How to Get Paid as a Family Caregiver in South Carolina

South Carolina families can be paid to care for a loved one at home through self-directed attendant care under the state's Community Choices Waiver (CC Waiver). The participant directs their own attendant, and a fiscal intermediary contracted by SCDHHS pays that attendant.1,2

The attendant may be a relative, but only within the limits of the South Carolina Family Caregiver Policy. A parent, stepparent or foster parent of a minor participant cannot be paid, and neither can a legally responsible adult. SCDHHS's manual does not mention spouses by name, so ask before you count on paying one.2

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 uses the self-directed Attendant Care option, a family member who meets SCDHHS's attendant qualifications can be hired as the paid attendant, unless they are a parent, stepparent or foster parent of a minor participant or a legally responsible adult. Start with a referral to DHHS/CLTC Centralized Intake at 888-971-1637, and ask whether a spouse can be paid in your situation.1,2

If your loved one is a veteran, check the VA programs first. The VA caregiver stipend (PCAFC) can go to a spouse who is the veteran's Primary Family Caregiver, and Veteran-Directed Care is worth asking about too.3

If your family can pay privately, a written caregiver agreement lets you pay a relative now. Because federal Medicaid rules look back 60 months at disposals of assets, get elder-law advice before payments start.4

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

The Community Choices (CC) Waiver is a South Carolina Medicaid home and community-based services waiver that offers an alternative to nursing home residence: assistive services at home for the frail elderly (age 65+) and people with physical disabilities (ages 18-64) who meet nursing facility level of care criteria. SCDHHS is its administrative and operating authority.1

Under the Attendant Care (Self-Directed) scope of services in SCDHHS's HCBS Provider Manual, dated July 1, 2025, services are directed by the participant or an appointed employer of record, who supervises the attendant's employment and schedules the services. That supervision has to be certified: a licensed University of South Carolina (USC) nurse certifies the participant or representative to supervise, and decides when they are no longer certified.2

A relative may be the paid attendant only within the limits of the South Carolina Family Caregiver Policy. The manual lists four kinds of family member who cannot be a paid caregiver: a parent, a stepparent or a foster parent of a minor Medicaid participant, and a legally responsible adult (a person with the legal responsibility of using their own assets for the participant's care). It does not use the word spouse, so the manual alone does not settle whether a spouse falls under that last bar. Ask SCDHHS before you plan around paying a spouse, and name the Attendant Care (Self-Directed) scope of services dated July 1, 2025 when you call.2

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: An attendant who meets SCDHHS's qualifications, including a qualified relative other than the family members barred above. Attendants must be at least 18; able to read, write and communicate with the participant or employer of record; fully ambulatory and physically able to help with daily activities such as lifting and transferring; and free of any known conviction for abuse, neglect or exploitation, for a crime against another person, for any felony, or concerning the misuse or abuse of any public assistance program, and not excluded from the Medicare or Medicaid programs. They must also complete tuberculosis screening before enrollment and an annual TB risk assessment to stay eligible.2

What it covers: The CC waiver's covered services include personal care and attendant care. Attendant care can include escorting the participant to covered Medicaid medical services, but the attendant is not allowed to provide transportation. If the assessed need is more than 40 hours a week, every effort must be made to find a separate attendant for the hours over 40.1,2

Eligibility, recipient: Frail elderly adults age 65 and older, or adults ages 18-64 with physical disabilities, who meet nursing facility level of care criteria. They must also qualify for South Carolina Medicaid, which applies the same eligibility requirements to nursing-facility care and HCBS waivers. Ask about current enrollment availability when you make the referral.1,4

How you get paid: A fiscal intermediary contracted by SCDHHS processes payment to the attendant. Before the first authorization is issued, a newly matched attendant must attend Electronic Visit Verification (EVV) and billing training at the SCDHHS Area office.2

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

While you wait: If your loved one needs care before CC waiver services start, two bridges can pay a family caregiver in the meantime: a VA pathway (if the person is a veteran or a veteran's surviving spouse), or a private arrangement funded from family assets. If you go the private route, get elder-law advice and put it in writing first, because federal Medicaid rules look back 60 months at disposals of assets made on or after February 8, 2006. Both options are covered below.4

If your loved one's income is over the cap, sign the trust now, not once the paperwork is settled. South Carolina is an income-cap state: the nursing-facility and waiver group has a limit of 300 percent of the SSI federal benefit rate, $2,982 a month for an individual in 2026, which SCDHHS calls the Medicaid Cap. Someone over it can use an Income Trust, which they fund by depositing their income into it each month, and income that flows through it does not count toward the cap. Here is the part that costs families money: SCDHHS states that eligibility cannot be established before the month the trust document is signed. Every month of delay is a month of waiver or nursing-facility care the trust cannot pay for, so complete the document as soon as possible. Note too that the applicant must appoint a trustee and cannot serve as their own.4

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

Who can be paid: The designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either a family member of the veteran (a spouse, son, daughter, parent, stepfamily member, or extended family member) or someone who lives full time with the veteran, or is willing to if VA designates them.3

2026 stipend: The PCAFC monthly stipend is the federal GS-4, Step 1 annual rate for the veteran's locality pay area, divided by 12 and multiplied by 0.625, or by 1.00 if VA determines the veteran is unable to self-sustain in the community. Legacy participants are tiered differently until October 1, 2028. The caregiver must be enrolled in direct deposit to receive it. Confirm your exact amount with the VA Caregiver Support Coordinator.3

Veteran eligibility: VA lists four requirements, and all must be true: a VA disability rating (individual or combined) of 70 percent or higher; a discharge from the U.S. military or a date of medical discharge; a need for at least 6 months of continuous, in-person personal care services; and enrollment in VA health care. Meeting them is a first screen, not approval: you and the veteran apply together and go through VA's application process.3

Why it stands out: A monthly stipend that can go to a spouse, plus other Primary Family Caregiver benefits such as at least 30 days of respite care per year.3

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

3. VA Veteran-Directed Care (VDC)

Who can be paid: Workers the veteran hires and supervises, which VA says might include "their own family member or neighbor." If you hope to pay a spouse, ask VA whether that is allowed before you plan around it.5

How it works: The veteran manages their own flexible budget and decides what mix of goods and services best meets their needs. Through an options counselor, the Aging and Disability Network Agency arranges fiscal management services and provides ongoing counseling and support.5

Availability in South Carolina: VA says all enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and it is available, and that services may vary by location. ACL lists approved VDC providers in South Carolina under the Ralph H. Johnson, Wm. Jennings Bryan Dorn and Fayetteville VA medical centers, but a listing does not by itself show that a medical center is referring veterans. Talk with your VA social worker to find out if it is available in your location.5

Best for: South Carolina veterans who want to choose and direct their own caregiver.

4. VA Aid and Attendance Pension

2026 maximums: VA publishes these as annual ceilings, not flat payments. A veteran with no dependents: up to $29,093 a year. A veteran with one dependent: up to $34,488 a year. VA pays the difference between countable income and the ceiling, so income lowers the amount received.6

Eligibility: VA's pension tables set a higher maximum for a veteran who qualifies for Aid and Attendance ($29,093 a year with no dependents) than for one who does not ($17,441). From December 1, 2025, to November 30, 2026, the net worth limit to be eligible for Veterans Pension benefits is $163,699, counting the claimant's and dependents' assets and income for VA purposes; the primary residence, a car, and basic home items are not counted as assets.6

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: Federal law sets a 60-month (five-year) look-back for a disposal of assets made on or after February 8, 2006. SCDHHS publishes its own statement of the rule only in a manual we cannot cite, so take the state-specific detail from SCDHHS directly. Before paying a relative from your loved one's savings, ask a South Carolina elder-law attorney how SCDHHS treats those payments under the look-back, how to document the arrangement in writing, and how any transfer penalty would be calculated.4

Best for: Families with enough assets to private-pay now who are planning for a possible Medicaid application later.

Comparing the South Carolina Paid Family Caregiver Pathways

How to Choose

Tax Considerations

• CC Waiver self-directed Attendant Care pays the attendant through a fiscal intermediary contracted by SCDHHS; ask it how your pay is reported for tax purposes.2
• VA PCAFC pays the Primary Family Caregiver a monthly stipend; confirm its tax treatment with a tax preparer.3
• VA Aid and Attendance is paid to the veteran or surviving spouse; if they pay you from it under a private agreement, ask a tax preparer how that income is taxed.
• 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 can't pay family members." Its self-directed Attendant Care option can pay a relative who meets SCDHHS's attendant qualifications, within the limits of the South Carolina Family Caregiver Policy. The exceptions are a parent, stepparent or foster parent of a minor participant and a legally responsible adult.2

"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 safely without advice. Federal Medicaid rules look back 60 months at disposals of assets, so ask a South Carolina elder-law attorney how to put a caregiver arrangement in writing before any money changes hands.4

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.