Family Caregiver Pay Rate in South Carolina: Medicaid, VA, Private Pay

The family caregiver pay rate in South Carolina generally falls between about $13 and $32 per hour, and the figure you’ll actually see depends on which program pays you. Medicaid’s Community Choices waiver pays the least after administrative fees, VA caregiver stipends land in the middle on a federal formula, and private arrangements pay the most. Each path also comes with its own tax rules, documentation requirements, and application timeline.

Medicaid Community Choices Waiver Pay

South Carolina’s main Medicaid route for paying a family caregiver is the Community Choices waiver, run by the Department of Health and Human Services under Healthy Connections. The waiver covers frail adults 65 and older and people with physical disabilities ages 18 through 64 who need a nursing-facility level of care but prefer to stay home.¹ Under the self-directed model, the person receiving care acts as the employer and can hire a family member for bathing, dressing, meals, and similar daily tasks.²

South Carolina’s Medicaid fee schedule reimburses personal care services at $25.00 per hour under the Community Long Term Care program.³ That is what Medicaid pays into the program, not what the caregiver takes home. A financial management service handles payroll, tax withholding, and employer obligations for the care recipient, and those administrative costs come out of the budget.⁴ After those deductions, the actual wage typically lands between $13 and $16 per hour, roughly matching the statewide median for home health and personal care aides.

Your weekly hours are capped by the recipient’s individual service plan, which a case manager develops based on medical need. You don’t set the schedule on your own. The plan dictates both the tasks covered and the total weekly hours authorized.

The care recipient has to meet both medical and financial thresholds. Medically, they must require a nursing-facility level of care, meaning regular hands-on help with activities like transferring, toileting, or eating. Financially, their monthly income can’t exceed $2,982 for an individual as of January 2026, with a spousal income allocation of $4,066.50 per month when a spouse remains in the community.⁵ Documentation of income, resources, and account balances is part of the application.⁶

VA Caregiver Stipends for South Carolina Veterans

Veterans with serious service-connected injuries have access to two federal caregiver programs, both of which can pay family members. These stipends are separate from Medicaid and use a completely different formula.

Program of Comprehensive Assistance for Family Caregivers

The VA’s main caregiver program pays a monthly stipend to one eligible primary family caregiver.⁷ The veteran must have a serious injury incurred or aggravated during active military service.⁸

The stipend is based on the Office of Personnel Management General Schedule pay rate for grade 4, step 1, in the locality where the veteran lives, divided by 12.⁹ The VA multiplies that figure by a percentage tied to the veteran’s care needs:

Level One pays the monthly GS-4 Step 1 rate multiplied by 0.625. In a typical South Carolina locality, that works out to roughly $1,800 to $1,900 per month.
Level Two pays the monthly GS-4 Step 1 rate multiplied by 1.00, and is reserved for veterans the VA determines are unable to sustain themselves in the community. This can reach approximately $2,900 to $3,000 per month.

Exact amounts depend on which OPM locality pay area covers the veteran’s address. Most of South Carolina falls under the Rest of United States locality, though areas near Charlotte may use the Charlotte-Concord pay area.¹⁰ The stipend is not taxable, so caregivers don’t report it on federal returns.

To apply, submit VA Form 10-10CG, which asks for the veteran’s service history, injury, and the caregiver’s relationship and residency.¹¹

Veteran-Directed Care

Veteran-Directed Care gives the veteran a flexible budget to manage their own services. The veteran decides what mix of goods and services best meets their needs and can hire family members, friends, or neighbors to provide care.¹² The hourly rate a family caregiver earns depends on the overall budget the VA approves, which reflects assessed care needs and local market rates. Enrollment happens through the local VA medical center’s social work or geriatrics department.

Private Pay and Long-Term Care Insurance

Families who don’t qualify for Medicaid or VA programs typically pay out of pocket or use long-term care insurance, and private rates run noticeably higher. As of 2024–2025, the statewide average for private home care is around $32 to $33 per hour, which translates to roughly $68,000 a year for full-time care. Metro areas like Charleston or Columbia tend to cluster near or above the state average.

When a relative provides the care directly rather than through an agency, the rate is negotiable. Families often land somewhere between the Medicaid-level rate and the full agency rate, commonly in the $18 to $28 range for a family caregiver without professional certification. Whatever rate you agree on should reflect fair market value for the area, because that number will matter later if the care recipient applies for Medicaid.

Long-term care insurance policies can reimburse family caregivers, but most set a daily or monthly benefit cap. Whether the policy covers a family member depends on the contract. Some require the caregiver to hold a home health aide certification or similar credential. Read the policy before assuming family care is covered, and keep detailed time logs, since insurers typically demand them before releasing payment.

How the Different Programs Are Taxed

The hourly or monthly figure isn’t take-home until taxes are accounted for, and the rules depend entirely on which program is paying.

Under the Community Choices waiver’s self-directed model, the financial management service runs payroll and handles employer tax obligations. It withholds Social Security, Medicare, and income taxes and files the returns. You get a W-2 at year’s end, and the income is reported like any other job.⁴

When a family pays a caregiver directly, the care recipient is generally acting as a household employer. If you pay a household employee $3,000 or more in cash wages during 2026, you must withhold and pay Social Security and Medicare taxes: 7.65 percent from the worker’s wages and a matching 7.65 percent as the employer.¹³ You’ll need an Employer Identification Number and must file a W-2 for the caregiver. There are exceptions: you don’t owe Social Security or Medicare taxes on wages paid to your spouse, your child under 21, or your parent (unless specific conditions apply). Federal income tax withholding isn’t required either, though the caregiver can request it with a W-4.¹⁴

The PCAFC stipend is not taxable. The VA treats it as a benefit rather than earned income, similar to disability compensation, and you don’t report it on your federal return. If you also receive pay from a Medicaid program or a private arrangement, that income is taxable in the normal way; only the VA stipend itself is tax-free.

Why a Written Personal Care Agreement Matters

If the person you’re caring for might ever need Medicaid-funded nursing home care, every dollar you’ve been paid as a caregiver will be scrutinized. South Carolina applies a 60-month look-back period when someone applies for Medicaid long-term care. During that review, payments to family members without proper documentation are treated as gifts, which count as disqualifying transfers and trigger a penalty period of Medicaid ineligibility.

A written personal care agreement proves the payments were compensation for services, not gifts. This is the single most overlooked step in family caregiving arrangements, and skipping it can cost a family tens of thousands of dollars in nursing home bills during a penalty period. The agreement should include:

Specific services, listing the actual tasks (bathing, meal preparation, medication reminders) rather than vague language like “general help”
Schedule and hours, including how care frequency and time are tracked
Pay rate and payment method, with the hourly rate reflecting fair market value for your area; using the Medicaid reimbursement rate or local agency rates as a benchmark is the safest approach
Start date and termination conditions, such as what happens if the recipient moves to a facility
Signatures from both the care recipient (or their legal representative) and the caregiver

Notarization isn’t strictly required in every case, but it strengthens the agreement’s credibility during a Medicaid review. Any amount paid above fair market value can still be treated as a disqualifying transfer, so keep documentation showing how you arrived at your rate. Local agency quotes and the SCDHHS fee schedule are useful benchmarks.³

Comparing Your Options Side by Side

The gap between programs is wide enough that choosing the wrong path, or not knowing a path exists, can cost thousands of dollars a year. The main options for a South Carolina family caregiver:

Medicaid Community Choices waiver (self-directed): roughly $13 to $16 per hour after financial management fees. Medicaid reimburses $25.00 per hour for personal care, but take-home pay is lower. Hours are capped by the service plan. Income is taxable.
VA PCAFC stipend: approximately $1,800 to $3,000 per month depending on care tier and locality. Not taxable. Only available for veterans with serious service-connected injuries.
VA Veteran-Directed Care: hourly rate varies with the approved budget and typically reflects local market rates.
Private pay: negotiable, with South Carolina market rates for professional home care averaging around $32 per hour. Family caregivers without certification often negotiate lower. Taxable as household employment income above $3,000 annually.

Veterans with both VA eligibility and Medicaid coverage may be able to coordinate benefits, though the programs can’t pay for the same hours of care twice. If you’re caring for a veteran who also qualifies for Medicaid, contact both agencies to understand how the programs interact before choosing one over the other.

How to Apply

For the Community Choices waiver, start by contacting the South Carolina Department of Health and Human Services or your local Community Long Term Care office to request a level-of-care assessment. The care recipient has to be evaluated to confirm nursing-facility-level needs.¹ Proof of income and assets is part of the Medicaid financial eligibility determination.⁶ After an application is submitted, a case manager conducts a home assessment and develops a service plan specifying the types of assistance needed and the hours authorized. The timeline from initial application to the first payment commonly spans 30 to 90 days, and waitlists sometimes extend it further. Payroll setup through the financial management service adds another step before paychecks begin.

For the Program of Comprehensive Assistance, submit VA Form 10-10CG online or through a VA medical center. The form requires details about the veteran’s service history, medical condition, and the caregiver’s identity and residency.¹¹ The VA then schedules a clinical evaluation of the veteran’s needs and assigns a care tier that determines the stipend level.¹⁵ For Veteran-Directed Care, enrollment goes through the local VA medical center’s social work or geriatrics department, where the veteran receives a budget and works with a counselor to allocate it across services, including family caregiver wages.¹²

1
South Carolina Department of Health and Human Services. Community Choices (CC) Waiver
2
Medicaid. Self-Directed Services
3
South Carolina Department of Health and Human Services. HCBS Waivers Fee Schedule Updated October 1, 2025
4
Medicaid. Self-Directed Services – Section: Financial Management Services
5
South Carolina Department of Health and Human Services. Program Eligibility and Income Limits
6
South Carolina Department of Health and Human Services. Getting Started
7
Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers
8
Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers Eligibility Criteria Fact Sheet
9
U.S. Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers Monthly Stipend for Primary Family Caregivers Fact Sheet
10
Office of Personnel Management. 2026 General Schedule
11
Veterans Affairs. About VA Form 10-10CG
12
Administration for Community Living. Veteran Directed Care
13
Internal Revenue Service. Publication 926 (2026), Household Employer’s Tax Guide
14
Internal Revenue Service. Topic No. 756, Employment Taxes for Household Employees
15
Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers Eligibility Criteria Fact Sheet – Section: Stipend Levels