South Carolina Medicaid pays for care at home instead of in a nursing home, mainly through the Community Choices (CC) Waiver. The Community Choices Waiver is South Carolina's primary Medicaid home and community-based services (HCBS) waiver for older and physically disabled adults. South Carolina Medicaid HCBS waivers like Community Choices are Section 1915(c) waivers, which means they let the state cover in-home and community care for people who would otherwise qualify for a nursing facility, provided they meet a nursing facility level of care.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC The program is run by the South Carolina Department of Health and Human Services (SCDHHS) through its Community Long Term Care (CLTC) division.
In This Guide
- What South Carolina Medicaid HCBS Waivers Are
- The Community Choices Waiver in Detail
- Who Qualifies for South Carolina Medicaid HCBS Waivers
- What the Community Choices Waiver Covers
- The Interest List and How Enrollment Works
- How to Apply for Home Care Through South Carolina Medicaid
What South Carolina Medicaid HCBS Waivers Are
Home and community-based services, usually shortened to HCBS, is the umbrella term for long-term care that Medicaid delivers outside an institution: in your own home, a family member's home, or another community setting rather than a nursing facility. States deliver these services under several federal authorities, and the one South Carolina uses for its main aged-and-disabled program is Section 1915(c) of the Social Security Act, the federal HCBS waiver authority.
A Section 1915(c) waiver rests on a simple trade. The state agrees to cover home care for a person who is sick or frail enough to need a nursing facility, on the theory that community care can meet the same need at a comparable cost. That is why every applicant has to meet a nursing facility level of care: the waiver is meant as an alternative to institutional placement, not a separate benefit for people with lighter needs.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC It is also why these programs are capped. Unlike regular Medicaid coverage, a 1915(c) waiver serves a limited number of people at a time rather than everyone who qualifies.
In South Carolina, the waiver that fills this role for older adults and adults with physical disabilities is the Community Choices Waiver, and the rest of this guide focuses on how it works.
The Community Choices Waiver in Detail
The Community Choices (CC) Waiver is administered by SCDHHS through its Community Long Term Care (CLTC) division, the branch of South Carolina Medicaid that manages home and community-based long-term care. The waiver operates as part of Healthy Connections, the name South Carolina uses for its Medicaid program. Its federal waiver record is 0405.R05.00 on Medicaid.gov, which lists it as an approved 1915(c) waiver.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC
The program's purpose is to keep people in the community who could otherwise be admitted to a nursing home. Rather than paying a facility a daily rate, Medicaid pays for a package of in-home and community supports built around each person's needs and coordinated by a case manager. Think of the case manager as the point of contact who assesses what you need, arranges the services, and adjusts the plan as your situation changes.
Who Qualifies for South Carolina Medicaid HCBS Waivers
Qualifying for the Community Choices Waiver comes down to two tests you have to pass together: a functional test about your care needs and a financial test about your income and resources.
The functional test: a nursing facility level of care. The waiver serves frail adults age 65 and older, as well as adults ages 18 to 64 with physical disabilities, who meet a nursing facility level of care.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC In plain terms, that means your health and daily-living needs are significant enough that you could be admitted to a nursing home. South Carolina confirms this through a Community Long Term Care (CLTC) level-of-care determination, which we cover in the application section below.
The financial test. Because the waiver pays for the same kind of long-term care a nursing home provides, it uses the same financial rules as institutional Medicaid. South Carolina is an income-cap state, so the monthly income limit is set at 300% of the Supplemental Security Income (SSI) Federal Benefit Rate (FBR), which works out to $2,982 for a single applicant in 2026, effective January 1, 2026.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC The countable-resource, or asset, limit is $2,000, the standard SSI resource amount.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC
If you are married and your spouse will remain at home, that is not the whole story. South Carolina protects additional resources for a community spouse who stays in the home, so a married couple is not held to the single $2,000 figure across both of them.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC These spousal protections can be detailed, so it is worth confirming the current figures with SCDHHS or a benefits counselor before you plan around them.
What the Community Choices Waiver Covers
The Community Choices Waiver funds a broad set of in-home and community services, all coordinated through case management. Covered services include:Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC
- Personal care and attendant care (help with bathing, dressing, and other daily activities)
- Adult day health care, including adult day health care nursing
- Respite care, both in-home and institutional, to give family caregivers a break
- Companion care
- Home-delivered meals
- Home accessibility adaptations, also called environmental modifications, such as ramps or grab bars
- Personal emergency response systems (PERS), the wearable alert devices that call for help
- Specialized medical equipment and supplies
- Telemonitoring
The through-line is that these supports are meant to let a person handle daily life at home who would otherwise need a nursing facility to get the same help. What the waiver covers is set by its approved federal service array, so if you need a specific service, ask your case manager whether it falls within the plan.
The Interest List and How Enrollment Works
Here is where the capped nature of the waiver matters most. Because the Community Choices Waiver is a Section 1915(c) waiver rather than an open entitlement, it serves a limited number of people at a time, and enrollment is limited.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC That means access is not automatic even for someone who clearly qualifies on both the functional and financial tests.
Whether there is a waiting list, sometimes called an interest list, and how long it runs can change over time. The current status is something to confirm directly with SCDHHS rather than assume, since it depends on the state's available slots at the moment you apply.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC If you are planning ahead for a parent or spouse, asking about the interest list early is worthwhile, because your place in line, if there is one, can affect how quickly services begin.
How to Apply for Home Care Through South Carolina Medicaid
Applying for the Community Choices Waiver runs on two tracks that come together: proving you need a nursing facility level of care, and qualifying financially for Medicaid.
To start, a person who needs a nursing facility level of care, whether at home or in a facility, contacts Healthy Connections through SCDHHS.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC If you are seeking care in your own home, the order of operations matters: you obtain a Community Long Term Care (CLTC) level-of-care determination before completing the Medicaid application, and referrals for the waiver are handled through the SCDHHS Community Long Term Care Centralized Intake.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC
Federal rules give you more than one way to file the underlying Medicaid application. Under 42 CFR 435.907(a), the state agency has to accept applications online, by phone, by mail, and in person, so you can choose whichever channel is easiest for your family.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Federal rules also cap how long the state can take to decide. Under 42 CFR 435.912, an eligibility determination generally may not exceed 45 calendar days for most applicants, or 90 calendar days when eligibility is based on a disability, running from the date you apply.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf Those are outer limits, not typical timelines, and they cover the financial eligibility decision rather than any wait for a capped waiver slot.
Frequently Asked Questions
If I qualify, how soon can Community Choices Waiver services start?
Two clocks run separately. Under federal rules, the state generally must decide your Medicaid financial eligibility within 45 calendar days, or within 90 days when the decision is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf A waiver slot is a separate matter: because the Community Choices (CC) Waiver is capped, services begin when a slot is available, not automatically when you qualify.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC That gap is why confirming the current interest-list status with SCDHHS early is worth doing.
How is the Community Choices Waiver different from nursing-home Medicaid?
Both cover the same level of long-term care and use the same financial rules, but the setting is different. Nursing-home Medicaid pays a facility to care for you as a resident, while the Community Choices Waiver pays for home and community-based services (HCBS) so you can receive comparable care in your own home or community.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC That is the point of a Section 1915(c) waiver: it is an alternative to nursing facility placement for people who meet a nursing facility level of care.
Who decides which Community Choices Waiver services I actually receive?
A case manager. The waiver funds a fixed set of in-home and community supports, but you do not automatically receive all of them: a case manager assesses your needs, builds a care plan around them, and adjusts it as your situation changes.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC If you think you need a specific service, ask your case manager whether it falls within the approved plan.
How do I start an application for home care through South Carolina Medicaid?
Contact Healthy Connections through SCDHHS, and if you want care in your own home, obtain a Community Long Term Care (CLTC) level-of-care determination before you finish the Medicaid application; waiver referrals go through the SCDHHS CLTC Centralized Intake.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov — South Carolina Waiver Descriptions Factsheet (SC Community Choices Waiver 0405.R05.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/SC You can file the underlying Medicaid application online, by phone, by mail, or in person, because federal rules require the state to accept all of those channels.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907
Learn More
Find personalized help understanding South Carolina Medicaid HCBS waivers 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.