Updated September 4, 2026. Quick answer: yes, through Community Choices Waiver, Attendant Care (Self-Directed). Most adult family members can be hired and paid to provide the care. Whether a spouse specifically qualifies is not clearly stated in the materials reviewed this session.
How South Carolina pays a family caregiver
| Program | Community Choices Waiver, Attendant Care (Self-Directed) |
|---|---|
| Can a family member be paid? | Yes. “Attendant may be related to participants served by the agency within limits allowed by the South Carolina Family Caregiver Policy. The following family members cannot be a paid caregiver: a. A parent of a minor Medicaid participant; b. A stepparent of a minor Medicaid participant; c. A foster parent of a minor Medicaid participant; d. Person who has the legal responsibility of utilizing their own assets for the care of the Medicaid participant (legally responsible adult)” |
| Can a spouse be paid? | Not clearly addressed in the materials reviewed this session. |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
$16.20/hour (Attendant Care, Self-Directed, procedure code S5125, effective November 1, 2025). “Attendant Care – Self Directed S5125 $16.20 per hour”
How it works
South Carolina’s Community Choices 1915(c) Medicaid waiver added a self-directed Attendant Care option effective July 1, 2025, administered with a fiscal intermediary contracted by SCDHHS that processes payment to the attendant. The participant or an appointed Employer of Record supervises the attendant and sets the schedule within case-manager-authorized hours, and the attendant clocks in and out through Electronic Visit Verification to bill for care.
What this doesn’t answer
The Attendant Care (Self-Directed) scope-of-services document lists which relatives are barred (a parent, stepparent, or foster parent of a minor participant, and any legally responsible adult who must use their own assets for the participant’s care) but never uses the word spouse anywhere in the text obtained this session. Whether a spouse specifically falls under the undefined legally responsible adult exclusion is not stated explicitly in this primary document, so spouse eligibility is marked Unclear rather than guessed.
Sources
- South Carolina DHHS: HCBS Provider Manual, Scopes of Services: Attendant Care (Self-Directed), effective July 1, 2025
- South Carolina DHHS: HCBS Waivers Fee Schedule, effective November 1, 2025
Read September 4, 2026.
Same question, other states: South Dakota · Tennessee.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.