South Carolina Community Choices Waiver: Home Care Through Medicaid

Your parent qualifies clinically for a nursing home but wants to stay home. The Community Choices waiver is South Carolina's primary Medicaid program that funds home and community-based services as an alternative to institutional placement — if your parent can secure a slot.

Administered by the South Carolina Department of Health and Human Services (SCDHHS) through the Community Long Term Care (CLTC) program, the Community Choices waiver covers a range of personal care and support services designed to keep seniors safely in their homes or in participating Community Residential Care Facilities (CRCFs).

What the Waiver Covers

Once enrolled, the Community Choices waiver funds:

• Personal care assistants — daily help with bathing, dressing, grooming, meal preparation, and light housekeeping
• Adult day health care — structured daytime programs providing socialization, meals, and basic health monitoring (Medicaid reimburses at $80/day as of October 2025)
• Home-delivered meals — nutritional support for homebound participants
• Home accessibility modifications — ramps, grab bars, bathroom safety equipment, and other structural changes to prevent falls
• Respite care — temporary relief for family caregivers
• Companion services — supervision and socialization for participants who should not be left alone

Participants can select their own personal care aides, and adult children can serve as paid caregivers under the program. However, spouses and legal guardians are strictly prohibited from receiving compensation.

Eligibility Requirements

Qualification requires meeting both clinical and financial thresholds:

Clinical: Your parent must meet the Nursing Facility Level of Care (NFLOC) standard, established through a face-to-face assessment by a CLTC nurse consultant. This requires documented, daily need for hands-on assistance with multiple Activities of Daily Living (ADLs) — or at least eight hours of daily skilled nursing care. A dementia diagnosis alone does not qualify — the assessment evaluates measurable functional limitations.

Financial: The same Medicaid income and asset limits apply as for nursing home Medicaid. Gross monthly income must be at or below $2,982 (a Miller Trust is required if income exceeds this cap). Countable assets cannot exceed $2,000 for a single applicant. Spousal protections apply: the at-home spouse retains up to $66,480 under the Community Spouse Resource Allowance.

The Waitlist Problem

This is where the Community Choices waiver's promise runs into reality. Demand massively outstrips available slots. The Community Support waiver waitlist exceeded 15,500 individuals as of late 2024, with wait times stretching from several months to multiple years depending on the region and priority level.

While your parent waits for a slot, they must find alternative care. Options during the waitlist period:

• Non-waiver AAA services — the local Area Agency on Aging can provide home-delivered meals, transportation, and caregiver support grants funded through the Older Americans Act
• Private-pay home care — hiring aides directly at $27 to $30 per hour
• Family caregiving — which carries no direct cost but significant indirect costs through lost wages and caregiver burnout
• Limited state services — some non-waiver Medicaid services may be available depending on your parent's enrollment category

How to Apply

1. Call the SCDHHS Centralized Intake line at 1-888-971-1637 to request a CLTC referral
2. Prepare documentation — Social Security card, government photo ID, proof of SC residency, current medical records
3. Complete the NFLOC assessment — a CLTC nurse consultant will conduct a face-to-face evaluation, typically in your parent's home
4. Submit the Medicaid application — through the local SCDHHS county office or at apply.scdhhs.gov
5. Wait for slot allocation — once clinically and financially approved, your parent is placed on the waitlist until a slot opens

If your parent is currently hospitalized, the discharge planner can request a fast-tracked CLTC assessment to accelerate the process.

Is the Waiver Worth Pursuing?

Despite the waitlist, applying early is critical. The clock on the waitlist starts when the application is submitted, not when your parent's needs become acute. Families who wait until a crisis forces the decision often face months or years of private-pay costs that could have been reduced by earlier application.

The South Carolina Elder Care Decision Guide maps out the complete waiver application process alongside the nursing home Medicaid pathway, helping families pursue both options simultaneously and plan financially for the waitlist period.

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