How to Get Paid as a Family Caregiver in South Carolina

As of July 1, 2025, South Carolina families can, for the first time, be paid to care for a loved one through the state's Community Choices Waiver (CC Waiver).1

Under self-directed Attendant Care, the waiver participant hires and manages their own caregiver, which may include a qualified family member. Confirm the specific family-member rules, including any spouse restrictions, with SCDHHS at (888) 549-0820, since the policy took effect in mid-2025 and the detailed requirements should be verified directly.1

This guide lays out every legitimate way to be paid as a family caregiver in South Carolina for 2026.

The Short Version

If your loved one qualifies for the South Carolina Community Choices Waiver and the self-directed Attendant Care option, your family member can be hired as the paid attendant. Call SCDHHS at (888) 549-0820 to confirm current eligibility and family-member rules, including any spouse restrictions.1

If your loved one is a veteran, check the VA programs first. The VA caregiver stipend and Veteran-Directed Care can pay a spouse and often match or beat what Medicaid pays.3

If your family has enough private assets, a written personal services contract can pay a caregiver now while documenting the arrangement for later Medicaid planning.2

What Makes South Carolina Different: The New Self-Directed Option

The Community Choices (CC) Waiver is South Carolina's primary home and community-based services waiver for older adults (age 65+) and people with physical disabilities (ages 18-64) who need a nursing-facility level of care. It is administered by SCDHHS.1

Until July 2025, the CC waiver used an agency-delivered model for attendant care. Effective July 1, 2025, SCDHHS added a self-directed Attendant Care option in which the waiver participant takes the role of employer: they recruit, hire, train, and supervise their own attendant caregiver. Family members may be eligible under this option.1

Because this is a newly implemented policy, the detailed rules (including exactly which relatives can be hired, whether a spouse qualifies, and whether a co-resident is excluded) should be confirmed directly with SCDHHS. Call (888) 549-0820 before assuming eligibility. When you call, ask specifically about the Attendant Care Self-Directed policy (finalized July 1, 2025) and the Self-Directed Care FAQs (dated August 11, 2025). Naming those two documents helps the representative point you to the current attendant-pay and family-hire rules rather than the older agency-delivered model.1

The South Carolina Paid Family Caregiver Pathways

1. Community Choices Waiver: Self-Directed Attendant Care

Who pays: South Carolina Healthy Connections Medicaid, through the CC waiver administered by SCDHHS.

Who can be paid: A family member or friend who meets SCDHHS attendant caregiver qualification requirements. The Medically Complex Children (MCC) waiver, a sibling program, explicitly allows a parent of a minor child as the paid attendant, suggesting similar flexibility may apply under the CC waiver self-directed model. The exact rules for the CC waiver's self-directed option, including spouse eligibility, should be confirmed with SCDHHS at (888) 549-0820 before relying on them.1

What it covers: Attendant care and personal care services authorized in the member's care plan.

Eligibility, recipient: Frail elderly adults age 65 and older, or adults ages 18-64 with physical disabilities, who need a nursing-facility level of care and meet Medicaid financial eligibility criteria. Verify waitlist status; CC waiver enrollment can be limited.1

How you get paid: Through SCDHHS's fiscal intermediary arrangement. Confirm payroll details when enrolling.

Best for: A family member caring for a CC waiver-eligible South Carolinian who wants to direct their own care.

While you wait: CC waiver enrollment can be capped, and a new application may sit on a waitlist. If your loved one needs care now, two bridges can pay a family caregiver in the meantime: a VA pathway (if the person is a veteran or a veteran's spouse), or a private personal services contract funded from family assets. The contract route has a second benefit: it keeps those payments from being treated as gifts under the Medicaid look-back later. Both options are covered below.2

2. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran, including a spouse, adult child, or other family member.3

2026 stipend: The PCAFC stipend is based on the federal GS-4, Step 1 rate for the veteran's locality. Confirm your exact amount with the VA Caregiver Support Coordinator.3

Veteran eligibility: A VA disability rating (individual or combined) of 70 percent or higher, a need for in-person personal care services, and enrollment in VA health care. Confirm the current criteria with a VA Caregiver Support Coordinator.3

Why it stands out: Tax-free stipend, pays spouses, can combine with Medicaid.

Best for: Families of eligible veterans where one person provides substantial daily care.

3. VA Veteran-Directed Care (VDC)

Who can be paid: Almost any caregiver the veteran chooses, including a spouse.

How it works: The veteran receives a flexible monthly VA budget and hires caregivers at a self-set rate. A fiscal agent handles payroll. Ask your VA Caregiver Support Coordinator whether VDC is available at your South Carolina VA medical center.

Best for: South Carolina veterans who want to pay a spouse or choose their own caregiver.

4. VA Aid and Attendance Pension

2026 maximums: Single veteran up to $2,424 per month; veteran with one dependent up to $2,874 per month. Confirm current rates at the VA pension rate page before applying.4

Eligibility: Wartime veteran or surviving spouse meeting Aid and Attendance functional criteria with assets and income under the $163,699 net-worth limit.4

How caregivers get paid: The pension goes to the veteran; the caregiver is paid from it under a private agreement. South Carolina's county Veterans Service Officers and the South Carolina Department of Veterans Affairs help file at no cost.

Best for: Wartime veterans or surviving spouses under the limits.

5. Private Personal Services Contract

Who can be paid: Any family member under a written contract, signed before care begins, at a fair-market rate.

Why the format matters: South Carolina applies a 60-month (five-year) Medicaid look-back to uncompensated transfers. Informal payments to a family member for care are treated as gifts and can create a penalty period. A properly drafted contract at fair-market rates converts those payments into a documented exchange. Confirm the current transfer-penalty divisor with SCDHHS or a South Carolina elder-law attorney.2

Best for: Families with enough assets to private-pay now who want to protect future Medicaid eligibility.

Comparing the South Carolina Paid Family Caregiver Pathways

How to Choose

Tax Considerations

• CC Waiver self-directed Attendant Care pays W-2 wages through the fiscal intermediary.
• VA PCAFC is a federal tax-free stipend.3
• VA Aid and Attendance is tax-free to the veteran; caregivers pay ordinary income tax on what they receive.
• IRS Notice 2014-7: If you live in the same home as the person you care for and are paid through a Medicaid waiver, your wages may be excludable from federal gross income. South Carolina has a state income tax; confirm the state-level treatment with a tax preparer.

Common Misconceptions

"The CC waiver has never paid family members." It did not have a self-directed option before July 2025. The new self-directed Attendant Care model (effective 7/1/2025) opens the door for family-member hiring. Confirm the current rules with SCDHHS.

"Medicare will pay me to be Mom's caregiver." Medicare does not pay family caregivers. It covers only short-term skilled home health through certified agencies.

"I can informally get paid from Dad's savings." Not without a written personal services contract. Informal payments trigger South Carolina's 60-month Medicaid look-back.

Where to Get Help in South Carolina

Related Terms

• Consumer Directed Services (CDS): The national term for self-directed programs like SC's self-directed Attendant Care.
• HCBS waiver: The federal authority behind the Community Choices Waiver.
• Activities of Daily Living (ADLs): The functional basis for attendant care hours.
• Nursing Facility Level of Care: The clinical threshold for CC waiver eligibility.

Learn More

Find personalized help getting paid as a family caregiver 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.