Columbia Senior AdvisorBy Columbia Senior Advisor Care Team · October 15, 2026
Community Choices pays for services at home while your parent keeps their own doctors. PACE replaces Medicare and Medicaid coverage with one team that provides everything around a day center. PACE serves Richland and Lexington (and Calhoun through Orangeburg's program); Community Choices is statewide.
The shared starting point
Both programs are for people who meet South Carolina's nursing facility level of care, meaning they need enough help that a nursing home would be appropriate, but who can live safely at home with support. Both usually involve Medicaid. And both are underused by Midlands families, who often hear about them only after a hospital stay.
Community Choices had 21,027 participants statewide in July 2026, according to SCDHHS's waiver chart; PACE programs are far smaller and local.
How they compare
The core differences:
| Community Choices waiver | PACE | |
|---|---|---|
| Who runs it | SCDHHS Community Long Term Care | A local PACE organization (Prisma Health SeniorCare PACE-Midlands) |
| Where | Every Midlands county | Richland and Lexington; Calhoun via the Orangeburg program |
| Doctors | Keep your own | PACE's own physicians and network |
| Services | Personal care, companion care, meals, respite, adult day health, home changes | All medical and long-term care, including hospital and nursing home |
| Center | Optional adult day health care | A PACE day center is the hub |
| Cost | Covered for eligible Medicaid members | No premium with Medicare and Medicaid |
Sources: SCDHHS waiver summary chart (July 2026) and SCDHHS PACE program data.
When Community Choices fits better
A parent with a long relationship with a Lexington or Irmo physician, a family nearby to fill gaps, and needs centered on bathing, dressing and meals often does well with Community Choices. A case manager builds a service plan, and services come from enrolled agencies.
The limits are hours and waiting lists. The waiver does not cover round-the-clock care, and slots can run short. Referrals go to CLTC intake at (888) 971-1637.
When PACE fits better
A parent juggling several chronic conditions, frequent emergency room trips and a family stretched thin often gains more from PACE's single team, which manages medications, specialists, transportation and day care together and keeps paying if nursing home care is eventually needed.
The trade-off is giving up your own doctors. Someone with Medicare but not Medicaid can join by paying a premium for the Medicaid share, which is expensive.
Outside Richland and Lexington
Kershaw, Fairfield and Saluda families do not have PACE, according to SCDHHS's program data, so Community Choices is the route. Calhoun County is covered by The Orangeburg Senior Helping Center's PACE program. Confirm coverage for your parent's exact address before planning around PACE.
For help deciding, the Central Midlands Area Agency on Aging ((803) 376-5390) can explain both programs side by side.
Two families, two choices
Picture a widow in Irmo who sees the same internist she has trusted for twenty years, lives with a daughter who works days, and mainly needs help bathing and someone to check on her at lunch. Community Choices can send a personal care aide and fund adult day health care, and she keeps her doctor. That arrangement fits her life.
Now picture a retired mechanic in West Columbia with heart failure, diabetes and early dementia, three emergency room visits in four months and a son who lives in Charlotte. PACE's single team can manage his medications, see him at the day center several times a week, arrange specialists and transport, and step in when his condition changes. For him, giving up his own doctors may be a fair trade.
Questions to ask either program
Ask how long enrollment takes, what happens if needs increase, who to call at night, and whether there is a waiting list. For Community Choices, ask your case manager how many hours of personal care the plan allows and which agencies serve your parent's address. For PACE, ask how often participants attend the center, how transportation works from your parent's street and which hospitals and nursing homes the program uses.
Whichever route you take, write down what your parent needs help with on an ordinary day and on a bad day. That list makes the assessment more accurate, and it is the best way to tell whether a plan is working three months later.
Frequently asked questions
Is PACE available in Columbia, SC?
Yes. Prisma Health SeniorCare PACE-Midlands serves Richland and Lexington counties.
Can my parent keep their doctor on Community Choices?
Yes. Community Choices pays for home and community services; it does not replace your parent's doctors.
Does PACE pay for nursing home care?
Yes, if a participant eventually needs it, PACE continues to cover it.
How do I apply for Community Choices?
Call SCDHHS Community Long Term Care Centralized Intake at (888) 971-1637.
Can someone be in PACE and Community Choices at the same time?
No. PACE covers all Medicare and Medicaid services itself, so a participant would not also enroll in the waiver.
What does nursing facility level of care mean?
It is SCDHHS's assessment that a person needs enough help that nursing home care would be appropriate; both programs require it.
Is there PACE in Kershaw or Fairfield County?
SCDHHS lists no PACE organization for Kershaw, Fairfield or Saluda counties.
What was Prisma Health SeniorCare PACE-Midlands called before?
Palmetto SeniorCare, the name under which CMS approved the Columbia program in 2003.
