Waiver Consulting Group — Start any program. In any state.

South Carolina - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

South Carolina funds Respite Care Services primarily through the Community Choices (CC) Waiver and the Intellectual Disability/Related Disabilities (ID/RD) Waiver, administered by the South Carolina Department of Health and Human Services (SCDHHS). The service provides temporary, short-term relief care that allows an unpaid primary caregiver to step away while ensuring the waiver participant continues to receive necessary supervision, personal care, and support.

Before an agency can submit a Medicaid provider enrollment application to offer these services, it must first secure the appropriate operational license from the South Carolina Department of Public Health (SCDPH). South Carolina does not issue a standalone "respite" license; instead, providers must hold an active In-Home Care Provider license to deliver services in the participant's home, or a Community Residential Care Facility (CRCF) license to provide out-of-home, facility-based respite.

1. Service Definition and Scope

In South Carolina, Respite Care is defined as short-term care provided to individuals unable to care for themselves, furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care. The service is designed to prevent institutionalization by supporting the informal caregiving arrangement.

The scope of service varies based on the delivery setting. In-home respite is delivered in the participant's primary residence, while out-of-home respite is provided in a licensed facility. Effective July 1, 2025, the SCDHHS HCBS Provider Manual explicitly outlines the scope for Respite in a CRCF, requiring facilities to manage 24-hour patient days and coordinate closely with Community Long Term Care (CLTC) or the Office of Intellectual and Developmental Disabilities (OIDD).

2. Regulatory and Oversight Agencies

The South Carolina Department of Health and Human Services (SCDHHS) is the state Medicaid agency responsible for funding, waiver administration, and provider enrollment. Within SCDHHS, the Community Long Term Care (CLTC) division and the Office of Intellectual and Developmental Disabilities (OIDD) manage specific waiver populations and authorize respite hours.

The South Carolina Department of Public Health (SCDPH)—formerly known as DHEC—is the regulatory body responsible for inspecting and licensing the underlying healthcare agencies and facilities. The South Carolina Department of Disabilities and Special Needs (DDSN) also plays a critical oversight role for providers serving the ID/RD waiver population.

3. Gatekeeping Prerequisites: Who Can Even Apply

South Carolina strictly requires providers to hold an active, appropriate state license before SCDHHS will accept a Medicaid enrollment application for Respite Care Services. There is no generic Medicaid respite certification that bypasses SCDPH licensure. If a provider loses their SCDPH license, they are immediately terminated as a Medicaid provider.

For out-of-home respite, the structural prerequisite is holding a Community Residential Care Facility (CRCF) license. For in-home respite, the prerequisite is an In-Home Care Provider license. If an agency intends to provide skilled nursing respite, they must obtain a Home Health Agency license, which is subject to South Carolina's Certificate of Need (CON) review process, creating a significant market-entry barrier for skilled respite.

4. Licensure and Certification Requirements

Agencies providing in-home respite must comply with SCDPH Regulation 61-122 (Standards for Licensing In-Home Care Providers). This regulation dictates the organizational structure, administrator qualifications, client rights, and mandatory policy manuals required to operate legally in the state.

Facilities providing out-of-home respite must comply with SCDPH regulations governing Community Residential Care Facilities. These rules mandate specific physical plant standards, including wheelchair accessibility, minimum square footage per resident, and strict environmental safety protocols.

5. Medicaid Provider Enrollment

Once licensed by SCDPH, the agency must enroll as a Medicaid provider through the SCDHHS provider enrollment portal. The enrollment process requires the submission of the active state license, ownership disclosure forms, and an executed provider agreement.

Providers must specifically enroll to serve the waivers that fund respite, such as the Community Choices (CC) Waiver or the ID/RD Waiver. Enrollment is not universal; an agency must be approved by the specific division (CLTC or OIDD) managing the target population.

6. Staffing, Training and Background Checks

South Carolina requires all respite care staff to meet strict health, safety, and training standards before providing direct care. Agencies must maintain comprehensive personnel files proving compliance with SCDPH and SCDHHS mandates.

Direct care workers must pass state and national background checks and complete mandatory health screenings. If skilled care is provided, the agency must verify nursing credentials directly through the state licensing board.

7. Documentation, Policies and Records

Providers must maintain rigorous documentation to support both their SCDPH license and Medicaid claims. SCDHHS requires providers to utilize automated systems mandated by the CLTC division to document the provision of services.

Agencies are responsible for verifying participant Medicaid eligibility upon accepting a referral and monthly thereafter. Failure to document eligibility or adhere to the authorized care plan will result in claim denials and potential recoupment.

8. Billing, Rates and Claims

Respite services are billed to SCDHHS based on the authorized units in the participant's care plan. For CRCF out-of-home respite, the unit of service is a 24-hour patient day. For in-home respite, services are typically billed in 15-minute or hourly increments depending on the specific waiver.

All claims must be supported by prior authorization from the waiver case manager. Providers must use the state's Medicaid Management Information System (MMIS) and adhere to the billing codes and modifiers published in the current HCBS Provider Manual.

9. Approval Sequence and Timeline

Becoming a respite provider in South Carolina is a sequential process that cannot be compressed. An entity must first be legally formed and secure a physical location (especially for CRCFs) before applying for SCDPH licensure.

Only after the SCDPH license is in hand can the agency apply for Medicaid enrollment. The entire process, from initial facility inspection or policy review to receiving the first waiver referral, typically spans 4 to 9 months depending on the license type.

10. Common Denials and Survey Findings

SCDPH surveyors and SCDHHS auditors frequently cite providers for administrative lapses rather than direct care failures. A common critical finding is the failure to maintain the underlying state license, which triggers immediate Medicaid termination.

In the waiver program, providers are often penalized for failing to respond to referrals within the mandated two-day window, or for billing for services when the participant's Medicaid eligibility had lapsed because the provider failed to perform the required monthly check.

11. Key Contacts and Resources

Providers must regularly consult official state resources to maintain compliance with changing regulations and billing codes. The SCDHHS HCBS Provider Manual is updated frequently, with major revisions typically taking effect on July 1 of each year.

Licensing questions should be directed to SCDPH, while enrollment and authorization issues are handled by SCDHHS and the specific waiver operating divisions.

See all South Carolina services · South Carolina Medicaid consulting · book a consultation.