Community Choices Waiver: Get Paid to Care for a Family Member in South Carolina

Yes -- for Attendant Care. This is one of the notable features of South Carolina's self-directed option that launched July 1, 2025. Under the SCDHHS HCBS Provider Manual, the family members who cannot be a paid attendant are parents, stepparents, and foster parents of a minor Medicaid participant, and any "legally responsible adult" who is obligated to use their own assets for the participant's care. A spouse of an adult participant is not on that exclusion list for Attendant Care, so a husband or wife can generally be hired and paid as the self-directed attendant. The one caveat: spouses are specifically excluded from being paid for Companion Care, so the spouse route works through Attendant Care, not Companion Care. Because this is a newer policy and the wording matters, confirm your exact situation with SCDHHS at (888) 549-0820 before you rely on it.

South Carolina sets fixed rates for CLTC waiver services rather than letting families negotiate freely. Under recent SCDHHS rate schedules, self-directed Attendant Care has been set around $16.20 per hour, self-directed Companion Care around $12.80 per hour, and agency Personal Care II around $19.40 per hour. Most self-directed caregivers therefore fall in roughly the $13 to $18 per hour range depending on the specific service and the participant's plan. SCDHHS has raised HCBS rates several times in recent years, so the current 2026 number may be a bit higher than the figures published in older bulletins. The caregiver is paid as a W-2 employee through the financial management services (fiscal intermediary) agency, so federal and state taxes, Social Security, and Medicare are withheld. Always confirm the current self-directed Attendant Care rate with SCDHHS or the fiscal intermediary before counting on a specific wage.

Plan for roughly one to three months, and sometimes longer. Federal law gives the state up to 45 days to approve or deny a Medicaid long-term-care application, but the full timeline also depends on how quickly the level-of-care assessment is scheduled, how fast you return paperwork, and whether a waiver slot is available. The Community Choices Waiver is not an open-ended entitlement -- it runs within a capped number of slots each year -- so there can be a waitlist even after you medically qualify. Once you are approved and choose self-direction, there is additional lead time to get your caregiver enrolled: a background check with fingerprinting, a tuberculosis screening, EVV and billing training, and enrollment with the fiscal intermediary. You can shorten the wait by gathering documents early: proof of income and assets, South Carolina residency, identification, and any medical records that support the need for hands-on care.

You do not need to be a Certified Nursing Assistant, Home Health Aide, or licensed nurse to be a self-directed attendant. The core requirements are practical: the attendant must be at least 18, able to read, write, and communicate with the participant or employer of record, physically able to help with activities of daily living, and free of disqualifying convictions. Before starting, the attendant completes Electronic Visit Verification (EVV) and billing training through the SCDHHS area office and a tuberculosis screening, and must submit an annual TB risk assessment to stay enrolled. A University of South Carolina Center for Disability Resources (USC-CDR) nurse handles the caregiver "match" and can identify and help arrange any participant-specific training that a particular case requires -- for example, if the participant needs a skilled health-maintenance task performed. This keeps the door open for family members who have been informally caregiving for years but hold no clinical certification.

Both can be self-directed under the Community Choices Waiver, but they cover different things and have different family rules. Attendant Care is hands-on care of a supportive and health-related nature: help with bathing, dressing, eating, grooming, toileting, transferring and mobility, plus meal preparation, light housekeeping in the participant's living areas, shopping and errands, medication reminders, and escorting to covered medical services. With a prescriber's sign-off it can even include certain skilled "health maintenance" tasks. Companion Care is non-hands-on supervision and socialization for a participant who mainly needs someone present for safety and company. The most important practical difference for families: a spouse may be paid for Attendant Care but is excluded from paid Companion Care. Companion Care self-directed rates are also lower than Attendant Care. If you want a spouse to be the paid caregiver, Attendant Care is the route.

Several entities share the work so that no single agency both employs and supervises your caregiver. SCDHHS Community Long Term Care (CLTC) operates the Community Choices Waiver: a CLTC case manager assesses eligibility, authorizes your hours, and writes the Service Plan. The University of South Carolina Center for Disability Resources (USC-CDR) provides the nurse who matches the attendant to the participant and helps with training and TB oversight. A financial management services (FMS) agency -- the fiscal intermediary contracted by SCDHHS -- enrolls your caregiver as a Medicaid provider, collects the tax and employment paperwork, runs payroll, and issues payment (commonly by direct deposit about twice a month). The participant or their designated employer of record stays responsible for the day-to-day direction: choosing the caregiver, setting the schedule, and supervising the care. Contact SCDHHS at (888) 549-0820 for the current fiscal intermediary assigned to your case.

The number of hours comes from the participant's assessed needs, which the CLTC case manager writes into the Service Plan and authorizes in one-hour units. A single self-directed attendant is generally limited to 40 hours per week. If the participant is approved for more than 40 hours of care, the plan brings in a second attendant -- either another family member or an aide from an in-home agency -- to cover the additional hours. If one attendant provides care for more than one participant, the program tries to keep their combined hours at or under 40 per week as well. This structure is deliberate: it spreads care across more than one person for higher-need participants and keeps the program away from routine overtime. If your family expects to need more than 40 hours a week of paid care, plan early with your case manager for a second approved caregiver.

No. Choosing the self-directed Attendant Care option does not change the participant's eligibility for the rest of their South Carolina Healthy Connections Medicaid benefits -- doctor visits, hospital care, prescriptions, and other covered services continue as usual. Self-directed Attendant Care is one specific waiver service that sits alongside the participant's broader Medicaid coverage. The wages paid to the caregiver are the caregiver's income, not the participant's, so they do not count against the participant's Medicaid income limit. Caregivers should keep in mind that their own pay is taxable W-2 income and could interact with other benefits they personally receive, such as SNAP or certain need-based programs -- it is worth checking with a tax professional or benefits counselor about a caregiver's individual situation. For questions about how the waiver interacts with the member's Medicaid coverage, call SCDHHS Healthy Connections at (888) 549-0820.