South Carolina pays family members to provide in-home care through the self-directed Attendant Care option in its Community Choices Waiver, which became available as of July 1, 2025.
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.
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.
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.
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.
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.
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.
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.
The South Carolina Paid Family Caregiver Pathways
1. Community Choices Waiver: Self-Directed Attendant Care
Who pays: South Carolina 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.
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.
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.
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.
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.
Veteran eligibility: Service-connected disability of 70 percent or higher, needs personal care for at least six continuous months, enrolled in VA health care.
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.
Eligibility: Wartime veteran or surviving spouse meeting Aid and Attendance functional criteria with assets and income under the $163,699 net-worth limit.
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 enforces a 60-month Medicaid look-back. 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.
Best for: Families with enough assets to private-pay now who want to protect future Medicaid eligibility.
Comparing the South Carolina Pathways
| Pathway | Pay a spouse? | Who pays | Best fit |
|---|---|---|---|
| CC Waiver self-directed Attendant Care | Confirm with SCDHHS | SC Medicaid | Family member of CC waiver enrollee |
| VA PCAFC | Yes | VA (tax-free stipend) | Eligible veteran's primary caregiver |
| VA Veteran-Directed Care | Yes | VA (veteran-set budget) | Veteran wanting to pay a spouse |
| VA Aid and Attendance | Pension to veteran | VA (pension) | Wartime veteran under limits |
| Personal services contract | Yes (private funds) | Private | Family with assets, planning ahead |
How to Choose
- Is your loved one a veteran? VA programs pay a tax-free stipend (PCAFC), allow paid spouses (Veteran-Directed Care), and don't require Medicaid eligibility. Check these first.
- Is your loved one Medicaid-eligible and on or likely eligible for the CC waiver? Contact SCDHHS at (888) 549-0820 to ask about enrollment in the CC waiver and the self-directed Attendant Care option, and to confirm which family members can be hired.
- Does your family have private assets and want to plan ahead? Work with a South Carolina elder-law attorney on a personal services contract before payments start.
- Not sure where to start? Call the South Carolina Lt. Governor's Office on Aging at 1-800-868-9095 or use their local resource finder.
Not sure which South Carolina program fits your family? Chat with Brevy's care navigator for a personalized comparison based on your loved one's veteran status, CC waiver eligibility, and care needs.
Tax Considerations
- CC Waiver self-directed Attendant Care pays W-2 wages through the fiscal intermediary.
- VA PCAFC is a federal tax-free stipend.
- 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.
Frequently Asked Questions
Possibly, under the Community Choices Waiver self-directed Attendant Care option. The policy was finalized July 1, 2025; the specific rules about spousal eligibility should be confirmed with SCDHHS at (888) 549-0820. If your spouse is a veteran, VA Veteran-Directed Care and the PCAFC stipend can pay a spouse regardless of Medicaid rules.
The CC waiver is South Carolina's main HCBS waiver for frail elderly adults (65+) and adults 18-64 with physical disabilities who need nursing-facility-level care. As of July 1, 2025, it includes a self-directed Attendant Care option that allows the participant to hire their own caregiver, which may include a family member.
Contact SCDHHS at (888) 549-0820 or through scdhhs.gov to apply for CC waiver enrollment. A SCDHHS case manager will assess functional and financial eligibility. Once enrolled and approved for self-directed Attendant Care, the participant hires the caregiver through the fiscal intermediary.
Waiver enrollment may be limited. Confirm current availability and any waitlist with SCDHHS when applying.
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
- How to Get Paid as a Family Caregiver in Washington
- How to Get Paid as a Family Caregiver in North Carolina
- Caregiver Burnout: Signs, Stages, and How to Get Support
- VA Senior Care Benefits in South Carolina
- The Cost of Senior Care in South Carolina
- Medicaid Planning Strategies
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.