Medicaid Nursing Home Rates by State

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South Carolina

Medicaid nursing facility payment · Cost-based · researched October 2026

South Carolina’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Cost-based

Case-mix level

Facility average

Classification

State index

Rate updates

Once a year

Managed care (LTC)

No

Quality program

None

Paid outside the rate

Small

Bed hold

Hospital and leave

Published rates

Not published

Assisted living

Limited

Personal needs allowance

$60 / month

Overview

• South Carolina sets a separate prospective per diem for each nursing home from its own annual cost report (federal fiscal year ending Sept 30, filed by Jan 1), rebased every Oct 1 using the cost report that ended one year earlier (Oct 1, 2026 rates use FYE 9/30/2025 costs).
• Each cost center is paid at the lower of the home's cost or a 'standard' (cap).
• The standards are the mean cost per day of homes in the same bed-size group (0-60, 61-99, 100+ beds), x105% (x110% for general services/nursing in 2022-2024).
• Costs not subject to standards (utilities, special services, medical supplies and oxygen, property tax and insurance, legal fees) pass through.
• The total is inflated by a state Revenue and Fiscal Affairs index (2.6% for Oct 2025, 1.7% for Oct 2026).
• Then the state adds a fair rental value (FRV) capital per diem, a cost incentive or profit (capped at $1.75/day combined) and a facility-specific non-emergency transport (NEMT) add-on.
• The nursing standard is adjusted by each home's percent of Medicaid days at skilled level ('Level A').
• Homes with 3,000 or fewer Medicaid days a year get the weighted-average industry rate instead.

What matters in South Carolina

• Each home gets its own cost-based rate, rebased every October 1 from costs one year earlier, capped by bed-size standards.
• A state permit caps each home's Medicaid patient days; the statewide cap is 4,452,015 days for FY2026-27.
• No provider tax: the 2002 bed franchise fee has been suspended every year, including FY2026-27.
• Acuity counts only through 'percent skilled' (state level-of-care share), not MDS, and only moves the nursing cap.
• Non-QMB dual eligibles get no Medicare coinsurance payment; for QMBs the home usually receives $0.
• No quality pay program exists; off-rate money is small, mainly UPL (federal ceiling) gap payments to public homes.

Frequently asked

Does South Carolina limit the Medicaid patient days a nursing home may serve?

Yes. A state permit caps each home's Medicaid patient days, and the statewide cap is 4,452,015 days for FY2026-27.

Does South Carolina charge nursing homes a provider tax?

No. The 2002 bed franchise fee has been suspended every year, including FY2026-27.

Does a South Carolina home that buys an older building receive a higher capital payment?

No. On a sale or lease after 10/1/2019, the new owner receives the prior owner's capital payment with no revaluation.

How much is paid outside the posted rate in South Carolina?

Small, under 5% of base, mainly quarterly UPL gap payments to non-state public homes.

What does South Carolina Medicaid pay on Medicare coinsurance days?

Lesser-of for QMBs only, usually $0; other dual eligibles receive no coinsurance-day payment.

Does South Carolina require a minimum share of spending on care?

No care spending floor; homes must capitalize $500 per Medicaid bed a year or lose 10% of capital pay.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

State-specific SCDHHS Financial and Statistical Report for Nursing Homes, filed in the SENIORS Excel workbook (South Carolina Electronic Nursing Home Income/Expense Operating Report System) since FYE 9/30/2018. It covers Oct 1-Sep 30; government and ICF/IID homes may use Jul-Jun, and hospital-based homes may use their own FYE. It is due Jan 1 (30-day extension for good cause), and late filers can have payments withheld. A Capital Data Survey (FRV inputs) is filed with it. Homes with 3,000 or fewer Medicaid days a year are not required to file. Chains file a home office cost report. Medicare 2540 reports are used only for the UPL tests.

Base year and rebasing

Rebased every year. 4.19-D Sec. III: 'The rate cycle will be October 1 through September 30 and will be recomputed every twelve (12) months.' Oct 1, 2026 rates use FYE 9/30/2025 cost reports, and Oct 1, 2025 rates used FYE 9/30/2024. Standards are recomputed each year from the same cost reports. Rates are set on unaudited costs and are retroactively adjusted, both ways, when the field audit changes allowable cost (since 10/1/1994).

Components

Component	Method	Notes
General Services (nursing, restorative, social worker, activity director)	Lower of cost or standard. Standard = mean cost per day of private and non-state governmental freestanding and hospital-based homes in the same bed-size group (0-60, 61-99, 100+), using days = beds x 365 x 85%, x 105% (Oct 2025 and Oct 2026 notices; 110% from Oct 2022 through Oct 2024). Each home's standard is then raised or lowered by its percent of Medicaid days at skilled level ('Level A'), from the prior Jul-Jun paid days including hospice NF days and excluding coinsurance days.	Since 10/1/1997, General Services, Dietary and Laundry/Housekeeping/Maintenance are compared to their standards as one combined total, so overspending in one can be offset by underspending in another. Acuity appeals have not been allowed since 12/31/2011.
Dietary; Laundry, Housekeeping and Maintenance	Lower of cost or standard, tested in the combined total above. Standard = mean cost per day of private for-profit freestanding homes in the same bed-size group (days = available bed days less complex care days x 85%) x 105%.
Administration and Medical Records	Lower of cost or standard (bed-size mean x 105%, private for-profit freestanding homes). Homes below the standard keep 100% of the difference as 'profit', within the overall caps below.	Owner/relative salaries are capped by bed size (e.g. FY2026 administrator $105,842 / $119,358 / $155,170), indexed to state employee COLAs. Home office/management fees are tested for reasonableness.
Costs not subject to standards	Pass-through at the home's actual allowable cost per day: utilities, special services, medical supplies and oxygen, property taxes and building/equipment insurance, legal fees.	Covered ancillary costs (therapy, specialty beds) for Medicaid residents not paid by Medicare or others are kept in allowable cost.
Cost incentive and profit	Cost incentive = the amount by which the home's combined General Services + Dietary + LHM cost is below the combined standards, up to 7% of the standards. Profit = 100% of the amount Administration is below its standard, capped at 3.5% of allowable cost. Incentive + profit are capped at $1.75 per patient day.	The $1.75/day cap is small, so most savings below the caps are not kept by the home.
Capital (FRV)	Fair rental value since 10/1/2019; see capital field.	Capital per day uses the greater of actual days or 90% occupancy.
NEMT add-on	Facility-specific non-emergency medical transportation add-on = allowable Medicaid NEMT cost / Medicaid days from the cost report two years back (FYE 9/30/2024 for Oct 2025 rates). Homes capped under the 10/1/2018 trip criteria get the lower of their 2018 add-on or the new figure.	The home is responsible for residents' non-emergency transport.

Inflation

State composite nursing home index from the SC Revenue and Fiscal Affairs Office (11 weighted expenditure proxies, Q3 to Q3), required by budget proviso 33.2. Applied once to the summed cost per day (not to capital). 4.10% for Oct 2023, 1.8% for Oct 2024, 2.6% for Oct 2025, 1.7% for Oct 2026.

Verified October 11, 2026

Case mix

System

State index

Applied at

Facility average

How it works

Each home gets one per diem for all Medicaid residents. Acuity enters only through the General Services (nursing) standard, which moves up or down with the home's share of Medicaid days at skilled level of care ('percent skilled' / Level A) in the prior state fiscal year (4.19-D Sec. III.B.1.e).

Classification

Percent skilled: Medicaid paid days at the skilled ('Level A') level of care, determined by SCDHHS Community Long Term Care (CLTC) level-of-care certification, divided by total Medicaid days. MDS, RUG and PDPM do not set the per diem. RUG-IV (with Medicare rates trended for 2020-2024) is used only to compute the upper payment limit for the public-home supplemental payment.

Applies to

General Services (nursing) cost standard only. It matters only for homes whose nursing cost is near or above the standard.

Acuity measured from

Medicaid residents only. Since 10/1/2021, computed annually from the prior Jul 1-Jun 30 paid days, including NF days paid under the hospice benefit and excluding dual-eligible coinsurance days (since 10/1/2003). Oct 2026 rates use SFY2026 paid days.

Updated

annual (Oct 1)

Move to PDPM

Not applicable. SC never used RUG or MDS case mix for the NF per diem, so the 2023 end of CMS RUG support did not affect the rate. The only RUG use, the public-home UPL ceiling, now uses Optional State Assessments plus Medicare RUG-IV rates trended forward by the FY2020-2024 Medicare updates (SPA 23-0014).

Verified October 11, 2026

Low-acuity residents

None. SC does not pay a reduced or flat rate for low-acuity residents. Every Medicaid resident in a home gets the same facility per diem, whether certified at skilled or intermediate level of care. Low acuity lowers the home's whole nursing standard through 'percent skilled' (facility average), not an individual resident's rate. Residents below intermediate level of care are not Medicaid-eligible for NF care (CLTC level-of-care certification), not paid at a reduced rate. Checked: 4.19-D Sec. III (SC 25-0009 version) and the NF Services Provider Manual (CCR 2026-07-01).

Verified October 11, 2026

Capital

Fair rental value (FRV) since 10/1/2019, the only capital payment; depreciation, interest and lease costs are no longer paid. Square feet = greater of actual gross sq ft or 275 sq ft x Medicaid-certified beds, capped at an age-group maximum per bed. Value = sq ft x new construction cost per sq ft ($215.55 base, indexed yearly by RSMeans: $276.71 Oct 2023, $283.25 Oct 2024, $274.71 Oct 2025, $278.39 Oct 2026) x RSMeans location factor (by 3-digit zip), plus $7,000 equipment per Medicaid bed. Less 2.0%/yr depreciation on a weighted average age capped at 30 years (floor 40% of value). Plus land at 7.5% of building value. The total is multiplied by a rental factor = 3-year average 10-year Treasury + 3.00%, with a 7.50% floor and 9.50% ceiling (7.50% currently). Income offsets are deducted, then the result is divided by the greater of actual total days or 90% occupancy. Age is reduced by bed additions and renovations of at least $500 per Medicaid bed. Spending test: a home must capitalize at least $500 per Medicaid bed each FFY, or its capital per diem is cut 10% in the next rate year. The test was waived for Oct 2022-Sep 2024 rates; new or replacement buildings are exempt for 5 years. On a sale or lease after 10/1/2019, the new owner gets the prior owner's capital payment (no revaluation).

Verified October 11, 2026

Budget adjustment factor

None as a standing across-the-board factor. Year-to-year funding is controlled by the standard multipliers (general services 110% of mean in Oct 2022-Oct 2024, 105% in Oct 2025-Oct 2026), the minimum-occupancy factor (85% vs 90%), and the inflation factor, which is capped at the RFA index (proviso 33.2). Oct 2025 rates were projected to cut aggregate spending about $1.5M; Oct 2026 rates to add about $51M. The UPL test (4.19-D Sec. M.4) would cap each home at its Medicare-cost per diem if aggregate payments exceeded Medicare principles.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

small

Estimate

Under 5% of base, judged from structure, not dollars. The only sizable off-rate program, the Essential Public Safety Net UPL payment, goes to the few non-state governmental homes. The professional liability pool (claims over $50K) and NATCEP settlements are small. No MCO directed payments or quality pool exist. Dollar amounts for the public-home UPL payments were not found.

Components

Essential Public Safety Net NF supplemental (quarterly UPL gap, non-state governmental homes): size unknown. CPE settlement for state-owned DMH homes: size unknown. Professional liability claims over $50K via gross adjustment: case by case. NATCEP training/testing cost settlement: small.

Source

https://scdhhs.gov/sites/dhhs/files/Attachment%204.19-D.doc

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

Only non-state governmental NFs (county or other public owners) whose operator also owns the assets can get the quarterly Essential Public Safety Net UPL supplemental payment. It fills the gap up to a Medicare RUG-IV-based ceiling, which private homes cannot get. State-owned NFs run by the SC Department of Mental Health are paid a separate cost-based rate (FY2020 base trended 5.092%) with CPE reconciliation. Number of qualifying homes and dollar gap not found.

Funding

Non-federal share for public homes from the public owner (IGT/CPE implied; 4.19-D does not name the transfer mechanism for the EPSN payment). State-owned homes use CPE. The 'operator is also the owner of the assets' test excludes public homes leased to or run by private operators.

Source

https://scdhhs.gov/sites/dhhs/files/Attachment%204.19-D.doc

Verified October 11, 2026

Quality program

Notes

No quality-based payment program found. 4.19-D R.N describes a 'Quality Initiatives Grant Award Program': grants for My InnerView surveys, bladder scanners or electronic medical records, which the home must offset against allowable cost. It is not a pay-for-performance add-on, and whether it is still funded is unknown.

Verified October 11, 2026

Provider tax

Charged

none

Standard amount

None in effect. The 2002 nursing home bed franchise fee is suspended each year by budget proviso 33.10 (still suspended in the FY2026-27 Appropriations Act).

Lower for high-Medicaid homes

no

Returned in the rate

n/a

Source

https://www.scstatehouse.gov/sess126_2025-2026/appropriations…

Verified October 11, 2026

Provider tax notes

None in effect. A nursing home bed franchise fee enacted in 2002 has been suspended every year by budget proviso 33.10 ('Franchise fees imposed on nursing home beds and enacted by the General Assembly during the 2002 session are suspended'), including FY2026-27.

Verified October 11, 2026

Supplemental payments

(1) Essential Public Safety Net Nursing Facility supplemental payment (4.19-D Sec. III.K.III, since 10/1/2011, budget proviso origin 2008-09): quarterly UPL gap payments to non-state governmental NFs whose operator also owns the assets. The ceiling = Medicaid days spread across RUG-IV groups using Optional State Assessments x Medicare RUG-IV rates trended to the payment year. The payment = that ceiling minus Medicaid per diem payments, including pharmacy, lab, x-ray and ambulance. It is exempt from the lower-of-cost-or-charges test. Size not found. (2) State-owned NFs (SC Department of Mental Health homes): cost-based prospective rate with certified public expenditure (CPE) reconciliation. (3) Professional liability pool: claims over $50,000 paid outside the rate via gross adjustment, Medicaid share by Medicaid occupancy (100% of allowed since 10/1/2016). (4) Nurse aide (NATCEP) training/testing costs reimbursed through annual cost settlement. No MCO directed payments for NFs.

Verified October 11, 2026

Other add-ons

(1) NEMT add-on (facility-specific, since 10/1/2019; see cost_basis). (2) Cost incentive/profit up to $1.75/day. (3) The 2% General Services add-on (Oct 2022, for nursing/CNA wage growth) and 'Lost COVID Occupancy' payments (phase-out began Oct 2022) are no longer on the Oct 2025 rate computation sheet. (4) Hospice room and board: SCDHHS pays the hospice at least 95% of the NF's daily Medicaid rate.

Verified October 11, 2026

Units paid separately

(1) Complex Care Program (since 10/1/2011): $450/day flat rate (the 2011 figure; no update found) for Medicaid residents admitted from an acute hospital (at least 10 consecutive days) who meet NF level of care plus 2 or more criteria (stage 4 wound with wound vac, trach, suctioning, long-term IV fluids, continuous disruptive behavior, HIV, bariatric, recent-diagnosis therapy for Medicaid-only, dialysis, total care, vent). It needs SCDHHS approval (Form 185S), recertification every 90 days, and an enrolled Complex Care provider; it cannot be combined with hospice. (2) Ventilator Unit (subacute): $708/day for residents in a dedicated vent wing of at least 20 beds (plan says effective 11/21/2024; the final public notice says 10/1/2024; about +$1.5M/yr). Complex care and vent days are stepped out of the cost report and excluded from FRV and standard days. (3) Homes with 3,000 or fewer Medicaid days/yr: weighted average industry rate, set at the start of each cycle, no cost report required. (4) New homes and homes changing bed capacity by more than 50%: budget-based interim rate at 120% of standards for 6 months, then settled. (5) State-owned DMH NFs: cost-based (FY2020 base trended 5.092%) with CPE settlement. (6) Swing beds: statewide weighted-average rate excluding therapy. (7) Out-of-state NFs: the other state's Medicaid rate, only when no SC bed is available. (8) Temporary management homes: 100% of allowable cost, no standards.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

No managed LTC for nursing homes. Since 1/1/2026 all NF services are paid by SCDHHS fee-for-service. Until 12/31/2025, Healthy Connections Medicaid MCOs paid the first 90 days of a Medicaid skilled NF stay (a short-stay arrangement), and Healthy Connections Prime (an MMP for duals) covered NF services. Prime ended 1/1/2026; its members moved to D-SNP Medicare Advantage plans, with NF services returned to Medicaid FFS. The 1/1/2026 'managed care carve-in' put NF residents, duals and Community Choices/HIV-AIDS/Vent waiver members into MCOs for state plan medical services only (public notice 12/30/2025: 'Waiver and nursing facility services will remain authorized and reimbursed through the fee-for-service delivery model').

Verified October 11, 2026

Who pays

fee_for_service. Nursing facility per diems are authorized and paid by SCDHHS fee-for-service. Since 1/1/2026, NF residents (and duals) are enrolled in Healthy Connections Medicaid MCOs, but only for medical services such as hospital care; NF and waiver services stay FFS. Before 1/1/2026, MCOs paid the first 90 days of a skilled NF stay, and Healthy Connections Prime (the duals plan, now ended) covered NF services.

Verified October 11, 2026

Managed care rate floor

Not applicable to NF per diems since 1/1/2026 (FFS). For the carve-in transition, MCOs must honor prior authorizations and pay previously authorized services at 100% of the applicable Medicaid FFS rate for 180 days (SCDHHS carve-in page). No standing MCO floor for the pre-2026 first-90-day NF stays was found. Source: https://www.scdhhs.gov/partners/managed-care/managed-care-carve

Verified October 11, 2026

Included in the daily rate

Included: room, board, nursing, routine personal hygiene items, incontinence care and supplies, basic personal laundry, OTC drugs (except insulin), medical supplies and oxygen, diabetic testing supplies, and covered ancillary services (PT, OT, ST, specialty beds) for Medicaid residents when Medicare or other payers don't pay (homes must bill Medicare first). Non-emergency transport is in the rate via the NEMT add-on. Paid separately: prescription drugs (pharmacy billing; the 4-script monthly limit with override), lab, x-ray, ambulance, physician services, and hospital care (MCO-covered for enrollees since 1/1/2026). NATCEP and large professional liability claims are paid outside the rate. Sources: NF Services Provider Manual (CCR 2026-07-01); 4.19-D R.L and K.III.

Verified October 11, 2026

Bed hold

Hospital stays

Paid: SCDHHS reserves the bed up to 10 calendar days per hospital stay, if the stay is expected to be short and the resident is expected to return to the same home. Medicaid also sponsors the 10-day hold for dual eligibles. The percent of the per diem is not stated (billed as reserved days). No annual cap stated. Complex Care residents have the same 10-day hold.

Leave days

Paid: 18 days per state fiscal year (Jul-Jun), each leave at most 9 days, leaves not consecutive, physician-authorized in the plan of care. A separate 30-day hold is allowed for an approved rehabilitation/training program (e.g. Vocational Rehabilitation) with written approval.

Occupancy rule

None stated for bed-hold payment.

Notes

No bed hold for swing-bed residents moved to acute status in the same hospital. Bed holds are checked by random sample and NF audits.

Source

https://provider.scdhhs.gov/internet/pdf/manuals/Nursing/Manu…

Verified October 11, 2026

Personal needs allowance

Per month

60

Effective

2025-10-01

Notes

SCDHHS final action notice (Sept. 29, 2025): PNA for residents of nursing facilities and ICF/IID raised from $30 to $60 effective on or after Oct. 1, 2025, by State Plan amendment (about $3.7M a year). ICF/IID residents in a work therapy program are not affected. Do not confuse with the CRCF/OSS PNA ($79 SSI-only / $99).

Confidence

confirmed

Source

https://www.scdhhs.gov/communications/final-action-increase-p…

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

4.19-D Sec. III.P: since 12/1/2001 SCDHHS does not pay Medicare Part A coinsurance days for NFs (swing beds exempt). Since 10/1/2008 it pays coinsurance only for Qualified Medicare Beneficiaries (QMBs): 'the gross Medicaid rate/day less the amount paid by Medicare/day not to exceed the Medicare coinsurance rate/day.' Non-QMB duals get nothing. Coinsurance days are excluded from the percent-skilled calculation. No specific rule found for Medicare Advantage/D-SNP cost-sharing.

Effect

Medicare's SNF per diem is usually far above SC's Medicaid rate, so the home usually receives $0 of the day 21-100 coinsurance.

Source

https://scdhhs.gov/sites/dhhs/files/Attachment%204.19-D.doc

Verified October 11, 2026

Required care spending

Applies

no

Rule

No care/staff spending floor. As a cost-based system, the rate follows each home's own cost (below the standards) with a one-year lag, and savings below the standards are mostly not kept (incentive + profit capped at $1.75/day). Separate capital rule (not care spending): under FRV, each home must capitalize at least $500 per Medicaid-certified bed per FFY or take a 10% cut to its capital per diem the next rate year. The test was waived for Oct 2022-Sep 2024 rates; homes that quadrupled the threshold are exempt the next period, and new or replacement buildings are exempt for 5 years. Licensing proviso 31.17 requires 1.63 non-licensed direct care hours per resident day (staffing, not spending).

Source

https://scdhhs.gov/sites/dhhs/files/Attachment%204.19-D.doc

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) Operating costs: per-day cost is figured on the greater of actual days or minimum-occupancy days. The Oct 2025 and Oct 2026 final notices say 90%, and the cost-center standards are also at 90% occupancy for Oct 2026. The plan text still reads 85% (reduced from 90% in Oct 2022). (2) Capital/FRV: greater of actual days or 90% occupancy. (3) General Services standard is built with beds x 365 x 85% days in the plan text. (4) New homes: 120% of standards for the first 6 months, then rates use the higher of actual occupancy or 90%. Wings taken offline for unsafe-building renovations are excluded from the minimum-occupancy calculation.

Source

https://www.scdhhs.gov/communications/public-notice-final-act…

Verified October 11, 2026

MDS accuracy penalties

None found. The per diem does not use MDS case mix, so there is no MDS-accuracy rate penalty. The acuity input (percent skilled) comes from CLTC level-of-care certification on paid days and cannot be appealed (since 12/31/2011). Bed holds are checked by random sample and NF audits; cost reports are desk-reviewed and field-audited, with retroactive rate adjustment.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

annual

When

Oct 1 each year: full rebase to the cost report one year earlier, new standards, new inflation factor, new FRV inputs, new percent skilled and new NEMT add-on. Retroactive changes when the field audit of the base cost report changes allowable cost. New, replacement or CHOW homes get interim or carried-over rates mid-year.

Verified October 11, 2026

When rates change

October 1 (federal fiscal year) rate cycle through Sept 30. Budget proviso 33.13 requires the LTC rate SPA to reach the SCDHHS Director by Aug 1 and CMS by Aug 15 each year. Public notice of proposed action is posted in late July or August, and final action in September. Oct 1, 2026 rates: final notice 9/8/2026; the SPA was not yet on the approvals list as of 10/2026.

Verified October 11, 2026

Posted rates

Home-level rates published

No

Where

No facility-level NF rate list found on scdhhs.gov (the fee schedules page has no NF rates; the Long Term Living nursing facilities page links only the manual, forms and TAD schedules). Rates are set per facility and sent to providers. Methodology is posted in Attachment 4.19-D: https://scdhhs.gov/sites/dhhs/files/Attachment%204.19-D.doc

Format

none

Cadence

Annual (Oct 1) per facility, not posted publicly

History

Methodology history via SPA approval packets (e.g. SC 22-0015, 23-0014, 24-0014, 25-0009) at https://www.scdhhs.gov/resources/state-plan/state-plan-amendm…

Home identifier

SC Medicaid provider number (the rate computation sheet keys on 'PROVIDER NUMBER')

Verified October 11, 2026

Rate build-ups

Published

No

Where

Only the blank template is public: 'Computation of Reimbursement Rate - Percent Skilled Methodology', 4.19-D page 12. Per-facility sheets were not found online.

What they show

Template: reporting period, maximum bed days less complex care, patient days used vs incurred, beds, actual occupancy, % skilled, and for each cost center allowable cost, standard, computed rate and profit/incentive. Then the subtotal, inflation factor (2.60%), cost of capital, profit (max 3.5%), cost incentive, effect of the $1.75 cap, NEMT add-on and final reimbursement rate.

Format

doc/pdf (template only)

Example file

https://www.scdhhs.gov/sites/dhhs/files/SC%2025-0009%20CMS%20…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

limited

Program

Community Choices 1915(c) waiver (0405; five-year renewal approved 9/2/2026, retroactive to 7/1/2026) covers Residential Personal Care (RPC), a 'second tier' personal care service in enrolled Community Residential Care Facilities (CRCFs, SC's assisted living), for residents at intermediate NF level of care. The first tier, OSCAP (Optional Supplemental Care for Assisted Living Participants), gives CRCFs extra pay for personal care for residents of the state-funded Optional State Supplementation (OSS) program.

What is paid

Services only. Room and board is paid by the resident's SSI or income plus the state-funded OSS payment (100% state, no federal match), which covers the gap between the resident's countable income and the OSS net income limit. The resident keeps a personal needs allowance.

Rate

RPC/OSCAP rates not found (not on the 11/1/2025 HCBS fee schedule). OSS: maximum payment $1,645/month and net income limit $1,724 from 7/1/2023; PNA $79 (SSI-only) / $99. Later OSS adjustments not verified.

Limits

Community Choices waiver slots and waitlist apply; numbers not checked. RPC is limited to enrolled RPC CRCFs.

Source

https://provider.scdhhs.gov/internet/pdf/manuals/oss/Manual.pdf

Verified October 11, 2026

Sources

1. SC State Plan Attachment 4.19-D (NF, ICF/IID, IMD rate setting), file saved 11/7/2025 · state plan
2. SPA SC 25-0009 approval packet (Oct 1, 2025 NF rates) · state plan
3. SPA SC 24-0014 approval packet (Oct 1, 2024 NF rates) · state plan
4. SPA SC 23-0014 approval packet (Oct 1, 2023 NF rates) · state plan
5. SPA SC 22-0015 (Oct 1, 2022 NF rates: occupancy cut, standards up, 2% GS add-on, Lost COVID Occupancy phase-out) · state plan
6. Public Notice of Final Action: Setting Payment Rates for LTC Facility Services (Oct 1, 2026), 9/8/2026 · agency page
7. Public Notice of Final Action: Setting Payment Rates for LTC Facility Services (Oct 1, 2025), 9/18/2025 · agency page
8. Public Notice of Final Action: Managed Care Enrollment Carve In, 12/30/2025 · agency page
9. SCDHHS Managed Care Carve-in page and FAQs · agency page
10. Healthy Connections Prime (MMP) member page (Prime ended 1/1/2026) · agency page
11. Public Notice of Final Action: Ventilator Unit Reimbursement, 11/20/2024 · agency page
12. Nursing Facility Services Provider Manual (CCR 2026-07-01) · agency page
13. FY2026-27 SC Appropriations Act Part IB provisos (31.12, 31.17, 33.2, 33.10, 33.13, 117.172) · statute
14. Optional State Supplementation Services Provider Manual (Oct 2020; CCR 2026-07-01) · agency page
15. OSS Rate Increases bulletin (eff. 7/1/2023) · agency page
16. Community Choices and HIV/AIDS 1915(c) Waiver Changes and Program Renewal Status, 9/2/2026 · agency page
17. HCBS Waiver Fee Schedule eff. 11/1/2025 · rate file
18. SCDHHS SPA approvals list · agency page
19. Personal needs allowance · secondary

Other states

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