South Carolina's home health care industry operates in a state with a significant aging population, rural healthcare challenges, and an evolving regulatory landscape following the 2023 DHEC restructuring. Agencies must adapt to the new Department of Public Health oversight, understand the Community Choices and CLTC waiver programs, and navigate a labor market with federal minimum wage requirements while monitoring potential wage pass-through legislation.

Home Health Agency Requirements in South Carolina

Following the 2023 restructuring of the Department of Health and Environmental Control (DHEC) through Act No. 60 (S.399), home health agency licensing is now administered by the South Carolina Department of Public Health (DPH). The transition became effective in 2025, with regulations transferred from Chapter 61 to Chapter 60 of the S.C. Code of Regulations.

Regulatory Changes

State Register Document No. 5352 (effective May 23, 2025) includes technical changes related to the DHEC restructuring, including updates to definitions, acronyms, email addresses, physical addresses, and agency references from DHEC to DPH.

Home Health Agency Licensing

Home health agencies are regulated under Regulation 61-77, Standards for Licensing Home Health Agencies. Key requirements include:

  • License issued by DPH to provide home health services in designated counties
  • Criminal record check of direct care staff per Section 44-7-2910 et seq.
  • Licensee bears ultimate responsibility for compliance

A home health agency is defined as a public, nonprofit, or proprietary organization, whether owned or operated by one or more persons or legal entities, which furnishes or offers to furnish home health services.

In-Home Care Provider Licensing

In-home care providers are governed separately under Regulation 60-122, Standards for Licensing In-Home Care Providers, and the Licensure of In-Home Care Providers Act (Section 44-70-10, et seq.).

An in-home care provider is defined as a business entity, corporation, or association, whether operated for profit or not, that for compensation directly provides or makes provision for in-home care services. This category is distinct from home health agencies and applies to non-medical personal care services.

Certified Nursing Assistant (CNA) Certification

South Carolina's CNA certification is administered through the Department of Health and Human Services (SCDHHS), with competency testing conducted by Credentia. The state maintains a Nurse Aide Registry through the SC Department of Labor, Licensing and Regulation (LLR).

Training Requirements

South Carolina requires state-approved Nurse Aide Training Programs to provide:

  • Minimum 100 hours of total training
  • 60 classroom lecture hours including 20 hours of skills training
  • At least 40 hours of clinical skills training
  • Most programs can be completed in 4-8 weeks
  • Program costs typically range from $800 to $1,500

Eligibility Requirements

  • Minimum age of 16 years (though many employers require 18+)
  • High school diploma or GED (required by most programs)
  • Background check clearance

Certification Exam

SCDHHS partners with Credentia to administer the National Nurse Aide Assessment Program (NNAAP) Examination. The exam includes:

  • Written test: 70 multiple-choice questions with a two-hour time limit (may be taken at a test center or online)
  • Skills evaluation: Five randomly selected nurse aide skills with a 30-minute time limit (must be completed in person)
  • Oral option: 60 multiple-choice questions plus 10 reading comprehension questions (available in English or Spanish)

Candidates must pass both components within two years of training completion and within three attempts.

Employer-Paid Testing

South Carolina has a significant benefit for nursing home employees: federal and state laws prohibit nursing homes participating in Medicaid/Medicare programs from charging employed nurse aides for examination fees. If employed by or with a written commitment from such a facility, the employer must pay for the exam and any retests.

Certification Renewal

CNA certification is valid for 24 months. To renew through CNA365:

  • Complete at least 8 consecutive hours of paid nursing-related duties under nurse supervision within the past 24 months
  • Submit renewal application before expiration

South Carolina CNA Compensation

CNAs in South Carolina earn competitive wages, with an average of $17.09 per hour ($35,141 annually). Wages vary based on specialization, location, and experience.

Home Health Aide (HHA) Requirements

Home health aides in South Carolina must meet training requirements established by their employing agencies and applicable federal requirements for Medicare-certified agencies. HHAs typically work under nurse supervision providing personal care and basic health services.

South Carolina Medicaid and Home Care Services

South Carolina's Medicaid program, Healthy Connections, provides home and community-based services through multiple waiver programs administered by SCDHHS.

Community Choices (CC) Waiver

The Community Choices waiver provides an alternative to nursing home placement for qualified individuals who choose to receive assistive services at home. The waiver serves:

  • Frail Elderly: Age 65 and older
  • Adults with Physical Disabilities: Ages 18-64

Participants must meet nursing facility level of care criteria to qualify for waiver services.

Community Long Term Care (CLTC) Waiver

The CLTC waiver provides HCBS services including in-home care, adult day care, and delivered meals to help seniors and disabled individuals avoid institutionalization. Like other HCBS waivers, CLTC may have waiting lists due to limited enrollment slots.

2026 Financial Eligibility

For HCBS Waivers in South Carolina:

  • Income (Single): $2,982 per month
  • Assets (Single): $2,000
  • Assets (Married, both applying): $4,000 combined
  • Monthly Maintenance Needs Allowance (MMNA): $4,066.50
  • Community Spouse Resource Allowance (CSRA): $66,480 (standard)

Look-Back Period

South Carolina enforces a 60-month look-back period for Nursing Home Medicaid and HCBS waivers. Asset transfers below fair market value within this period may result in a penalty period of ineligibility.

July 2025 HCBS Provider Manual Update

Effective July 1, 2025, SCDHHS updated its Home and Community Based Services Provider Manual, including updates to Provider Scopes and Standards and policy guidance for HCBS settings requirements for residential and non-residential settings.

December 2026 Renewal Changes

Starting December 2026, beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps. This change will affect administrative processes for agencies serving Medicaid waiver participants.

Electronic Visit Verification (EVV)

South Carolina has implemented Electronic Visit Verification (EVV) for personal care services and home health care services in compliance with the 21st Century Cures Act. Providers must use approved EVV systems to capture required data points.

Medicare Home Health in South Carolina

Medicare-certified home health agencies in South Carolina must meet federal Conditions of Participation and operate under the Patient-Driven Groupings Model (PDGM) for reimbursement.

South Carolina-Specific Considerations

South Carolina's geography includes significant rural areas with healthcare access challenges. Agencies must consider travel distances, workforce availability in rural counties, and the distribution of aging populations when planning service areas.

South Carolina Labor Laws for Home Care

South Carolina follows federal minimum wage and overtime standards, with significant legislative activity around direct care worker compensation.

Current Minimum Wage

South Carolina's minimum wage is $7.25 per hour, matching the federal minimum wage. The state has no higher state minimum wage requirement. Currently, providers have no requirement to pay workers more than the federal minimum despite receiving higher Medicaid reimbursements.

Pending Legislation: Bill 486 (Wage Pass-Through)

Bill 486 proposes minimum compensation requirements for direct care workers providing Medicaid-funded personal care services:

  • January 1, 2026: HCBS provider agencies must use at least 70% of Medicaid reimbursement as compensation to direct care workers (wage pass-through percentage)
  • January 1, 2028: Wage pass-through increases to 75%
  • January 1, 2030: Wage pass-through increases to 80%

This legislation would significantly impact agency operating margins and worker compensation. Agencies should monitor this bill's progress.

Pending Legislation: Minimum Wage Bills

Multiple minimum wage bills are under consideration in the South Carolina General Assembly:

  • Bill 3226: $8.75/hour effective January 1, 2026; $9.75/hour effective January 1, 2027
  • Bill 3809: $17.00/hour effective January 1, 2027

Agencies should prepare for potential wage increases by monitoring legislative developments.

Overtime Requirements

South Carolina follows federal FLSA standards:

  • Overtime pay at 1.5x regular hourly wage for hours over 40 in a workweek
  • Live-in workers are exempt from overtime requirements

Workers' Compensation

Workers' compensation insurance is required for employers with four or more employees in South Carolina.

Paid Leave

South Carolina currently has no paid leave law that applies to household employers. There is no state-mandated paid sick leave requirement.

Caregiver Pay in Practice

Despite the $7.25 minimum wage, market rates for caregivers are higher. According to ZipRecruiter data, the average hourly pay for home caregivers in South Carolina is approximately $12.78 per hour, with most wages ranging between $12.07 (25th percentile) and $15.38 (75th percentile).

Workforce Challenges and Strategies

South Carolina agencies face significant workforce challenges driven by low wage requirements, rural geography, and competition with other industries.

Key Challenges

  • Low Minimum Wage: The $7.25 federal minimum makes recruitment difficult against higher-paying retail and food service jobs
  • Reimbursement Gap: Medicaid reimburses approximately $25/hour while workers may receive $7.25-$15
  • Rural Access: Large rural areas face workforce shortages and long travel distances
  • Competition: Healthcare systems and nursing homes compete for the same CNA workforce

Recruitment Strategies

  • Employer-Paid Training and Testing: Leverage the federal requirement for Medicaid/Medicare facilities to pay for CNA testing
  • Career Tech Partnerships: Work with community colleges and vocational programs offering CNA training
  • Market-Rate Wages: Pay above minimum wage (closer to the $12-15 market rate) to attract qualified candidates
  • Rural Outreach: Target recruitment in rural communities with limited job opportunities

Retention Strategies

  • Competitive Compensation: Offer wages at or above the $17.09/hour CNA average
  • Career Advancement: Create pathways from HHA to CNA to LPN/RN
  • Mileage Reimbursement: Essential for rural service delivery
  • Schedule Flexibility: Accommodate workers with family or educational commitments
  • Recognition Programs: Acknowledge caregiver contributions to improve morale

Preparing for Legislative Changes

  • Monitor Bill 486 wage pass-through requirements
  • Track minimum wage legislation (Bills 3226 and 3809)
  • Prepare budget scenarios for potential wage increases
  • Develop advocacy positions on worker compensation issues

Resources for South Carolina Home Care Agencies

  • SC Department of Public Health (DPH): Agency licensing and regulatory guidance (dph.sc.gov)
  • SC Department of Health and Human Services (SCDHHS): Medicaid programs and waiver information
  • SC Department of Labor, Licensing and Regulation (LLR): CNA registry and certification
  • Credentia: CNA competency testing
  • CNA365: Certification renewal

The Bottom Line

Operating a home health or home care agency in South Carolina requires adapting to the new DPH licensing structure following the DHEC restructuring, understanding the Community Choices and CLTC waiver programs, and navigating a challenging labor market. The $7.25 minimum wage creates recruitment difficulties, but pending legislation (Bill 486 wage pass-through and minimum wage bills) may significantly change the compensation landscape. Agencies should pay market-rate wages ($12-15+/hour) to compete effectively while monitoring legislative developments. Success requires leveraging employer-paid testing benefits, building career tech partnerships, and developing efficient rural service delivery models. The July 2025 HCBS Provider Manual updates and December 2026 eligibility renewal changes add compliance requirements that agencies must incorporate into their operations.