"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 61-77 for skilled, doctor-ordered care that Medicare can cover, and licenses South Carolina In-Home Care Providers under Regulation 61-122 for non-medical daily help that Medicare won't.
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 61-77
- Home Care: The In-Home Care Provider Under Reg 61-122
- Which One Do You Need?
- What It Costs
- 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 61-77 to deliver skilled care, and it licenses an In-Home Care Provider under Regulation 61-122, the rule that implements the state's In-Home Care Providers Act, to deliver non-medical help.
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.
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.
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 61-77 license covers. 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 61-77
Skilled home health in South Carolina comes from a Home Health Agency that DPH licenses under Regulation 61-77, often one that has also earned Medicare certification. The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The 61-77 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. 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.
When those conditions are met, Medicare pays for the covered skilled services: the nursing visits, the therapy, and the home health aide help that's attached to that skilled care. What Medicare home health won't do is staff an aide in the home for general daily help with no skilled-care purpose. That's non-medical in-home care, and it's the next section.
Home Care: The In-Home Care Provider Under Reg 61-122
Non-medical home care in South Carolina comes from an In-Home Care Provider, licensed by DPH under Regulation 61-122, the rule that carries out the state's In-Home Care Providers Act. 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. Eligibility and the specific services covered run through the state.
- 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. 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?
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 61-77 delivers skilled care, while an In-Home Care Provider under Reg 61-122 delivers the non-medical help.
| Home Health Agency (Skilled, Reg 61-77) | In-Home Care Provider (Non-Medical, Reg 61-122) | |
|---|---|---|
| What it is | Skilled, physician-ordered care: nursing and physical, occupational, or speech therapy under a plan of care, on a part-time or intermittent basis | Non-medical help: personal care (bathing, dressing, eating, mobility), homemaking, and companionship that keeps someone safe at home |
| Who provides it | A DPH-licensed Home Health Agency under Regulation 61-77, often Medicare-certified, and its clinical staff (nurses and therapists) | A DPH-licensed In-Home Care Provider under Regulation 61-122 and its aides |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or Healthy Connections (South Carolina Medicaid) for eligible low-income South Carolinians |
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
Home health, when Medicare covers it, costs the beneficiary nothing for the covered skilled services. 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 home health aide ran about $68,640 a year in 2024, according to the CareScout/Genworth Cost of Care Survey, on a basis of 44 hours a week. Homemaker services ran about the same. 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 full-week assumption will pay less than the annual figure suggests.
For low-income South Carolinians who qualify, that private cost can be covered instead through Healthy Connections.
Frequently Asked Questions
No. Medicare does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support that an aide provides. Medicare's home health benefit covers skilled, physician-ordered care (nursing and therapy) for people who are homebound and need it on an intermittent basis. For non-medical home care, the options are private pay, long-term care insurance, or, for eligible low-income South Carolinians, Healthy Connections.
Home health is skilled medical care a physician orders and a licensed clinician delivers, covered by Medicare when the person is homebound and needs intermittent skilled care. Non-medical home care is everyday help with daily living that Medicare does not cover. In South Carolina, DPH licenses the two separately: a Home Health Agency under Regulation 61-77 for the skilled care, an In-Home Care Provider under Regulation 61-122 for the non-medical help.
An In-Home Care Provider is licensed by DPH under Regulation 61-122, which carries out the state's In-Home Care Providers Act, to deliver non-medical support: personal care, homemaking, and companionship. It's a separate license class from a Home Health Agency, and the care it provides is the kind Medicare does not pay for. Low-income South Carolinians may have it covered through Healthy Connections instead.
The Department of Public Health (DPH) does. Licensing of both Home Health Agencies (Regulation 61-77) and In-Home Care Providers (Regulation 61-122) moved to DPH when the former Department of Health and Environmental Control (DHEC) split into separate agencies on July 1, 2024. A reader who finds older material citing DHEC is looking at the same licensing function under its former home.
Yes, and many do. A person recovering from surgery might receive Medicare-covered home health (a nurse and a therapist for a set period) while also needing ongoing in-home care (an aide for bathing and meals). The two run on separate payment tracks, Medicare for the skilled care and private pay or Healthy Connections for the non-medical care, so arranging one does not arrange or pay for the other.
Learn More
- Assisted Living in South Carolina
- Nursing Homes in South Carolina
- Memory Care in South Carolina
- Medicaid Planning Strategies
- Caregiver Burnout: Signs and Support
Find personalized help arranging care at home in South Carolina at brevy.com.
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