Greenville Senior AdvisorBy Greenville Senior Advisor Care Team · October 21, 2026
Community Choices pays for personal care, companion care, adult day health care, respite, home-delivered meals and more for South Carolinians at nursing facility level of care who qualify for Medicaid. SCDHHS's July 2026 chart shows 21,027 people enrolled and the waiver renewed through June 30, 2031. Start with CLTC Centralized Intake at (888) 971-1637.
What Community Choices is for
Community Choices is a Medicaid home and community-based services waiver. It lets people who would otherwise qualify for nursing home care receive services at home or in the community instead. It serves adults 65 and older and adults 18 to 64 with physical disabilities. SCDHHS runs it through its Community Long Term Care division, which assesses applicants and assigns case managers.
The waiver has existed since 2003, and before that as the Elderly and Disabled Waiver from 1984. Because it is a waiver rather than an entitlement, enrollment slots are limited and a waiting list can form.
What it pays for
SCDHHS's July 2026 waiver summary chart lists these services:
| Community Choices service |
|---|
| Case management |
| Personal care and attendant care |
| Companion care (agency or individual) |
| Home-delivered meals |
| Adult day health care, including adult day health care nursing |
| Respite (in-home, institutional or in a CRCF) |
| Personal emergency response system and telemonitoring |
| Home accessibility adaptations and specialized medical equipment |
| Residential Personal Care II (personal care in a participating CRCF) |
| Pest control |
A case manager builds a service plan based on the participant's needs. The waiver does not pay for 24-hour care, rent or groceries.
Who qualifies
An applicant must meet nursing facility level of care on SCDHHS's assessment and qualify for Medicaid. For long-term care Medicaid in 2026, that generally means income up to $2,982 a month, which is 300% of the $994 SSI rate, and countable resources of $2,000 or less for an individual. Income above the cap can sometimes be handled with a qualified income trust. Medicaid looks back 60 months for transfers of assets below fair value.
Spousal rules protect part of a couple's income and assets for a husband or wife who remains at home, which often makes the waiver workable for married couples.
Community Choices in assisted living
One waiver service, Residential Personal Care, is delivered in participating DPH-licensed CRCFs to participants who meet intermediate nursing home level of care. It pays for help with daily activities, not for rent and meals, and no skilled medical service may be performed under it. Only some Upstate CRCFs participate, so ask each facility.
For residents with very low income, Optional State Supplementation, which pays room and board as well as care in participating CRCFs, is often the better fit. The two programs have different tests: OSS looks mainly at income, Community Choices at level of need.
While you wait
If there is a wait for a Community Choices slot, other help can bridge the gap. The Appalachian Council of Governments Area Agency on Aging and Upper Savannah COG run programs funded under the Older Americans Act, such as home-delivered meals and family caregiver support, which do not require Medicaid. Adult day care centers can provide daytime supervision, often at the lowest cost of any paid care option, about $1,560 a month for five days a week at South Carolina's 2025 median.
If your parent's needs are high and you live in Greenville, Pickens or Anderson County, ask PACE-Upstate whether it can enroll your parent sooner. PACE has its own capacity limits, but its enrollment process is separate from the waiver's.
What a case manager does
Once a participant is enrolled, a Community Choices case manager becomes the family's main contact. The case manager reviews needs, builds and updates the service plan, arranges providers from SCDHHS's approved list, and reassesses the participant each year. If needs change after a fall or a hospital stay, call the case manager rather than waiting for the annual review; the plan can be revised.
Families can usually choose among enrolled provider agencies for services such as personal care and adult day health care. Ask the case manager which agencies serve your parent's ZIP code reliably, and do not hesitate to ask for a change if an agency repeatedly misses visits.
How to start in the Upstate
Call SCDHHS Community Long Term Care's Centralized Intake at (888) 971-1637 or use the online CLTC referral form. Have ready a list of the daily activities your parent needs help with, current medications, recent hospital stays, monthly income and approximate savings. CLTC will schedule a level-of-care assessment. If your parent is not already on Medicaid, the Medicaid application runs alongside it.
The Appalachian Council of Governments Area Agency on Aging (864-242-9733) for Greenville, Anderson and Pickens counties, and Upper Savannah COG for Laurens County, can help with the referral and sometimes arrange interim services. In Greenville, Pickens and Anderson counties, PACE-Upstate is an alternative worth comparing for people with complex medical needs.
Frequently asked questions
Who runs the Community Choices waiver?
SCDHHS, through its Community Long Term Care division; referrals go to CLTC Centralized Intake at (888) 971-1637.
Does Community Choices pay family caregivers?
Some services, such as individual companion care, can be provided by individuals rather than agencies under the waiver's rules; ask the case manager what applies.
Does Community Choices pay for assisted living?
It can pay for Residential Personal Care in participating CRCFs, but not for rent and meals.
How many people are enrolled?
SCDHHS's July 2026 waiver chart lists 21,027 enrollees statewide.
