South Carolina's Community Choices Waiver, a Medicaid program that helps older and disabled adults get care at home, may pay a qualified relative, such as an adult child, as their attendant. Community Choices Waiver family caregiver pay runs through self-directed services: the person receiving care, or an appointed employer of record, directs, schedules and supervises the attendant, and a fiscal intermediary contracted by the state pays the attendant.

In This Guide

What South Carolina's Community Choices Waiver Pays Family Caregivers For

The Community Choices Waiver helps adults who meet nursing facility level of care, either 65 and older or 18 to 64 with physical disabilities, get care at home instead of moving to a nursing home. The South Carolina Department of Health and Human Services (SCDHHS) runs it as a 1915(c) waiver; its renewal dates are in our South Carolina Medicaid HCBS waivers guide.

A Community Choices Waiver participant must also qualify for South Carolina Medicaid under its nursing facility rules, whose 2026 income limit for one person is $2,982 a month; income deposited into an Income Trust doesn't count toward it.

Which Family Members Can Be Paid?

Apart from relatives barred in the table below, the Community Choices Waiver may pay any other qualified family member for services including Attendant Care and Personal Care.

Your relationship Self-directed services Hired by a provider agency
Adult child or other relative Yes, if you meet the qualifications and aren't legally responsible Yes, within Family Caregiver Policy limits
Spouse (including married but separated) Only if not legally responsible; you request it No
Legal guardian of an adult Only if not legally responsible No, if legally responsible
Parent, stepparent or foster parent of a minor No No
Relative who lives with the participant Ask the program Ask the program

SCDHHS defines a "legally responsible" person as one who has to use their own funds to care for the participant. The waiver documents don't say who decides that; ask SCDHHS Centralized Intake. A spouse's full options, including VA benefits, are in getting paid to care for your spouse in South Carolina.

What You Need to Become the Paid Attendant

Under SCDHHS's July 1, 2025 Attendant Care (Self-Directed) rules, an attendant must:

  • Be at least 18 and able to read, write and communicate with the participant or employer of record
  • Be fully ambulatory and able to help with daily activities, including lifting and transferring
  • Follow a supervised service plan, billing procedures and paperwork
  • Have no known conviction for abuse, neglect or exploitation of adults or children or for any crime against another person, no felony conviction, and no conviction for misusing a public assistance program
  • Not be excluded from Medicare or Medicaid, and provide references on request
  • Show a tuberculosis screening result before the Medicaid provider enrollment date, then submit a TB risk assessment every year

The Community Choices Waiver's 2026 renewal also requires attendants to be free from communicable diseases and show competency in caring for the participant, verified by a South Carolina licensed nurse.

If an attendant misses the annual TB risk assessment, SCDHHS suspends the attendant as a provider, the participant is told attendant services must end in ten business days so they can find a replacement, and SCDHHS then ends the attendant's enrollment.

A licensed University of South Carolina (USC) nurse also has to certify that a Community Choices Waiver participant or representative, the person who directs your work, can safely supervise the attendant, and that nurse decides if they're no longer certified.

What the Job Covers and How Many Hours

A South Carolina Community Choices attendant can escort the participant to covered Medicaid medical services but is not allowed to provide transportation. You can go with your mom to the cardiologist; the ride needs another source: Healthy Connections Medicaid offers non-emergency medical transportation; booking details are in our South Carolina senior transportation guide.

A Community Choices Waiver attendant working for more than one participant should not go over 40 combined hours a week.

How Family Caregiver Pay Works Under South Carolina's Community Choices Waiver

The $14.48 South Carolina aide median (BLS, May 2025) is not a Community Choices rate. Before cutting back other work, ask the fiscal intermediary for your actual rate and how your pay is reported; see who sends your W-2 or 1099.

Under IRS Notice 2014-7, 1915(c) waiver payments can be left out of federal gross income when you give the care in a home you share with the person, but not when you keep a separate home. Ask a tax professional, and see whether waiver payments are taxable.

How to Start

1
Step 1

Call SCDHHS Centralized Intake

, which takes Community Choices Waiver referrals at 888-971-1637.

2
Step 2

Apply for Medicaid if your parent isn't enrolled

Apply online through Healthy Connections, or send SCDHHS's paper Application for Nursing Home, Residential or In-Home Care by fax, mail or to a county office.

3
Step 3

Ask for self-directed Attendant Care

and name who will supervise you, for a USC nurse to certify.

4
Step 4

Clear enrollment

, including your TB screening.

5
Step 5

Attend billing training

Before the first authorization, attend Electronic Visit Verification (EVV) System and billing training at the participant's SCDHHS Area office.

Frequently Asked Questions

What if my parent can't supervise me?

A Community Choices Waiver participant can have services directed by a representative, who may be a legal guardian, a family member, or a friend. That representative then supervises you, once the USC nurse certifies them.

Can a stepparent be paid to care for an adult stepchild?

Possibly. The Community Choices Waiver bars a stepparent only when the participant is a minor, so a qualified stepparent of an adult who isn't legally responsible can be paid.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in South CarolinaHow to get paid as a family caregiver in South Carolina in 2026: Community Choices self-directed attendant care, VA options, and the 60-month look-back. CaregiverGetting Paid to Care for Your Spouse in South CarolinaCan you get paid to care for your spouse in South Carolina? What Medicaid self-direction plus VA PCAFC, Veteran-Directed Care, and Aid and Attendance allow. CaregiverCaregiver Programs in South CarolinaEvery caregiver program in South Carolina: paid caregiver pathways, NFCSP respite grants, VA benefits, and tax rules for family caregivers in 2026. MedicaidSouth Carolina Medicaid HCBS WaiversSouth Carolina's Community Choices Waiver is the state's main Medicaid HCBS program, paying for home and community care for adults who need nursing-home care.

Find personalized help becoming your parent's paid attendant through South Carolina's Community Choices Waiver 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.

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