The Community Choices waiver for Upstate families

What is the Community Choices waiver in South Carolina?

Community Choices is South Carolina's Medicaid home and community-based services waiver for adults 65 and older, and adults 18 to 64 with physical disabilities, who meet nursing facility level of care but choose to receive services at home or in the community; SCDHHS runs it through its Community Long Term Care (CLTC) division.

It has operated since 2003 and before that as the Elderly and Disabled Waiver from 1984. SCDHHS's July 2026 waiver chart shows 21,027 people enrolled statewide and the waiver approved through June 30, 2031. Because it is a waiver, not an entitlement, enrollment slots are limited and a waiting list can form.

What services does Community Choices pay for?

Community Choices pays for case management, personal care and attendant care, companion care, home-delivered meals, adult day health care, respite, emergency response systems, home modifications and equipment, and Residential Personal Care II in participating CRCFs, according to SCDHHS's July 2026 waiver summary chart.

• 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 around what the participant needs. The waiver does not pay for 24-hour care at home, and it does not pay rent or groceries.

Can Community Choices pay for assisted living in South Carolina?

Partly. Community Choices can pay for Residential Personal Care, help with daily activities delivered in a participating DPH-licensed CRCF to a participant who meets the intermediate nursing home level of care, but the waiver pays for the care, not the rent and meals, and no skilled medical service may be performed under it.

SCDHHS's Residential Personal Care scope of services (July 1, 2025) requires the CRCF to meet DPH licensing standards, to accept or decline a referral within two working days, and to verify the participant's Medicaid eligibility monthly. Only some Upstate CRCFs participate, so ask each facility directly. For residents with very low income, Optional State Supplementation is the more common route.

Who qualifies for Community Choices?

An applicant must be 65 or older, or 18 to 64 with a physical disability, 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 and countable resources of $2,000 or less for an individual.

The income figure is 300% of the 2026 SSI federal benefit rate of $994. People with income above it may still qualify by placing the excess in a qualified income trust; an elder law attorney can set one up. Medicaid looks back 60 months for transfers of assets for less than fair value. Spousal protections let a husband or wife at home keep part of the couple's income and assets.

How do Greenville families apply for Community Choices?

Start with a referral to SCDHHS Community Long Term Care's Centralized Intake at (888) 971-1637, or the online CLTC referral form; CLTC schedules a level-of-care assessment, and the person also applies for Medicaid if not already enrolled.

Have ready a list of daily activities your parent needs help with, current medications, recent hospital stays, monthly income and approximate savings. The Appalachian Council of Governments Area Agency on Aging (864-242-9733) and, for Laurens County, Upper Savannah COG can help with the referral and with interim services while an application is pending.