Greenville Senior AdvisorWhat is the difference between OSS and Community Choices?
Optional State Supplementation is a state payment to a participating CRCF for a resident with very low income, covering care and room and board as payment in full, while Community Choices is a Medicaid waiver that pays for services, mostly at home, for people who meet nursing facility level of care.
OSS is about where someone lives and what they can afford: it makes a CRCF bed affordable for a person whose income is under $1,804 a month in 2026. Community Choices is about how much help someone needs: it requires a nursing-home level of need and pays for personal care, companion care, adult day health care and other services, including Residential Personal Care in participating CRCFs.
Who qualifies for each program?
OSS requires net income under $1,804 a month in 2026, Medicaid-level resources and a need for the care a CRCF provides; Community Choices requires age 65 or older (or 18 to 64 with a physical disability), nursing facility level of care, and Medicaid eligibility, generally income up to $2,982 a month and resources of $2,000 or less.
The difference in level of need matters: a person who needs supervision and help with medications but not nursing-home-level care may qualify for OSS but not for Community Choices. A person with significant needs who wants to stay home is the typical Community Choices participant.
Which program pays for assisted living rent?
Only OSS: its payment to the participating CRCF covers room and board along with care, while Community Choices' Residential Personal Care pays only for personal care services in the CRCF and leaves rent and meals to the resident.
| 2026 OSS figure (effective January 1, 2026) | Amount |
|---|---|
| Maximum monthly payment to the facility | $1,719 |
| Net income limit for the resident | $1,804 |
| Personal needs allowance, SSI-only income | $85 a month |
| Personal needs allowance, other income | $105 a month |
Source: SCDHHS Medicaid Bulletin MB# 26-001 (January 8, 2026).
How do we apply for each?
OSS and the Medicaid that comes with it go through SCDHHS's Healthy Connections application (apply.scdhhs.gov or (888) 549-0820) with the participating CRCF completing provider forms, while Community Choices starts with a referral to SCDHHS Community Long Term Care's Centralized Intake at (888) 971-1637.
Either way, the Area Agency on Aging can help: the Appalachian Council of Governments (864-242-9733) for Greenville, Anderson and Pickens counties, and Upper Savannah COG for Laurens County. Ask each facility on your list whether it participates in OSS, Residential Personal Care, or both.
Can someone switch from one program to the other?
Yes, as circumstances change: a person receiving Community Choices services at home might move into a participating CRCF under OSS when living alone becomes unsafe, and an OSS resident whose needs rise to nursing facility level of care may be assessed for other services or a nursing home.
Moves between programs take paperwork and time, so planning a step ahead helps. A case manager or Area Agency on Aging counselor can explain how a move would affect benefits.
At a glance
| Optional State Supplementation | Community Choices waiver | |
|---|---|---|
| Pays for | CRCF care plus room and board, as payment in full | Services: personal care, companion, adult day, respite and more |
| Where | A participating CRCF | Mostly at home; Residential Personal Care in participating CRCFs |
| Level of need | Needs the care a CRCF provides | Nursing facility level of care |
| 2026 income test | Net income under $1,804/month | Medicaid long-term care rules (about $2,982/month) |
Sources include S.C. Code Regs. 60-84, DPH Healthcare Quality and SCDHHS pages and bulletins, CareScout, CMS and VA rate tables as cited above; see our editorial standards.
