Community Choices: Medicaid help at home and in assisted living

What is the Community Choices waiver?

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

It dates to 2003, and before that ran as the Elderly and Disabled Waiver from 1984. SCDHHS's July 2026 waiver chart reports 21,027 people enrolled statewide and federal approval through June 30, 2031. A waiver is not an entitlement: slots are capped, and a waiting list can form.

What does Community Choices pay for?

SCDHHS's July 2026 summary lists case management, personal and attendant care, companion care, home-delivered meals, adult day health care, respite, emergency response systems, home modifications, equipment and Residential Personal Care II in participating CRCFs.

• 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 the service plan around the participant's needs. The waiver does not cover 24-hour care at home and never pays rent or groceries.

Can Community Choices help pay for assisted living?

In part. Its Residential Personal Care service pays a participating, DPH-licensed CRCF for hands-on help with daily activities for a participant at the intermediate nursing home level of care, but it pays for the care only, not the room and meals, and no skilled medical service may be given under it.

SCDHHS's Residential Personal Care scope of services (July 1, 2025) requires the CRCF to meet DPH standards, answer a referral within two working days and check the participant's Medicaid eligibility every month. Only some Columbia-area CRCFs take part. For residents with very low income, OSS is still the more common route.

Who qualifies for Community Choices in 2026?

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, which for long-term care in 2026 generally means income up to $2,982 a month and countable resources of $2,000 or less for one person.

The income cap is 300% of the 2026 SSI federal benefit rate of $994. Income above it can still qualify if the excess goes into a qualified income trust each month, which an elder law attorney can set up. Medicaid reviews 60 months of asset transfers, and spousal rules let a husband or wife at home keep part of the couple's income and assets.

How does a Columbia family start a Community Choices application?

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

Before the assessment, write down the daily tasks your parent needs help with, current medications, recent hospital stays, monthly income and rough savings. The Central Midlands Area Agency on Aging ((803) 376-5390) can help with the referral and sometimes with short-term services while the application is pending.