The Community Choices waiver: 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 adults 18 to 64 with physical disabilities, who meet nursing facility level of care but choose to get services at home or in the community; SCDHHS runs it through its Community Long Term Care (CLTC) division.

The waiver has existed under this name since 2003, and as the Elderly and Disabled Waiver from 1984 before that. SCDHHS's July 2026 waiver chart counts 21,027 people enrolled statewide and shows the waiver approved through June 30, 2031. Because a waiver is not an entitlement, slots are capped and a waiting list can develop.

What does Community Choices pay for?

Case management, personal care and attendant care, companion care, home-delivered meals, adult day health care, respite, personal emergency response and telemonitoring, home modifications and equipment, and Residential Personal Care II in participating CRCFs, according to SCDHHS's July 2026 waiver 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 the service plan around what the participant needs. The waiver does not cover 24-hour care at home, rent or groceries.

Can Community Choices help pay for assisted living in Charleston?

Partly. The waiver can pay for Residential Personal Care, meaning hands-on help with daily activities delivered in a participating DPH-licensed CRCF to a participant at the intermediate nursing home level of care, but it pays for the care only, not the rent and meals, and no skilled medical service may be provided under it.

SCDHHS's scope of services (July 1, 2025) requires the CRCF to meet DPH standards, respond to a referral within two working days and confirm the participant's Medicaid eligibility every month. Participation varies from building to building around Charleston, so ask. For residents with very low income, Optional State Supplementation is often the more practical 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 no more than $2,000 for an individual.

The income figure is 300% of the 2026 SSI federal benefit rate of $994. Applicants with income above it may still qualify by routing the excess into a qualified income trust, which an elder law attorney can set up. Medicaid reviews 60 months of asset transfers, and spousal protections let a husband or wife at home keep part of the couple's income and assets.

How do Lowcountry families start a Community Choices referral?

Call SCDHHS Community Long Term Care Centralized Intake at (888) 971-1637 or use the online CLTC referral form; CLTC schedules a level-of-care assessment, and the applicant applies for Medicaid if not already enrolled.

Before the call, list the daily tasks your parent needs help with, current medications, recent hospital stays at MUSC, Roper St. Francis, Trident or East Cooper, monthly income and approximate savings. The Trident Area Agency on Aging (843-554-2275) can help with the referral and with stopgap services such as meals while an application is pending.