How to start a home care agency in South Carolina and reach your first client faster
South Carolina licenses nonmedical home care, and DPH rewrote the rules in May 2026. Owners must pass a SLED check and a drug test before DPH will license them, every caregiver needs a record check and a negative drug test before hire, and random testing never stops. Medicaid through Community Choices adds an SCDHHS contract, a nurse supervisor and electronic visit verification. Home health still needs a Certificate of Need. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
- One fixed price, agreed in writing
- You own 100%. No franchise fees or royalties
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to South Carolina rulesRegulation 60-122 and the SCDHHS personal care scope of services
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what South Carolina requires.
Personal care for Community Choices members
- State license
- DPH in-home care provider license (Regulation 60-122), required before SCDHHS will enroll you
- Who you deal with
- DPH, SCDHHS Community Long Term Care and the case managers who authorize services
- Must haves
- DPH license, SCDHHS Medicaid enrollment and HCBS personal care contract, owner or administrator with three years of health care administrative experience, RN or LPN supervisor, aide competency evaluation, 10 training hours a year, SLED, nurse aide registry and OIG checks, EVV and the Phoenix provider portal
- Realistic time to first client
- Several months after licensure
Orientation for South Carolina only. We confirm your exact path on the free call.
Three places new South Carolina agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Applying under rules that changed in May 2026
DPH replaced Regulation 60-122 in full on May 22, 2026. The new rule adds owner screening deadlines, written policies for every section, client record and care plan rules, rights notices, infection control, a disaster plan, 24 hour incident reports and a flat $200 late fee. Policy templates built on the 2014 text miss most of it.
What it costs: A packet sent back or citations at your first inspection, and weeks before you can serve a client.
Drug testing that never stops
The statute itself requires a drug test for the owner before licensure and for every caregiver before hire, and puts both under random testing. Each caregiver needs a negative five panel test taken within 30 days before the job offer, and your random testing policy goes in with the license application. Missing records are cited as the most serious class of violation.
What it costs: Caregivers you cannot schedule, and penalties of up to $5,000 per violation.
Medicaid waits on the license and a nurse
SCDHHS will not enroll a personal care provider without the DPH in-home care license. Its contract also requires an owner or administrator with three years of health care administrative experience, an RN or LPN who visits before services start, within 30 days and every four months, and a competency evaluation for every aide. Referrals must be answered within two working days.
What it costs: Months of payroll and rent with no Medicaid clients if the nurse and contract are not ready.
What does a delay cost your agency?
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Home care vs home health vs hospice in South Carolina
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Bathing, dressing, toileting, meals, walking, housekeeping, laundry, errands, transportation, medication reminders | Part time or intermittent skilled nursing and therapy ordered by a physician, APRN or PA, plus aide services | Palliative and supportive care for people who are terminally ill, and their families |
| State license | DPH in-home care provider license (S.C. Code 44-70; Regulation 60-122) | DPH home health agency license (S.C. Code 44-69; Regulation 60-77) | DPH hospice license (S.C. Code 44-71; Regulation 60-78) |
| Certificate of Need | No | Required before licensure (S.C. Code 44-69-75), approved county by county | No Certificate of Need step |
| Main payers | Private pay, Community Choices and other SCDHHS waivers; the same contract can serve OIDD waiver members | Medicare, Healthy Connections Medicaid and its health plans, commercial insurance | Medicare hospice benefit, Medicaid, commercial insurance |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment (paused since May 13, 2026) | Accreditation or state survey, then Medicare enrollment (paused since May 13, 2026) |
| Key staff | Administrator; RN or LPN supervisor for Medicaid; trained caregivers | Full time administrator, clinical manager (physician, APRN, PA or RN), clinical staff | Administrator, medical director, nursing staff, interdisciplinary team |
| Startup capital | Lowest | Higher: clinical payroll before Medicare revenue | Highest: interdisciplinary team before revenue |
| Time to first client | Weeks to months (private pay); several months more (Medicaid) | Longest: Certificate of Need, licensure, survey, enrollment | Longest: licensure, survey, enrollment |
Many South Carolina owners start with an in-home care provider license, build a caregiver team and cash flow, then look at home health. Plan the Certificate of Need early: DPH approves home health agencies for specific counties, the license then requires service to the whole of each county, and the CON comes before the license. Regulation 60-122 also requires separate records and separate public representation for any other line of business, so we plan both from day one.
South Carolina requirements at a glance
| Nonmedical home care license | In-home care provider license from the South Carolina Department of Public Health (DPH) under S.C. Code 44-70-10 et seq. and Regulation 60-122, rewritten effective May 22, 2026 |
|---|---|
| Home health and hospice licensing | DPH licenses home health agencies (S.C. Code Chapter 44-69, Regulation 60-77) and hospices (S.C. Code Chapter 44-71, Regulation 60-78) |
| Certificate of Need | Required for a new home health agency (S.C. Code 44-69-75; Regulation 60-15). Not required for in-home care providers or hospices. |
| Medicaid agency | South Carolina Department of Health and Human Services (SCDHHS), Community Long Term Care |
| Main Medicaid home care program | Community Choices waiver. Personal care stays fee for service through SCDHHS contracts, even for members moved into Healthy Connections health plans on January 1, 2026. |
| Owner screening | SLED name based criminal records check no older than 90 days and a five panel drug test taken within 30 days before DPH receives the application |
| Caregiver screening | Criminal record check under S.C. Code 44-7-2910, drug test before hire, random drug testing, sex offender and nurse aide registry checks |
| Caregiver training | Topics set by Regulation 60-122, before client contact and every year. Medicaid adds a nurse led competency evaluation and 10 training hours a year. |
| Electronic visit verification | Required by SCDHHS for Community Choices, HIV/AIDS, Vent and MCC waiver services, including nurse supervisory visits |
| Entity filing | South Carolina Secretary of State; withholding tax through SCDOR MyDORWAY |
Summary of South Carolina requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in South Carolina
The order matters. DPH must receive the application within 30 days of the owner's drug test and 90 days of the owner's SLED check, so finish the office, insurance and policies first, then screen the owner and file.
Form the business with the South Carolina Secretary of State
File your LLC or corporation, get an EIN, register for withholding through SCDOR's MyDORWAY and for unemployment insurance with the Department of Employment and Workforce, and check your city or county business license rules.
You do this; we give you the checklistDecide your payer mix
Private pay, Community Choices or both. SCDHHS personal care needs an owner or administrator with at least three years of health care administrative experience and an RN or LPN supervisor, so plan your staffing around it. Use the path finder above.
Decided on your free consultationLease a qualifying office and choose a name
Regulation 60-122 requires an in state primary office in a commercially zoned or unzoned area, with a county or municipal zoning permit, or a letter for unzoned land. Your name cannot match or resemble another licensed provider's, and franchise locations must add their geographic area.
You do this; we specify what is requiredArrange insurance
Liability insurance or a surety bond of at least $100,000 per occurrence and $300,000 aggregate, indemnity coverage for client injuries and losses, and workers' compensation. Copies go in with the application.
You do this; we specify what is requiredWrite policies to Regulation 60-122
Policies must address every section of the regulation: random drug testing, training, incidents, service agreements, care services plans, client rights, records, infection control and disaster preparedness. The administrator reviews and signs them at least every two years.
We write this for youScreen the owner and apply to DPH
The people signing the application get a SLED check and a five panel drug test. Then file the notarized in-home care provider application with Secretary of State papers, ownership lists, insurance, the random drug testing policy, the owner results and the $1,000 fee. No license is issued until DPH finds substantial compliance.
We prepare the applicationBuild the caregiver pipeline
Before anyone works: a record check under S.C. Code 44-7-2910, a negative drug test, sex offender and nurse aide registry checks, a signed health self assessment and training on the required topics. Keep random testing going and repeat training every year.
We set up the system and trackerEnroll with SCDHHS for Community Choices
Once licensed, enroll as a Medicaid provider and sign the HCBS personal care contract. Hire your RN or LPN supervisor, run the competency evaluation for every aide, set up EVV and the Phoenix provider portal, and answer referrals within two working days.
We prepare and manage it
Caregiver screening, drug testing and training
Regulation 60-122 sets the floor for every licensed in-home care provider. It lists required training topics but no minimum number of hours. SCDHHS adds its own competency, training and screening rules for aides who serve Medicaid waiver participants.
- Criminal record checks: Before hire, a check under S.C. Code 44-7-2910 through SLED or a vendor using SLED or FBI records. With 12 months of verified South Carolina residency, a state check is enough. Otherwise run a state check before hire and start a federal check after, unless 12 months in one other state can be verified. Repeat it after a gap of a year or more.
- Disqualifying records: No adverse findings on the sex offender or nurse aide registry, no abuse, neglect or exploitation of a vulnerable adult, no violent crime, and no drug, forgery, larceny or embezzlement offense within 10 years.
- Drug tests: A negative five panel test (cannabis, cocaine, amphetamines, opiates, phencyclidine) taken within 30 days before the job offer, then random testing under your written policy. A positive result keeps a caregiver off duty unless a physician confirms a prescribed medication.
- Required training: Before client contact and at least yearly: basic first aid, care for the client's condition such as dementia, confidentiality, documentation, ethics and relationships, lifting and transfers, infection control, and preventing abuse, neglect and exploitation. Both trainer and trainee sign and date the record.
- Health status: A health self assessment disclosing communicable diseases, reviewed and signed by a nurse, the administrator or hiring staff before client contact. The 2026 rule replaced the old tuberculosis risk assessment appendix.
- Medicaid aides: A competency evaluation or training program by an RN or LPN before serving waiver participants, required even for CNAs, then 10 hours of training each calendar year, no more than six of them by self study.
- Medicaid screening: A SLED check covering at least 10 years before hire and every two years, plus nurse aide registry and OIG exclusion checks on the same schedule. A felony in the last 10 years bars work with SCDHHS participants.
- Driving: Caregivers who transport clients need a valid license, and a copy of the official driving record goes in the file. SCDHHS requires a new record every two years.
Six mistakes that slow South Carolina agencies down
We look for every one of these in the first week of an engagement.
Using a policy template written before May 2026
- What it costs
- Policies missing records, rights, infection control or disaster planning are cited at inspection and must be corrected in writing.
- How we prevent it
- We write your manual to Regulation 60-122 as amended May 22, 2026.
Screening the owner too early
- What it costs
- A drug test older than 30 days or a SLED check older than 90 days when DPH receives the packet means doing them again.
- How we prevent it
- We time the owner screening to the filing date.
Scheduling a caregiver before the drug test is back
- What it costs
- A person is not eligible to work as a caregiver until a negative test is on file, and DPH treats this as a Class I standard.
- How we prevent it
- A tracker that blocks scheduling until checks, tests and training are on file.
Running the agency from a home office
- What it costs
- DPH and SCDHHS both require an office in a commercially zoned or unzoned area, so a residential address stalls the license and the Medicaid contract.
- How we prevent it
- We check the space against both rules before you sign a lease.
Planning home health without a Certificate of Need
- What it costs
- DPH cannot license a new home health agency until a Certificate of Need is approved for its counties.
- How we prevent it
- We map the Certificate of Need process for your counties on your first call.
Letting caregivers drift into skilled care
- What it costs
- Care under this license is strictly nonmedical. Aides may give medication reminders but may not administer medication, and skilled care needs a home health license.
- How we prevent it
- Clear service definitions and task lists so caregivers stay within nonmedical care.
In a free 30 minute call we confirm your South Carolina path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
South Carolina launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- South Carolina path and a dated launch plan
- Policy and procedure manual written to Regulation 60-122 and the SCDHHS personal care scope of services
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Community Choices ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Community Choices requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for SCDHHS (Community Long Term Care)
- Survey and audit readiness
- South Carolina city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DPH rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what South Carolina requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to Regulation 60-122 and the SCDHHS personal care scope of services |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for SCDHHS (Community Long Term Care) prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The South Carolina home care startup checklist
Every South Carolina step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type and payer mix (private pay, Community Choices, or both)
- Form your LLC or corporation with the South Carolina Secretary of State
- Get an EIN and register for withholding (MyDORWAY) and unemployment insurance
- Lease an office in a commercially zoned or unzoned area and get the zoning permit or letter
- Check your city or county business license rules
- and 15 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for South Carolina
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The South Carolina cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Community Choices, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in South Carolina
| Item | Notes |
|---|---|
| State license | In-home care provider: $1,000 initial, $800 yearly renewal, $200 late fee, $50 per amendment (Regulation 60-122). Home health and hospice: $100 plus $50 per county served. |
| Certificate of Need (home health only) | $500 filing fee plus an application fee of 0.5% of total project cost, capped at $7,000 (Regulation 60-15) |
| Home health inspections | DPH may charge $250 plus $25 per county for initial and routine inspections and $125 plus $25 per county for follow up inspections |
| Entity formation and local license | Secretary of State filing fee plus any city or county business license |
| Screening and drug testing | SLED checks, federal checks where residency cannot be verified, and drug tests before hire and at random through a vendor |
| Insurance | Liability insurance or surety bond, indemnity coverage, workers' compensation, auto coverage for caregivers who drive |
| Training and nurse supervision | Caregiver training materials, and an RN or LPN supervisor for Medicaid clients |
| EVV and scheduling software | Scheduling and records software; SCDHHS EVV and Phoenix for waiver services |
| Accreditation (home health, hospice) | Accrediting organization application and survey fees |
| Operating reserve | Covers payroll, rent and insurance while licensure, the SCDHHS contract or Medicare enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in South Carolina
Weeks to months: office, insurance, policies and owner screening first, then DPH review. DPH does not publish a processing time.
Several months more after licensure: SCDHHS enrollment, the HCBS contract, a nurse supervisor and EVV setup.
Longest: a Certificate of Need for home health, DPH licensure, a certification survey and Medicare enrollment, which CMS paused nationwide on May 13, 2026.
South Carolina demand gathers around Greenville and Spartanburg, Columbia, Charleston, Myrtle Beach and the Grand Strand, Hilton Head and Bluffton, and Rock Hill and Fort Mill on the Charlotte border, while agencies in Aiken often hear from families across the river in the Augusta area. Rural counties in the Pee Dee and the Lowcountry mean long drives between clients, so reliable staffing and travel planning are your selling points there. Many families search for care for a parent from out of state, so a complete Google Business Profile and clear city pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in South Carolina?
Yes. Any business that provides nonmedical care in clients' homes for pay, directly or through referrals it profits from, needs an in-home care provider license from DPH under S.C. Code 44-70-30 and Regulation 60-122. House cleaning only, caregivers hired directly by a family, and licensed home health agencies and hospices are excluded.
How much does a South Carolina in-home care provider license cost?
Regulation 60-122 sets a $1,000 initial license fee and an $800 yearly renewal. A renewal filed after the expiration date adds a $200 late fee, and a provider that has not renewed within 30 days of expiration becomes unlicensed. Each amended license costs $50.
What changed in Regulation 60-122 in 2026?
DPH replaced the regulation in full effective May 22, 2026. It added owner screening deadlines, required policies for every section, client record and care plan rules, written client rights, infection control, disaster planning, 24 hour incident reporting and violation classes with a penalty schedule. A change in controlling interest now requires a new license.
Do South Carolina caregivers need drug tests?
Yes. S.C. Code 44-70-60 and 44-70-70 require a drug test before hire and random testing afterward. Regulation 60-122 requires a negative five panel test taken within 30 days before the job offer, and the agency's random testing policy must describe its method.
Do caregivers need certification in South Carolina?
No state certification is required for nonmedical caregivers. They must be at least 18, pass the screening and complete training on the regulation's topics before client contact and every year. Aides serving Medicaid waiver participants also need an RN or LPN competency evaluation and 10 training hours a year.
Does South Carolina require a Certificate of Need for home health or hospice?
Home health, yes: S.C. Code 44-69-75 requires a Certificate of Need from DPH before licensure, and approvals name the counties served. Hospices and in-home care providers do not need one under the current Certificate of Need law, which now covers only nursing homes and, until January 1, 2027, hospitals.
How do South Carolina agencies get Community Choices clients?
By holding the DPH in-home care license, enrolling with SCDHHS and signing its HCBS personal care contract. Community Long Term Care case managers authorize the hours and send referrals through Phoenix, and agencies must accept or decline within two working days. Personal care stays fee for service even for members now in Healthy Connections health plans.
Can a new home health agency or hospice enroll in Medicare right now?
CMS imposed six month nationwide moratoria on new Medicare enrollment of home health agencies and hospices, effective May 13, 2026. They were set to run to about November 13, 2026 and may be extended in six month steps or lifted early, so check their current status. State licensure is a separate step.
Is a franchise a better way to start a home care agency in South Carolina?
A franchise gives you a brand and playbook in exchange for fees and ongoing royalties, and each location still needs its own DPH license with its geographic area in its name. Starting independently with Lunaria costs one fixed price, and you own 100% of your agency with no franchise fees or royalties.
How much does South Carolina home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, Community Choices or home health and Medicare. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and we work in all 50 states and DC.
Sources checked for this guide (24)
- S.C. Code Title 44, Chapter 70, Licensure of In-Home Care Providers Act
- S.C. Code Title 44, Chapter 7 (Certificate of Need, 44-7-160; criminal record checks, 44-7-2910 to 44-7-2950)
- S.C. Code Title 44, Chapter 69, Licensure of Home Health Agencies (CON, 44-69-75)
- S.C. Code Title 44, Chapter 71, Quality Hospice Programs Act
- South Carolina State Register Vol. 50, Issue 5 (May 22, 2026), Document No. 5407, final Regulation 60-122
- South Carolina State Register Vol. 50, Issue 6 (June 26, 2026), errata to Document No. 5407
- S.C. Code of Regulations Chapter 60, Department of Public Health (Regulations 60-15, 60-77, 60-78, 60-122)
- DPH In-Home Care Providers page (Internet Archive copy, October 2026)
- DPH Licensure Application for In-Home Care Provider, form 1307-ENG-DPH (07/2025) (Internet Archive copy)
- DPH Certificate of Need updates, February 2025 (county specific home health approvals) (Internet Archive copy)
- SCDHHS Home and Community-Based Services Provider Manual, October 1, 2025 (Internet Archive copy)
- SCDHHS Scope of Services for Personal Care and related services, July 1, 2025 (Internet Archive copy)
- SCDHHS Scope of Services for Companion (Agency) Services, July 1, 2025 (Internet Archive copy)
- SCDHHS Carve-In Update for CLTC Case Managers, February 4, 2026 (Internet Archive copy)
- SCDHHS Carve-in Update for CLTC Case Managers, May 7, 2026 (Internet Archive copy)
- SCDOR Withholding (MyDORWAY registration)
- South Carolina Business One Stop
- Federal Register 2026-09717, moratorium on Medicare enrollment of home health agencies (govinfo)
- Federal Register 2026-09718, moratorium on Medicare enrollment of hospices (govinfo)
- CMS Provider Enrollment Moratoria page
- CMS Home Health and Hospice Nationwide Moratorium Q&As (last revised 7/09/26)
- CMS-855A Medicare enrollment application, institutional providers
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
This guide is general information and reflects South Carolina requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the South Carolina Department of Public Health, SCDHHS and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.