Charleston Senior AdvisorHow do OSS and Community Choices differ?
OSS is a state payment to a participating CRCF that, together with the resident's income, covers room, board and care in full for residents with very low income; Community Choices is a Medicaid waiver that pays only for the care portion, called Residential Personal Care, for residents who meet nursing facility level of care.
OSS fixes the total the facility receives: up to $1,719 a month in 2026, with the resident keeping a personal needs allowance of $85 or $105. Community Choices leaves rent and meals to the resident, which is why it works best for someone with enough income to cover room and board.
Who qualifies for each?
OSS is for residents whose net income is under $1,804 a month (2026) who meet Medicaid resource rules and need CRCF-level care; Community Choices requires nursing facility level of care on SCDHHS's assessment and Medicaid eligibility, generally income up to $2,982 a month and resources of $2,000 or less.
| OSS in 2026 (from January 1) | Amount |
|---|---|
| Most OSS will pay a facility each month | $1,719 |
| Resident's net income must be below | $1,804 |
| Personal needs allowance with SSI only | $85 a month |
| Personal needs allowance with other income | $105 a month |
Source: SCDHHS Medicaid Bulletin MB# 26-001 (January 8, 2026).
Which Charleston-area buildings accept them?
Only CRCFs enrolled with SCDHHS for each program, and participation is far from universal: many larger communities in Mount Pleasant, West Ashley and Summerville are private-pay only, while small residential homes are more likely to take OSS.
Ask on the first call, and ask separately about each program, since a building may take one and not the other. Ask too whether an OSS or waiver resident is placed in a shared room.
How do you apply?
OSS goes through SCDHHS's Healthy Connections application (apply.scdhhs.gov or (888) 549-0820) with provider forms from the facility; Community Choices starts with a referral to CLTC Centralized Intake at (888) 971-1637, followed by a level-of-care assessment.
The Trident Area Agency on Aging (843-554-2275) can help a family decide which application to start and keep it moving. Expect weeks, not days, and keep copies of everything submitted.
Side by side
| Optional State Supplementation | Community Choices (Residential Personal Care) | |
|---|---|---|
| Pays for | Room, board and care together, as payment in full | The care portion only |
| 2026 figures | Up to $1,719/month to the facility; income under $1,804 | Medicaid limits: $2,982 income, $2,000 resources |
| Level of care | Needs CRCF-level care | Needs nursing facility level of care |
| Start here | Healthy Connections application | CLTC intake (888) 971-1637 |
Sources: S.C. Code Regs. 60-84, DPH Healthcare Quality, SCDHHS bulletins and charts, CareScout, CMS and VA rate tables, as cited in each answer. See our editorial standards.
