How to Apply for the Community Choices Waiver in South Carolina

The Application Is Two Separate Tracks Running in Parallel

Applying for the Community Choices (CC) Waiver in South Carolina is not a single form you submit and wait on. It is two independent processes that must both reach approval before services begin:

Track 1: Clinical eligibility — handled by the Community Long Term Care (CLTC) division of SCDHHS. A CLTC Nurse Consultant conducts an in-home assessment using Form 1718 to determine whether your parent meets the Nursing Facility Level of Care (NFLOC) standard.

Track 2: Financial eligibility — handled by the SCDHHS central eligibility office. You submit Form 3400 (Healthy Connections Application) and Form 3400-B (the long-term care supplement) with five years of financial documentation.

These tracks process independently. Start both on the same day. Waiting to submit the financial application until after the clinical assessment is complete costs you weeks or months that run in parallel for free.

Step 1: Call CLTC Intake (Day 1)

Call the CLTC Centralized Intake office at (888) 971-1637 or submit an electronic referral through the SCDHHS Phoenix public portal. Have these ready:

• Your parent's full name, date of birth, and Social Security number
• Medicare and Medicaid card numbers (if any current coverage exists)
• A summary of your parent's functional limitations — be specific about which activities of daily living (bathing, dressing, toileting, transferring, eating, mobility) require hands-on assistance
• Your contact information as the responsible family member

The intake specialist will create a referral record and place your parent on the CC Waiver interest list. This is the most time-sensitive step in the entire process. The interest list had over 23,000 individuals as of January 2025, and your parent's position is determined by when the referral is received. Every day of delay moves them further back.

Step 2: Submit the Medicaid Application (Same Day or Within a Week)

Mail or fax Form 3400 and Form 3400-B to:

SCDHHS Central Mail Office P.O. Box 8206, Columbia, SC 29202 Fax: (888) 820-1204

Include the full financial documentation package: 60 months of bank statements, investment accounts, property deeds, insurance policies, vehicle titles, income verification, and records of any transfers or gifts made during the five-year look-back period.

SCDHHS has 45 days to process a complete application. If they request additional documentation, the clock pauses until you respond. Submit everything upfront to avoid resets.

Step 3: The NFLOC Clinical Assessment

When your parent's position on the interest list reaches the top — or if an emergency slot opens — the regional CLTC Area Office assigns a Nurse Consultant to conduct the in-home assessment.

The nurse evaluates your parent using SC DHHS Form 1718. To meet NFLOC, your parent must demonstrate:

• Need for hands-on assistance with at least two activities of daily living (bathing, dressing, toileting, transferring, eating), OR
• Need for at least eight hours of direct daily skilled nursing care

The assessment must be completed within 10 business days of assignment, and a second Nurse Consultant must review and authorize the determination within 3 business days after that.

Preparation matters. If your parent has dementia, the assessment should be scheduled at a time of day when their symptoms are most apparent. Document specific incidents — falls, wandering episodes, medication errors — and have them ready to share with the nurse. Ask your parent's primary physician to provide a letter supporting the NFLOC determination.

What the Waiver Covers

Once both clinical and financial eligibility are confirmed, a CLTC case manager develops an Initial Service Plan within 7 business days. The CC Waiver covers:

• Personal care services — help with bathing, dressing, grooming, and ADLs
• Companion care — supervision and socialization
• Adult day health care — structured daytime programs at licensed facilities
• Home modifications — grab bars, ramps, and accessibility improvements coordinated through the case manager
• Home-delivered meals — Medicaid-funded meal delivery separate from the AAA Meals on Wheels program
• Respite care — temporary relief for family caregivers
• Self-directed attendant care — an option that lets families hire and manage their own caregivers (including qualified family members) through a state-appointed fiscal intermediary

The waiver is designed as a nursing facility alternative. Services are calibrated to what would otherwise be provided in a facility setting, adapted for home delivery.

Financial Eligibility: The Numbers That Matter

South Carolina is a strict income-cap state. These are the 2026 thresholds:

The income cap is absolute. If your parent's gross monthly income is $2,983, they are disqualified — no spend-down pathway exists for long-term care Medicaid in South Carolina. The only workaround is a Qualified Income Trust (Miller Trust), an irrevocable trust that receives income above the cap and disburses it in a priority order set by state rules.

The $66,480 CSRA is a flat cap. Unlike most states that allow a sliding scale up to the federal maximum of $162,660, South Carolina fixes the spousal resource allowance at $66,480. This means married couples must spend down joint assets to $68,480 ($66,480 for the community spouse plus $2,000 for the applicant) before the applicant qualifies.

Exempt assets do not count: one vehicle, household goods, personal effects, up to $1,500 in designated burial funds, and the primary residence (up to $752,000 equity, or unlimited if a spouse, minor child, or disabled child lives there).

The Interest List: How Long It Takes

The CC Waiver is a capped program, not an entitlement. There are a fixed number of slots available statewide, and new slots open only when existing participants leave the program (through death, moving to a nursing facility, loss of eligibility, or relocation out of state).

The interest list functions as a queue. Position is based on referral date, not severity — there is no mechanism to jump ahead based on medical urgency (though emergency slots are occasionally made available by SCDHHS for individuals in immediate crisis).

Practical takeaway: if your parent might need Medicaid-funded home care within the next several years, initiate the CLTC referral now, even if they are not currently eligible. Being on the interest list costs nothing and preserves their position. Financial and clinical eligibility are only verified when a slot actually opens.

What to Do While Waiting

The gap between CLTC intake and waiver activation is where most families struggle. These are the bridging resources:

1. Private-pay home care — licensed In-Home Care Providers under Regulation 60-122, approximately $4,300/month for part-time coverage
2. NFCSP respite — contact your regional AAA for caregiver support and respite (no income test)
3. SCRC vouchers — $500 respite vouchers from the South Carolina Respite Coalition
4. PACE program — if your parent lives in Greenville, Richland/Lexington, Charleston/Berkeley/Dorchester, or Orangeburg/Bamberg/Calhoun counties, PACE provides integrated medical and personal care for dual-eligibles without a waiver waitlist
5. Meals on Wheels and transportation — contact your AAA for immediate nutritional and transportation support

The South Carolina Home Care Coordination Guide includes a waiver intake worksheet, a financial eligibility calculator, and a structured timeline for managing both the clinical and financial tracks simultaneously — including the specific forms, deadlines, and documentation SCDHHS requires at each step.

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