Guides → South Carolina

Getting paid to care for a parent in South Carolina

Updated 2026-08-10 · Every figure below is dated and sourced · Rules change — confirm with the agency
The short answer: South Carolina's door is Community Choices Waiver — Self-Directed Attendant Care (administered through Community Long Term Care, CLTC), run by South Carolina Department of Health and Human Services (SCDHHS), Community Long Term Care (CLTC) division. Pay: $16.20/hr is the Medicaid rate for self-directed Attendant Care (code S5125) on the SCDHHS HCBS Waiver Fee Schedule effective Nov 1, 2025 -- still the current schedule as of August 2026. Be aware this rate has not changed since July 1, 2022, so do not expect a recent bump. This is the Medicaid BILLING rate, not guaranteed take-home: the caregiver's gross wage is paid out of it through a SCDHHS-contracted fiscal intermediary that runs payroll, so what lands in the bank account is lower after payroll taxes. SCDHHS does not publish the attendant's exact net wage. Self-directed Companion care pays $12.80/hr on the same schedule. If a relative instead works as an employee of a home care agency serving the parent, the agency -- not the caregiver -- bills Medicaid. On the current schedule that is $25.00/hr for Personal Care (T1019) and $25.00/hr for agency Attendant Care (S5125 with modifier U2, billed as $6.25 per 15 minutes). The older two-tier setup, where "Personal Care I" (code S5130) paid $22/hr alongside Personal Care II at $25/hr from Jan 1, 2023, is no longer on the fee schedule. What the agency actually pays the worker is a market wage well below what it bills -- commonly in the low-to-mid teens per hour in South Carolina -- and the agency has to be willing to hire the relative in the first place.

One or more details on this page could not be fully confirmed against official sources at publish time — confirm specifics with the agency below.

Who can be the paid caregiver

Adult children, siblings, grandchildren, other relatives, and friends can be the paid caregiver -- either self-directed (hired directly by the participant) or as an employee of a Medicaid home care agency -- if they meet the same requirements as any other worker. The background check must show no conviction for abuse, neglect or exploitation of an adult or child, no conviction for any crime against another person, and no felony of any kind. Before enrollment the caregiver needs a TB blood test (BAMT) or a baseline two-step skin test. Training includes Electronic Visit Verification and billing training, plus hands-on training signed off by a USC Center for Disability Resources nurse. Who is shut out entirely: the spouse (including a spouse who is married but separated); the parent, stepparent, or foster parent of a participant who is a minor; and anyone SCDHHS determines is legally responsible for using their own money to pay for the participant's care. Legal guardians are the case people get wrong. A legal guardian CANNOT be paid through a home care agency. But a legal guardian CAN be paid to care for an adult when the service is self-directed -- as long as the guardian is not also the employer-of-record, and SCDHHS has determined the guardian is not legally responsible for using their own assets for the participant's care. So if you are your parent's guardian, do not let anyone tell you the door is closed; ask specifically for the SELF-DIRECTED option. Either way, the person who signs on as employer-of-record for self-direction cannot also be the paid attendant. If the adult child wants the paycheck, someone else -- the parent, or another designated responsible party -- has to be the employer-of-record.

The spouse question

No — spouses cannot be paid in South Carolina Medicaid waiver programs. The CMS-approved Community Choices waiver renewal (SC.0405.R05.00, effective 7/1/2026) selects 'No: the state does not make payment to legally responsible individuals,' and SC's Family Caregiver Policy explicitly bars 'the spouse of a Medicaid participant (including married but separated)' from being a paid agency caregiver; a Dec 2024 SC DDSN guidance memo confirms spouses are excluded from both agency and self-directed models across the disability waivers too. A spouse CAN be paid through VA routes (Veteran-Directed Care or PCAFC) if the parent is a qualifying veteran.

Waitlist reality

Real and significant. Community Choices is not an entitlement: a late-2025 amendment limited new enrollment to people at risk of 'serious and imminent harm,' and by February 2026 more than 3,300 people were on the Community Choices waiting list, with 22,000+ waiting across all SC waivers combined (Post and Courier, Feb 2026, quoting SCDHHS). Advocates say securing any waiver can take years. Access is generally prioritized by application date, so apply anyway — the clock starts at referral.

Worth knowing: Disqualifiers to state plainly: spouses cannot be paid under any SC Medicaid program (only VA routes); the parent must need nursing-home level of care AND meet strict Medicaid financial limits ($2,982/mo income, $2,000 assets in 2026 — over-income families may need a Miller trust/income trust); the paid attendant can't be the employer-of-record, is generally capped at 40 hrs/week, and must pass background checks and training. Recent rule changes: a late-2025 waiver amendment restricted new Community Choices slots to people at risk of serious and imminent harm, creating a 3,300+ person waitlist (Feb 2026); a rewritten Self-Directed Attendant Care policy took effect 7/1/2025; and the waiver was renewed effective 7/1/2026 through 6/30/2031. Why confidence is 'partial': the $16.20/hr figure is the official Medicaid billing rate for self-directed attendant care from the Nov 2025 fee schedule — the caregiver's exact take-home wage after the fiscal intermediary withholds employer payroll taxes could not be confirmed from official sources, and statewide Veteran-Directed Care availability (beyond the Charleston VA) is unconfirmed. One popular secondary source claims spouses may provide attendant care under Community Choices; the CMS-approved waiver application and DDSN guidance contradict this, so we report the official answer (no spouses). Practical tip: because of the waitlist, families should file the CLTC referral immediately (priority runs by application date) and pursue VA options in parallel if the parent is a veteran.

Other doors in South Carolina

ProgramWhat to know
Agency-employment route (Medicaid personal care)A non-spouse relative can be hired as a regular employee of the home care agency serving the parent under a waiver or state-plan personal care — no self-direction paperwork, but pay is the agency's market wage (about $12-15/hr) and the agency must agree to hire them.
Veteran-Directed Care (VDC)If the parent is a veteran enrolled in VA health care, VDC gives a flexible monthly budget to hire caregivers — including adult children AND spouses. Offered site-by-site; listings show it at the Ralph H. Johnson VA (Charleston). Ask the parent's VA social worker; statewide availability at every SC VA facility not confirmed.
VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)Monthly tax-free stipend for the caregiver of a veteran with a 70%+ service-connected rating; spouses eligible. Apply via VA Caregiver Support Line, (855) 260-3274.
Family Caregiver Support Program (SC Department on Aging / Area Agencies on Aging)Not wages — respite vouchers, supplies, and counseling for caregivers of adults 60+ or people with dementia. No Medicaid required. Call (800) 868-9095 or GetCareSC.com.
DDSN waivers (ID/RD, Community Supports, HASCI)If the parent's need stems from intellectual disability or head/spinal cord injury, these SCDDSN-administered waivers also allow paid non-spouse family caregivers via self-direction; long waitlists apply.
Structured Family CaregivingSouth Carolina does NOT have a structured family caregiving (per-diem live-in) program like Georgia or Indiana, and has no state-funded non-Medicaid program that pays caregiver wages.

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

  1. 1. Make a referral to SCDHHS Community Long Term Care (CLTC): call the statewide referral line at (888) 971-1637 or submit online at phoenix.scdhhs.gov/cltc_referrals/new. A family member can make the referral for the parent.
  2. 2. If the parent is not yet on Medicaid, apply at apply.scdhhs.gov or call Healthy Connections at (888) 549-0820. 2026 waiver financial limits: income $2,982/month, countable assets $2,000 (single), home equity under $752,000.
  3. 3. A CLTC assessor evaluates whether the parent meets nursing-facility level of care (needs help with bathing, dressing, toileting, etc.). Expect waitlist placement — ask where the parent stands and whether they meet the 'serious and imminent harm' priority criteria.
  4. 4. Once enrolled, tell the CLTC case manager the family wants SELF-DIRECTED Attendant Care with the family member as the paid attendant. The USC Center for Disability Resources (USC-CDR) handles attendant training and enrollment, and a SCDHHS-contracted fiscal intermediary runs payroll.
  5. 5. The caregiver completes background/registry checks, TB risk assessment, and training; the care plan sets authorized weekly hours (one attendant is generally capped at 40 hours/week).

Where to start: SCDHHS Community Long Term Care (CLTC) referral line: (888) 971-1637, or online referral at https://phoenix.scdhhs.gov/cltc_referrals/new (general Healthy Connections Medicaid line: (888) 549-0820)

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.

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Sources & dates checked: Program rules and payment rates change. Everything here is educational — real eligibility is decided by the agencies, based on your family's details.