South Carolina - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The South Carolina Department of Health and Human Services (SCDHHS) funds Companion Care through the Community Choices (CC) Waiver to provide non-medical supervision and socialization for frail elderly and physically disabled adults. Agencies seeking to bill for this service must first secure an In-Home Care Provider (IHCP) license from the South Carolina Department of Public Health (DPH) before submitting a Medicaid enrollment application through the SCDHHS provider portal.

The service can be delivered via licensed agency workers or through a participant-directed model where beneficiaries hire their own caregivers using a financial management services agency. Spouses are strictly prohibited from being hired to provide companion care under the CC Waiver, though other relatives and friends may qualify if they pass required background checks and competency evaluations.

1. Service Definition and Scope

Companion Care under the South Carolina Community Choices Waiver provides non-medical care, supervision, and socialization to individuals aged 18 and older who meet nursing facility level of care. The service is designed to prevent institutionalization by assisting with daily functioning without providing hands-on medical or nursing care.

This service focuses on maintaining a safe environment and providing social engagement for waiver participants. It does not cover room and board or skilled medical interventions.

• Target Population: Frail elderly (65+) and physically disabled adults (18-64) at risk of nursing home placement.
• Covered Activities: Non-medical supervision, socialization, and assistance with instrumental activities of daily living.
• Excluded Providers: Spouses cannot be reimbursed for providing companion care under this waiver.
• Delivery Models: Agency-directed through a licensed In-Home Care Provider and participant-directed using a Financial Management Services agency.

2. Regulatory and Oversight Agencies

SCDHHS serves as the State Medicaid Agency, with its Community Long Term Care (CLTC) division directly administering the Community Choices Waiver. The South Carolina Department of Public Health (DPH) handles the mandatory state licensure for agencies providing in-home non-medical care.

Managed Care Organizations (MCOs) also play a significant role in overseeing provider networks and reimbursing claims for members enrolled in managed care plans.

• State Medicaid Agency: South Carolina Department of Health and Human Services (SCDHHS) (https://www.scdhhs.gov)
• Waiver Administrator: SCDHHS Community Long Term Care (CLTC) (https://www.scdhhs.gov/resources/waivers/community-choices-cc-waiver)
• Licensing Authority: South Carolina Department of Public Health (DPH) (https://dph.sc.gov)
• Medicaid Enrollment Portal: SCDHHS Provider Enrollment (https://providerservices.scdhhs.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

South Carolina does not impose a Certificate of Need (CON), county sponsorship requirement, or competitive procurement (RFP) moratorium on Companion Care providers. The state operates an open enrollment model for Medicaid providers, provided they meet the foundational licensure requirement.

The primary structural precondition is obtaining state licensure prior to Medicaid enrollment. Without an active license, the Medicaid portal will reject the application.

• Licensure Prerequisite: Applicants must hold an active In-Home Care Provider license from SC DPH before applying for Medicaid enrollment.
• Certificate of Need: None exists for non-medical companion care agencies in South Carolina.
• Network Status: Open enrollment; no closed network or RFP required for fee-for-service Medicaid.
• Managed Care Contracting: Optional but necessary to serve MCO-enrolled members; requires separate credentialing with plans like Absolute Total Care or Molina Healthcare.

4. Licensure and Certification Requirements

Because Companion Care involves sending staff into client homes, agencies must be licensed as In-Home Care Providers by the SC DPH. This process involves submitting an application, paying a licensing fee, and passing an initial DPH inspection of agency policies and administrative records.

The licensure process ensures that agencies have the necessary administrative framework to safely manage non-medical caregivers in the community.

• License Type: In-Home Care Provider (IHCP) license issued by SC DPH.
• Application Form: DPH In-Home Care Provider Initial License Application.
• Policy Review: Applicants must submit operational policies, including abuse prevention and client rights, for DPH review.
• Inspection: DPH conducts an initial survey to verify compliance with state regulations before issuing the license.

5. Medicaid Provider Enrollment

Once licensed, agencies must enroll as Medicaid providers through the SCDHHS online portal. The process requires submitting the DPH license, proof of insurance, and ownership disclosures to obtain a Medicaid provider number.

Providers must ensure all identifying information matches exactly between their DPH license, IRS documentation, and the Medicaid application.

• Enrollment System: SCDHHS Provider Enrollment portal (https://providerservices.scdhhs.gov).
• Provider Type: Enrolled under the specific taxonomy and provider type for HCBS Waiver/In-Home Care.
• Required Documentation: Copy of active SC DPH In-Home Care Provider license and W-9.
• Application Fee: Subject to the federal Medicaid application fee unless waived by prior Medicare enrollment.

6. Staffing, Training and Background Checks

Companion care staff must meet basic educational and safety standards before providing services. Agencies are responsible for maintaining personnel files that document background checks, initial training, and ongoing competency evaluations.

Participant-directed caregivers must also pass background checks, though the Financial Management Services agency handles the administrative onboarding.

• Education Standard: High school diploma or GED is recommended for companion caregivers.
• Background Checks: Mandatory state and national criminal background checks for all direct care staff.
• Certifications: Current CPR and First Aid certification required prior to independent client contact.
• Initial Training: Onboarding must cover abuse prevention, socialization techniques, and emergency procedures.

7. Documentation, Policies and Records

SCDHHS and DPH require strict adherence to documentation standards to justify billing and ensure client safety. Providers must maintain detailed service logs and annual training records for all staff.

Failure to maintain these records can result in recoupment of funds during state audits or loss of licensure during DPH surveys.

• Service Logs: Must document the date, start and end times, and specific companion activities provided during each shift.
• Care Plan Alignment: Services delivered must strictly align with the CLTC-approved individual care plan.
• Training Records: Agencies must use forms such as the Annual In-Service Documentation Form to track ongoing staff education.
• Record Retention: Client and personnel records must be retained for a minimum of five years per Medicaid rules.

8. Billing, Rates and Claims

Companion Care is billed in 15-minute increments through the SCDHHS MMIS or the respective Managed Care Organization's clearinghouse. Rates are established by SCDHHS and published in the HCBS fee schedule.

Providers must verify client eligibility and MCO enrollment status prior to delivering services to ensure claims are routed to the correct payer.

• Billing System: Claims are submitted via the SCDHHS Web Tool or EDI to the state's MMIS.
• Unit of Service: Typically billed in 15-minute increments using specific HCPCS codes designated for companion services.
• Rate Publication: Current reimbursement rates are listed on the SCDHHS Community Long Term Care fee schedule.
• MCO Billing: Claims for members enrolled in Healthy Blue or First Choice must be routed to the specific MCO's claims address.

9. Approval Sequence and Timeline

The end-to-end process requires sequential approvals, starting with state licensure and ending with MCO credentialing. Delays in DPH surveys or incomplete Medicaid applications can significantly extend the timeline.

Providers cannot bill retroactively for services provided before the official Medicaid enrollment effective date.

• Step 1: Submit In-Home Care Provider license application to SC DPH (processing varies, often 60-90 days).
• Step 2: Pass DPH initial inspection and receive the physical license.
• Step 3: Submit Medicaid enrollment application via providerservices.scdhhs.gov (SCDHHS has up to 45-90 days to review).
• Step 4: Apply for credentialing with SC Medicaid MCOs (can take an additional 90-120 days per plan).

10. Common Denials and Survey Findings

Applications and claims are frequently denied due to administrative errors or failure to maintain required documentation. DPH surveyors commonly cite agencies for incomplete personnel files during routine inspections.

Medicaid enrollment applications are often rejected if the applicant attempts to apply before the DPH license is fully active.

• Enrollment Denial: Applying for Medicaid enrollment before the DPH In-Home Care Provider license is fully approved and active.
• Survey Citation: Missing or expired CPR/First Aid certifications in caregiver personnel files.
• Survey Citation: Failure to document required annual in-service training hours for staff.
• Claim Denial: Billing for companion care provided by a spouse, which is strictly prohibited under the CC Waiver.

11. Key Contacts and Resources

Providers should rely on official SCDHHS and DPH resources for the most current manuals, forms, and policy updates. The MCOs also maintain dedicated provider relations lines for credentialing and claims support.

Regularly checking the SCDHHS provider bulletins is essential for staying informed about rate changes and waiver amendments.

• SCDHHS Provider Enrollment: https://providerservices.scdhhs.gov
• Community Choices Waiver Info: https://www.scdhhs.gov/resources/waivers/community-choices-cc-waiver
• SC Department of Public Health (DPH): https://dph.sc.gov
• Absolute Total Care Provider Services: https://www.absolutetotalcare.com/

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