South Carolina Community Choices Waiver: South Carolina 2026 Guide
South Carolina’s Community Choices Waiver is the state’s main Medicaid program for long-term care at home. It serves people 65 and older and adults 18 to 64 with physical disabilities who meet a nursing facility level of care. The South Carolina Department of Health and Human Services (SCDHHS) runs it through its Community Long Term Care (CLTC) division.
Below we cover the 2026 eligibility rules for the Community Choices Waiver, the services it can pay for, the steps to apply, how waiting lists work, and how the program sits alongside nursing home Medicaid in South Carolina. For the full statewide rules on income, assets, spouses and the look-back, see our South Carolina Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
What the Community Choices Waiver is
Community Choices is a 1915(c) waiver. CLTC staff complete the level of care assessment, and a case manager develops the service plan. Some services can be self-directed. The waiver can also pay for residential personal care for people living in community residential care facilities (South Carolina’s assisted living), though room and board remain the resident’s responsibility.
Waivers get their name from federal law: South Carolina has permission to waive certain standard Medicaid rules so that money that would otherwise go only to nursing homes can pay for care at home and in community settings. Since no state has to offer a waiver, each program’s services and size are set by the state and its federal agreement. Being eligible, in other words, is not the same as being enrolled.
Who qualifies in 2026
To get the Community Choices Waiver, a person generally has to pass two separate tests, one about care need and one about money, and then receive an opening. In general, an applicant must:
- be 65 or older, or 18 to 64 with a physical disability;
- live in South Carolina;
- meet a nursing facility level of care, assessed by CLTC;
- meet Medicaid financial rules for long-term care; and
- have an opening in the waiver.
Income and assets. The financial side of the Community Choices Waiver follows South Carolina’s long-term care Medicaid rules. Savings, investments and real estate other than the home count; the home, a car, belongings and some burial funds usually do not. Gifts and below-value sales in the last 60 months are reviewed, and a transfer penalty can push back the start of services.
In 2026, the income limit for long-term care is $2,982 a month, with a Qualified Income Trust for people above that, and the single-person asset limit is $2,000. South Carolina’s spousal resource allowance is $66,480.
The main South Carolina long-term care figures for 2026, taken from our state guide, are below.
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $752,000 |
| Spouse at home: resource allowance | $66,480 (South Carolina spousal share) |
| Spouse at home: monthly income allowance | Up to $4,066.50 |
| Personal needs allowance (nursing home) | $60 a month (from October 1, 2025) |
| Look-back period | 60 months (5 years) |
Married applicants. When one spouse applies and the other stays at home, spousal impoverishment protections generally apply, so the spouse at home can keep a share of the couple’s assets and may receive part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.
Services the Community Choices Waiver can cover
The care plan picks from a menu of services. For the Community Choices Waiver, that menu includes:
- case management
- personal care and attendant care
- companion care
- home-delivered meals
- adult day health care
- respite
- personal emergency response systems
- home accessibility changes
- specialized medical equipment and supplies
- residential personal care in community residential care facilities
- self-directed attendant care
What is usually not covered. Waivers pay for care and support, not rent, food or other living costs, so in an assisted living or residential setting the person usually pays room and board from their own income. The plan of care often assumes some help from relatives where it is available. Medical care continues through Medicaid and Medicare in the usual way.
How to apply for the Community Choices Waiver
The usual sequence for the Community Choices Waiver is below. Running the financial application and the care assessment in parallel can shorten the wait.
- Submit a referral to SCDHHS, online or through CLTC. A family member, doctor or the person can make it.
- The person is placed on the waiting list if no slot is open.
- When a slot is available, CLTC schedules the level of care assessment.
- Apply for Medicaid through SCDHHS if not already enrolled.
- A case manager writes the service plan, and services start.
Practical tips. Keep copies of everything you send and note the name of each person you speak with. During the assessment, describe a typical bad day rather than a good day, and have a family member present who knows how much help is really needed. Memory problems, falls and the need for supervision all count, even when the person can still do some tasks alone. If the answer is no, the written notice explains how to request a fair hearing and the deadline.
Waiting lists and timing
Community Choices now has a waiting list. The program’s first-ever waiting list began when an enrollment cap took effect on November 1, 2025, and press reports of state data in early 2026 put the number waiting at about 3,300. SCDHHS says that, outside reserved slots, applicants are admitted first come, first served by date of application, so getting a referral in early matters.
Starting the process early keeps options open if a wait develops. While waiting, other options can help: state plan personal care, adult day programs, PACE where offered, Older Americans Act services through the Area Agency on Aging, and family caregiver support. The waiver waiting lists page explains common rules.
How it relates to nursing home Medicaid
the Community Choices Waiver serves people who meet the same care-need standard as nursing home residents, so it is an alternative to a nursing home rather than a lower level of care. Nursing home coverage cannot be capped, but waiver enrollment sometimes is. A participant who later needs a nursing home keeps Medicaid, though more of their income then goes toward care. People leaving a nursing home often get priority for waiver openings, with help from Money Follows the Person.
Tips for families
Begin before the situation is urgent; every step takes longer than families expect. Have five years of records ready and write down daily care needs for a couple of weeks before the visit. Income over the limit can often be handled with a Miller trust or spend-down, and any recent gifts deserve review before filing. If needs change, request a reassessment rather than waiting for the yearly review.
Because the Community Choices Waiver combines a care test, a money test and sometimes a wait, a Certified Medicaid Planner familiar with South Carolina can be a real help: checking finances against the 2026 limits, flagging look-back issues and keeping the application on track. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.
Related pages
- South Carolina Medicaid guide
- South Carolina Healthy Connections Prime and dual plans
- HCBS waivers explained
- Applying for a waiver
- Nursing home level of care
- Waiver waiting lists
- The five-year look-back
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.