Self-Direction and FMS in South Carolina

All states: self-direction map

South Carolina self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in South Carolina offer self-direction?

South Carolina offers self-direction inside seven 1915(c) Medicaid waivers, not as a separate program. It is mainly self-directed attendant care, plus in-home supports and respite in some waivers. Two agencies are involved: the South Carolina Department of Health and Human Services (SCDHHS) runs four of the waivers, and the Office of Intellectual and Developmental Disabilities (OIDD, formerly SCDDSN) runs three. In every one, the participant or a representative hires and supervises the worker.

• Community Choices (CC) Waiver, Attendant Care (Self-Directed): serves frail older adults (65 and over) and adults 18 to 64 with physical disabilities who meet nursing facility level of care. SCDHHS runs it through Community Long Term Care. The participant has employer authority. Budget authority is not confirmed.
• HIV/AIDS Waiver, self-directed attendant care: serves people with HIV/AIDS. SCDHHS runs it. The participant has employer authority. Budget authority is not confirmed.
• Mechanical Ventilator Dependent (Vent) Waiver, self-directed attendant care: serves people who depend on mechanical ventilation. SCDHHS runs it. The participant has employer authority. Budget authority is not confirmed.
• Medically Complex Children (MCC) Waiver, Children's Attendant Care (Self-Directed): serves MCC waiver participants aged 1 to 21 with extraordinary care needs. SCDHHS runs it, and an MCC nurse case manager authorizes the service. The participant or a designated representative is the employer. Budget authority is not confirmed.
• Intellectual Disability and Related Disabilities (ID/RD) Waiver, Adult Attendant Care (UAP Option): serves adults 21 and over with intellectual disability or related disabilities who can self-direct or have a representative who can. OIDD runs it, with SCDHHS as the Medicaid agency. In this waiver Adult Attendant Care can only be delivered as a participant-directed service. The participant or a designated responsible party is the Employer of Record. Budget authority is not confirmed.
• Head and Spinal Cord Injury (HASCI) Waiver, Self-directed Attendant Care (UAP Option): serves people with head or spinal cord injuries. OIDD runs it. The participant or a designated responsible party is the Employer of Record. Budget authority is not confirmed.
• Community Supports (CS) Waiver, In-Home Supports (self-directed): serves people with intellectual disability or related disabilities. OIDD runs it. The participant or a designated responsible party is the Employer of Record. Budget authority is not confirmed.
• Statewide Respite Services, participant-directed (ID/RD, CS and HASCI waivers): respite for family caregivers of participants in the three OIDD waivers. OIDD runs it. The same fiscal agent pays the workers. We did not find a primary document that spells out the employer role for respite.

Employer authority means the participant recruits, hires, schedules and supervises the worker. Budget authority means the participant also manages a set amount of money. We could confirm employer authority in South Carolina, but we could not confirm budget authority either way, because the participant direction appendix of each approved waiver could not be read. Treat it as unknown, not as absent, and ask the waiver case manager or SCDHHS.

One more organization has a role. The University of South Carolina Center for Disability Resources (USC-CDR, also called UAP) handles attendant referrals, has a nurse certify that the participant can supervise the attendant, and tracks the attendant's yearly TB risk check, under the SCDHHS scope of services for self-directed attendant care.

Who handles financial management services (FMS) in South Carolina?

One company, Morning Sun Financial Services, handles financial management services for self-directed workers in both the SCDHHS-run and the OIDD-run waivers. South Carolina uses a fiscal employer agent model, which means Morning Sun runs payroll and taxes while the participant or a designated representative stays the legal employer. We did not find any program that offers a choice among FMS vendors.

A fiscal employer agent is the organization that handles the paperwork side of being an employer. In a guide hosted by SCDHHS, Morning Sun says it processes payroll, pays wages and payroll taxes and handles employment paperwork. State documents use several names for the same role: SCDHHS says fiscal intermediary or FMS, and OIDD says fiscal agent.

• Legal employer: the waiver participant or a designated representative is the employer and holds the federal Employer Identification Number (EIN). OIDD documents call this person the Employer of Record. In the MCC waiver, when a minor is the employer, a managing employer can be named to help.
• Representatives: a designated representative who acts as employer cannot be paid for that role, and the person who holds the EIN as employer cannot also be the paid attendant.
• SCDHHS-run waivers: an April 2026 SCDHHS vendor conference deck names Morning Sun as the FMS vendor that pays in-home providers of attendant care and adult companion services. The state's Phoenix system submits the claim, the Medicaid system pays Morning Sun as the provider, and Morning Sun pays the worker.
• OIDD-run waivers: Morning Sun replaced the Charles Lea Center as fiscal agent for all self-directed services in these waivers on August 1, 2024, according to a state transition memo. That covers ID/RD Adult Attendant Care, HASCI Self-directed Attendant Care, CS In-Home Supports and Statewide Respite.

For questions about enrolling as a self-directed attendant, the Attendant Care Program at the USC Center for Disability Resources is the place to start. For payroll questions, ask Morning Sun or the waiver case manager.

Who can be a paid caregiver under self-direction in South Carolina?

Relatives can be paid as self-directed attendants in South Carolina, but some family members are barred. In most waivers a parent, stepparent or foster parent of a minor cannot be paid, and neither can a person who is legally responsible for using their own assets for the participant's care. The Medically Complex Children waiver is the exception: a parent can be the paid attendant there.

• SCDHHS-run waivers (self-directed attendant care): an attendant may be related to the participant within the South Carolina Family Caregiver Policy. A parent, stepparent or foster parent of a minor participant cannot be a paid caregiver, and neither can a person legally responsible for using their own assets for the participant's care.
• ID/RD, CS and HASCI waivers: a December 2024 family caregiver memo says these people cannot be a paid worker for self-directed services: the participant's spouse (including married but separated), a parent, stepparent or foster parent of a minor, and anyone SCDHHS determines is legally responsible for using their own assets for the participant.
• Legal guardians of adults: under SCDHHS policy in place since July 1, 2023, a legal guardian can be paid for in-home waiver services to an adult only when the service is self-directed, the guardian is not also the employer of record, and SCDHHS has determined the guardian is not legally responsible. Guardians cannot be paid through an agency.
• Medically Complex Children waiver: a parent may be the paid attendant caregiver, including for a minor child, as long as the parent is not the employer who holds the EIN. A parent acting as managing employer for a minor employer may still be the caregiver.

Hours are limited too. In the SCDHHS-run waivers, if the assessed need is more than 40 hours a week, every effort must be made to use a separate attendant for the hours over 40, and an attendant who serves several participants should not go over 40 combined hours a week. In the ID/RD waiver, Adult Attendant Care is limited to 34 hours a week per participant (136 units, counted together with companion and personal care), and one participant-directed worker may provide at most 40 hours a week across all participants and programs, under the ID/RD waiver manual chapter on Adult Attendant Care. We did not find the hour limits for the HASCI and CS waivers.

Does EVV apply to self-directed workers in South Carolina?

It depends on which agency runs the waiver. Electronic visit verification (EVV) applies to self-directed attendants in the SCDHHS-run waivers, who clock in and out in the state's EVV system, AuthentiCare. The three OIDD-run waivers (ID/RD, CS and HASCI) do not require EVV today, and their self-directed workers use timesheets.

• SCDHHS-run waivers: self-directed attendants must attend EVV system and billing training at the SCDHHS area office before the first authorization, clock in and out at the participant's residence, and follow all EVV system requirements. In the Community Choices waiver the state uses EVV to document the service that the FMS pays, and the Phoenix system compares claims to authorizations before payment goes to the FMS.
• Whose system: AuthentiCare is the state's system, not the fiscal agent's. The SCDHHS deck does not describe an alternate EVV pathway.
• Medically Complex Children waiver: when a legally responsible individual is the attendant, only authorized services delivered by an approved attendant and confirmed by EVV are reimbursable.
• ID/RD, CS and HASCI waivers: the SCDHHS HCBS Provider Manual says these waivers do not require the EVV billing system. An EVV launch planned for December 2022 was postponed, and no new date has been published.

Two points could not be confirmed. We did not find a published EVV exemption for live-in caregivers. We also did not find a clear rule on whether a self-directed attendant in the SCDHHS-run waivers can be paid when an EVV record is missing. The Morning Sun guide says the employer confirms caregiver time when needed, but the exact rules were not found. Ask Morning Sun or SCDHHS.

What is changing next for self-direction in South Carolina?

SCDHHS has started a procurement for its FMS contract because the current contract is expiring. The state lists the future vendor as to be determined, and no award or date has been published. Morning Sun remains the fiscal agent today.

The statement comes from the April 2026 SCDHHS vendor conference deck. We did not find a solicitation number, and we did not find a statement on whether the procurement also covers the fiscal agent arrangement for the OIDD-run waivers. This is a procurement in progress, not an announced change of vendor.

Two other items are worth watching, and neither is final:

• EVV system: the same deck lists the future EVV vendor as to be determined and says the new EVV will expand coverage to all required services. No go-live date is given. We did not find a statement on whether self-directed workers will change tools, or whether self-directed services in the OIDD-run waivers will be brought under EVV.
• Waiver renewals: draft renewals of the MCC and ID/RD waivers are posted on the SCDHHS waivers page with a proposed effective date of January 1, 2027. A proposed date can move, and the drafts still need approval. We did not review what the drafts say about participant direction, so check them directly if you serve those waivers.

South Carolina self-direction sources

• SCDHHS: Vendor conference deck (April 29, 2026)
• SCDHHS: Attendant Care (Self-Directed) scope of services (July 1, 2025)
• Morning Sun Financial Services: Children's Attendant Care guide (hosted by SCDHHS)
• SCDDSN (now OIDD): Family Caregiver Guidance memo (December 3, 2024)
• SCDDSN (now OIDD): Fiscal Agent Transition memo (July 22, 2024)
• OIDD: ID/RD Waiver manual, Chapter 10, Adult Attendant Care
• SCDHHS: HCBS Provider Manual
• SCDHHS: Community Choices Waiver renewal (2026)
• SCDHHS: Waivers

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• South Carolina EVV requirements

Other states with one statewide FMS vendor

Arkansas, Connecticut, District of Columbia, Indiana, Iowa, New Mexico, North Dakota, Oklahoma, Tennessee, Vermont, Washington, West Virginia, Wyoming. See every state on the self-direction map.

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.