868-9095.
If Medicare premiums and other Medicare costs are creating pressure on the household budget, our guide to South Carolina Medicare Savings explains separate cost-help programs. Those programs do not replace long-term home care, but lowering medical costs can free money for other needs.
Community Choices Is the Main Medicaid Home-Care Route
South Carolina Healthy Connections Medicaid uses the Community Choices (CC) Home and Community-Based Services waiver for many people who would otherwise need nursing-facility care. The waiver serves frail adults age 65 or older and adults ages 18 through 64 with physical disabilities who meet nursing-facility level-of-care criteria.
The approved waiver includes services such as personal care, attendant care, companion care, case management, adult day health, respite, home-delivered meals, personal emergency response systems, home accessibility modifications, specialized medical equipment, and telemonitoring. Services are based on the person’s assessed needs and approved service plan; getting into the waiver does not mean every service is automatically provided.
Who may qualify
There are two major gates: medical need and Medicaid financial eligibility. South Carolina says a person seeking in-home long-term care must meet nursing-facility level of care and should contact Healthy Connections about a CLTC determination before completing the Medicaid application.
| Rule | 2026 information | Why it matters |
|---|---|---|
| Individual monthly income | $2,982 | This is the SCDHHS limit listed for nursing-facility, HCBS waiver, and PACE eligibility as of January 1, 2026. |
| Level of care | Nursing-facility level of care | A financial screen alone is not enough. |
| Where to start | CLTC centralized intake | Call before assuming a standard Medicaid application is the only step. |
| Waiver capacity | Managed statewide | An eligible person may still face a wait for an available slot. |
See the current Medicaid eligibility limits before making financial decisions. The $2,982 figure is not a complete eligibility test. Resources, marital status, Medicaid category, and other rules can affect the result. Do not transfer assets, spend down savings, or assume you are ineligible without asking SCDHHS how its rules apply to your household.
How to start Community Choices
- Call the current CLTC centralized intake line at 1-888-971-1637.
- Explain the daily activities the person cannot do safely without help. Be specific about bathing, dressing, transfers, toileting, eating, memory or supervision needs, and recent falls or hospital stays.
- Ask what assessment is needed and what Medicaid application steps should happen next.
- If instructed to apply, use the official Healthy Connections application or the nursing-home/in-home-care forms listed by SCDHHS.
On September 2, 2026, SCDHHS announced that the Centers for Medicare & Medicaid Services approved the state’s five-year Community Choices renewal, with the approved changes retroactive to July 1, 2026. The waiver renewal notice is the best current status source.
Reality check: The approved waiver manages a limited number of participant slots. The current waiver says reserved-capacity rules can affect entry and that other available slots are filled first-come, first-served by application date. Ask CLTC where the person stands and what services can be used while waiting.
Can a Family Member Be Paid?
Sometimes. South Carolina’s 2026 Community Choices waiver includes participant-directed Attendant Care and Companion Care-Individual. This can let an eligible participant have more control over who provides certain approved services.
The 2026 Community Choices renewal allows payment to some qualified relatives, but the restrictions differ by service and delivery method. The waiver includes specific limits for parents of minors, spouses in some agency arrangements, and other legally responsible people. Do not assume a particular relative can be paid until the case manager confirms the rule for the approved service.
Do not hire a relative first and expect Medicaid to reimburse past work. Ask the case manager which participant-directed service is approved, whether the relative qualifies, and what enrollment, payroll, timekeeping, and electronic visit verification rules apply. Our paid family caregiver guide covers this question in more detail.
PACE Can Bundle Care in 11 Counties
The Program of All-Inclusive Care for the Elderly (PACE) can be another route for people with complex needs. South Carolina says a person must be at least 55, live in a PACE service area, meet nursing-home level of care as certified by SCDHHS, and be able to live safely in the community with PACE help.
As of 13 September 2026, South Carolina PACE is available in Anderson, Bamberg, Berkeley, Calhoun, Charleston, Dorchester, Greenville, Lexington, Orangeburg, Pickens, and Richland counties. PACE coordinates medical and long-term-care services through one program. Costs depend in part on whether the person has Medicaid as well as Medicare, so ask the local PACE organization for a written explanation before enrolling.
Home Again Can Help With a Move Back Home
If the person is already in a skilled nursing facility or hospital, ask about South Carolina’s Home Again program. It helps eligible Medicaid members transition back to the community with services and supports.
SCDHHS says the person must have been in a skilled nursing facility or hospital for at least 60 consecutive days, have Medicaid payment for at least one day before transition, and meet an Intermediate or Skilled level of care. A referral can be made online or by calling 1-888-971-1637.
Home Again can help organize supports, but SCDHHS is clear that neither Home Again nor a waiver provides 24-hour home care or replaces all help from family and friends. That makes a realistic safety plan essential before discharge.
Local Aging Services Can Reduce the Unpaid Gap
Not every older adult needs or qualifies for Medicaid waiver care. South Carolina’s aging network can still help with local services that make living at home safer.
The South Carolina Department on Aging says GetCareSC and local AAAs can help people find in-home care, meals, transportation, adult day services, and other community resources. The statewide number is 1-800-868-9095. South Carolina has 10 regional Area Agencies on Aging (AAAs); our South Carolina AAA directory helps you find the office serving your county.
The state’s Family Caregiver Support Program can connect caregivers with information, training, counseling, support groups, respite, and some supplemental services. Availability and funding can vary by region, so ask the local AAA what is open now and whether there is a waiting list.
Other supportive aging services may include personal care, transportation, and related help. These programs are useful backups, but they should not be treated as guaranteed replacements for an approved Medicaid service plan.
Veterans May Have Separate VA Home-Care Paths
Veterans should check VA options before paying an agency entirely out of pocket. The VA’s Homemaker and Home Health Aide service can help eligible enrolled Veterans with activities such as bathing, dressing, eating, grooming, toileting, and moving around. Services depend on clinical need, community-care eligibility, and local availability, and a copay may apply in some cases.
VA Aid and Attendance is different. It is an additional monthly pension payment for certain qualified Veterans and survivors who meet pension and care-related rules. It is not a promise that VA will directly pay a home-care agency.
Start with the Veteran’s VA social worker or care team. Our South Carolina veteran guide also lists state and local veteran-help routes.
Long-Term Care Insurance and Private Pay
If public programs do not cover enough hours, the household may need to combine several sources. Before paying privately, check any long-term care insurance policy. Ask the insurer what triggers benefits, whether there is an elimination period, which home-care providers qualify, what records are required, and whether the policy reimburses costs or pays a fixed cash benefit.
When comparing private home-care agencies, ask for the full written rate sheet. Check minimum shift length, weekend and holiday rates, mileage, cancellation rules, overnight pricing, caregiver replacement procedures, and whether the agency is responsible for payroll taxes, workers’ compensation, background checks, and supervision.
If equipment or accessibility needs are driving up care costs, South Carolina also has separate programs and reuse options. Our medical equipment guide may help with walkers, wheelchairs, and other durable medical equipment, while our disability help guide covers broader disability-related supports.
| Route | Best fit | Main limitation |
|---|---|---|
| Medicare | Skilled, intermittent home health | Not ongoing custodial care by itself |
| Community Choices | Long-term home and community supports | Medical, financial, and capacity rules apply |
| PACE | Coordinated medical and long-term care | Only in listed service counties |
| Aging network | Respite, meals, transportation, local supports | Services and funding vary locally |
| VA | Eligible Veterans needing home-based support | Eligibility and local availability vary |
| Private pay/insurance | Filling uncovered hours or broader choice | Can become expensive quickly |
How to Start Without Wasting Time
- Write down the care tasks. List exactly what the person cannot do safely and how often help is needed.
- Separate medical from personal care. Skilled nursing or therapy points toward Medicare or Medicaid medical benefits. Daily hands-on support points toward long-term-care programs.
- Call CLTC early. If nursing-home-level care may be needed, call 1-888-971-1637 before assuming a regular Medicaid application is enough.
- Call the aging network too. Use 1-800-868-9095 for local respite, meals, transportation, caregiver support, and service referrals while a larger application is pending.
- Ask every payer for a written decision. Keep notices, assessment results, service plans, denials, and appeal instructions in one folder.
Documents and information to gather
- Medicare and Medicaid cards, if any
- Photo identification and Social Security information
- Proof of South Carolina residence
- Recent income information and bank or resource records requested by Medicaid
- Medication list and names of doctors
- Hospital, rehabilitation, or nursing-facility discharge records
- A list of falls, unsafe incidents, and daily activities that require help
- Long-term care insurance policy, if one exists
- VA information for a Veteran or surviving spouse
- Power of attorney or authorized-representative papers, when applicable
Reality Checks
Community Choices is not 24-hour care. The number and type of services depend on assessment and the approved plan. A person who cannot be left alone may still need family support, private care, another program, or a different care setting.
Medicaid eligibility is more than one number. The 2026 $2,982 monthly figure for one person is important, but it does not decide the case by itself. Do not make gifts or asset transfers based on an internet summary.
Medicaid administration changed in 2026. Since January 1, certain Community Choices members have been enrolled in Medicaid managed care for State Plan medical services, while waiver services continue through the fee-for-service system. The official managed-care guidance explains the split. Ask the case manager which organization authorizes each service.
Provider availability matters. Approval does not always mean a worker can start immediately in every county. Ask what happens if the authorized provider cannot staff the case.
Common Mistakes to Avoid
- Waiting for a crisis: Start the CLTC assessment before the caregiver is completely exhausted.
- Calling all home care “Medicare-covered”: Medicare’s home-health benefit has skilled-care and homebound rules.
- Self-denying on income: Let SCDHHS apply the complete financial rules.
- Assuming family pay is automatic: The relative must fit the program’s rules and the service must be authorized.
- Paying privately before checking benefits: Ask Medicaid, Medicare, VA, insurance, and the local AAA what may apply first.
- Ignoring written notices: Denials and reductions often carry appeal deadlines.
Denied, Delayed, or Overwhelmed?
Ask for the reason in writing. A Medicaid notice should explain the decision and appeal route. South Carolina’s Medicaid appeal page says Medicaid eligibility appeals generally must be filed within 30 calendar days. Read your own notice because the facts and deadlines on it control your case.
If CLTC services are involved, contact the CLTC representative as well as the SCDHHS Member Contact Center at 1-888-549-0820. If the problem is a staffing delay rather than an eligibility denial, ask the case manager whether another enrolled provider or authorized service can meet the need.
Backup options while you wait
- Ask the local AAA about respite, meals, transportation, and caregiver supports.
- Ask the doctor whether any skilled need qualifies for Medicare home health.
- For a Veteran, ask the VA social worker about home and community services.
- For a facility resident who wants to return home, screen for Home Again.
- Use our South Carolina assistance guide to check other benefit categories that may reduce household expenses.
Phone Scripts
CLTC intake — 1-888-971-1637
“I am calling about long-term help at home. The person needs help with [bathing/dressing/transfers/toileting/supervision]. Can you tell me how to request a CLTC assessment and what Medicaid steps we should complete?”
Department on Aging — 1-800-868-9095
“I need services that can help an older adult stay at home while we work on long-term care. What Area Agency on Aging serves our ZIP code, and what respite, meals, transportation, or in-home support is available now?”
Doctor or discharge planner
“Does this person need skilled home health that Medicare may cover? If so, can you document the need, place the order, and help us find a Medicare-certified agency that serves the home?”
VA social worker
“The Veteran needs help with daily activities at home. Can you screen for Homemaker/Home Health Aide, respite, or other VA home and community services, and tell us whether any copay would apply?”
Resumen en Español
En Carolina del Sur, una opción principal para cuidado personal de largo plazo en casa es el programa Medicaid Community Choices. Si la persona necesita un nivel de cuidado parecido al de un centro de enfermería, llame a Community Long-Term Care (CLTC) al 1-888-971-1637 para preguntar por la evaluación y los pasos de Medicaid.
Medicare puede cubrir servicios médicos en el hogar, como enfermería o terapia, cuando se cumplen sus reglas. Normalmente no paga cuidado personal continuo si esa es la única ayuda que la persona necesita. Para comidas, transporte, apoyo al cuidador y servicios locales, llame al Departamento sobre Envejecimiento de Carolina del Sur al 1-800-868-9095.
Si Medicaid niega la solicitud, lea la carta de decisión de inmediato y siga las instrucciones de apelación. No transfiera dinero o bienes para tratar de cumplir las reglas de Medicaid sin recibir orientación sobre cómo las normas se aplican a su caso.
Frequently Asked Questions
Does Medicare pay for a home caregiver in South Carolina?
Medicare can cover part-time or intermittent home health aide help when you also qualify for skilled home health services such as nursing or therapy. It generally does not pay for ongoing personal care when bathing, dressing, supervision, or homemaker help is the only need.
What is the main South Carolina Medicaid program for home care?
Community Choices is the main Medicaid home and community-based waiver for many older adults and adults with physical disabilities who meet nursing-facility level-of-care and Medicaid eligibility rules. Start with CLTC at 1-888-971-1637.
What is the 2026 Medicaid income limit for long-term care?
SCDHHS lists a monthly individual income limit of $2,982 effective January 1, 2026 for nursing-facility, HCBS waiver, and PACE eligibility. It is not a complete eligibility test, so ask SCDHHS to apply the full financial rules before assuming you do or do not qualify.
Can a family member be paid to provide care?
Some qualified relatives may be paid for approved Community Choices services, including participant-directed options. The 2026 waiver has different restrictions by service and delivery method, including rules for parents of minors, spouses in some agency arrangements, and other legally responsible people. The service must be authorized and the worker must meet program requirements.
Can Community Choices provide 24-hour care at home?
No. Services depend on the assessment and approved plan, and South Carolina states that waiver programs do not provide 24-hour home care. Families with continuous supervision needs may need to combine supports or consider another care setting.
Where can I get local help while an application is pending?
Call the South Carolina Department on Aging at 1-800-868-9095 to reach the aging network and find the Area Agency on Aging serving your county. Ask about respite, meals, transportation, caregiver support, and other local services that may be available.
About This Guide
Sources
This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 13 September 2026 · Next review: 13 December 2026
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