Home Care vs. Home Health in South Carolina (2026)

"Home care" and "home health" sound like the same thing, but in South Carolina they're two separately licensed services, and the difference decides who pays. The state licenses South Carolina Home Health Agencies under Regulation 60-77 for skilled, doctor-ordered care that Medicare can cover, and licenses South Carolina In-Home Care Providers under Regulation 60-122 for non-medical daily help that Medicare won't.1

This guide draws that line so a family doesn't pay out of pocket for care a program would have covered, or wait on Medicare coverage that was never coming. The label that matters isn't the agency's name. It's whether the care is skilled or non-medical, and which program pays the bill.

In This Guide

• Key Takeaways
• The Core Difference
• Home Health: The Home Health Agency Under Reg 60-77
• Home Care: The In-Home Care Provider Under Reg 60-122
• Which One Do You Need in South Carolina?
• What It Costs in South Carolina
• Frequently Asked Questions

The Core Difference

The split is skilled versus non-medical, and in South Carolina it's written into two different licenses under two different regulations. DPH doesn't put in-home care under one rulebook. It licenses a Home Health Agency under Regulation 60-77 to deliver skilled care, and it licenses an In-Home Care Provider under Regulation 60-122, the rule that implements the state's Licensure of In-Home Care Providers Act (S.C. Code Section 44-70-10 et seq.), to deliver non-medical help.1

A Home Health Agency provides skilled, intermittent care: nursing and physical, occupational, or speech therapy that a physician orders because the person has a medical need only a licensed professional can meet. Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to rebuild strength after a stroke or a fall. The care is part-time and intermittent, not round-the-clock.1

An In-Home Care Provider delivers non-medical support: personal care, homemaking, and companionship, the everyday help that keeps someone safe at home. The person can be medically stable and still need this help every day.1

That separation is what decides the money. A Home Health Agency may also become Medicare-certified, which is the step that lets it bill Medicare for the skilled care its 60-77 license covers.1 An In-Home Care Provider delivers care Medicare doesn't pay for at all. So when a South Carolina family hears "home health agency," that's shorthand for the skilled, often Medicare-certified track, and "in-home care" points to the non-medical one.

The same person often needs both at once. Someone discharged after a hip replacement might need home health (a nurse and a physical therapist for a few weeks) and also in-home care (an aide for bathing and meals for months). Those come from different providers, licensed under different regulations, and they run on separate payment tracks: Medicare pays for the skilled piece, and something else pays for the non-medical piece.

Home Health: The Home Health Agency Under Reg 60-77

Skilled home health in South Carolina comes from a Home Health Agency that DPH licenses under Regulation 60-77, often one that has also earned Medicare certification.1 The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The 60-77 license is the floor; Medicare certification is the additional step that lets the agency bill Medicare for those services.

Medicare's home health benefit covers this care when a beneficiary meets the conditions.2 The two that trip families up most:

• Homebound. Leaving home takes considerable, taxing effort, and the person generally needs help or an assistive device to do it. Short, occasional trips out, to a medical appointment or to religious services, don't disqualify someone.
• Intermittent skilled need. A physician certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care the physician reviews, and the care comes from a Medicare-certified agency. "Part-time or intermittent" generally means combined skilled nursing and aide services of less than 8 hours a day and 28 or fewer hours a week (up to 35 on case-by-case review).2

When those conditions are met, Medicare pays for the covered skilled services, and the beneficiary generally pays $0: the nursing visits, the therapy, and the home health aide help that's attached to that skilled care.2 What Medicare home health won't do is staff an aide in the home for general daily help with no skilled-care purpose, deliver meals, or provide homemaker or custodial care when that's the only care needed. That's non-medical in-home care, and it's the next section.

Home Care: The In-Home Care Provider Under Reg 60-122

Non-medical home care in South Carolina comes from an In-Home Care Provider, licensed by DPH under Regulation 60-122, the rule that carries out the state's Licensure of In-Home Care Providers Act.1 The services are personal care, homemaking, and companionship. Because it isn't skilled medical care, the payer picture looks nothing like home health.

Who pays for in-home care comes down to a few routes:

• Private pay. Many families pay out of pocket, by the hour. This is the default when no one qualifies for a public program and the need is non-medical.
• Healthy Connections (South Carolina Medicaid). For low-income South Carolinians, Healthy Connections, the state's Medicaid program, generally funds non-medical in-home care so a person can stay at home rather than enter a facility, often through the South Carolina Community Choices Waiver, the state's home- and community-based services waiver for older adults and adults with disabilities. Eligibility and the specific services covered run through the South Carolina Department of Health and Human Services.1
• Long-term care insurance. A private policy, if the person holds one, may reimburse personal-care hours.

One line is worth stating plainly. Medicare does not pay for non-medical personal care.2 A family expecting Medicare to cover an aide for daily help will find it won't, no matter how much that help is needed. The ways to pay for in-home care are private funds, long-term care insurance, or, for eligible low-income South Carolinians, Healthy Connections.

Which One Do You Need in South Carolina?

Start with the need, not the brochure. The table maps the two services across the dimensions that decide what the care is and who pays. The license is your first clue: a Home Health Agency under Reg 60-77 delivers skilled care, while an In-Home Care Provider under Reg 60-122 delivers the non-medical help.1

A quick way to place a situation: if a physician has ordered skilled care and the person is homebound, you're looking at home health, and Medicare is the payer to check first. If the need is ongoing help with everyday tasks and there's no skilled medical component, you're looking at an In-Home Care Provider, and the question becomes whether to pay privately or qualify through Healthy Connections. Both can be in play at once, and plenty of South Carolina families arrange both.

What It Costs in South Carolina

Home health, when Medicare covers it, costs the beneficiary nothing for the covered skilled services.2 The cost question really lives on the non-medical side, where families pay out of pocket unless Healthy Connections covers it.

For non-medical home care in South Carolina, a non-medical caregiver ran about $71,786 a year in 2025, according to the CareScout Cost of Care Survey (the Genworth-affiliated survey, released March 2026).3 The 2025 survey reports a single "non-medical caregiver" line in place of the separate homemaker and home-health-aide figures used in earlier years. These are industry-survey medians, not government rates and not a maximum, so what a specific South Carolina agency charges can land above or below them, and the Charleston, Greenville, and Hilton Head areas tend to run higher than rural parts of the state. A family using fewer hours than the survey's full-week assumption will pay less than the annual figure suggests.3

For comparison, assisted living in South Carolina ran about $64,200 a year in the same 2025 survey, and a semi-private nursing-home room about $108,405 a year, so non-medical home care sits between the two when used full-time.3 For low-income South Carolinians who qualify, that private home-care cost can be covered instead through Healthy Connections.1

Learn More

Find personalized help arranging care at home in South Carolina at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.