How to start an assisted living facility in South Carolina

South Carolina requires a Community residential care facility license (room, board and personal care for 2 or more unrelated adults for more than 24 hours) from South Carolina Department of Public Health, Healthcare Quality — Healthcare Facility Licensing to operate an assisted living facility. Fee: Annual license fee of $10 per licensed bed or $75, whichever is greater; non-refundable (partial refund possible if an application is denied or withdrawn).

License required

Yes

License

Community residential care facility license (room, board and personal care for 2 or more unrelated adults for more than 24 hours)

Issuing agency

South Carolina Department of Public Health, Healthcare Quality — Healthcare Facility Licensing

Fee

Annual license fee of $10 per licensed bed or $75, whichever is greater; non-refundable (partial refund possible if an application is denied or withdrawn).

Renewal

Every year · Renewal is annual. Renewing 30 or more days after expiration may add a late fee of $75 or 25% of the license fee, whichever is greater.

Medicaid waiver coverage

HHS's 2015 compendium reported that South Carolina covers personal care in CRCFs under the Medicaid state plan for residents who get the Optional State Supplement.

Regulation

S.C. Regulation 60-84 (Standards for Community Residential Care Facilities)

Staffing

• Administrator must hold a community residential care facility administrator license from the S.C. Board of Long Term Health Care Administrators

Program

Healthy Connections Medicaid (South Carolina Department of Health and Human Services, SCDHHS)

Enrollment portal

SCDHHS online Provider Enrollment web application

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. SCDHHS's enrollment page does not list a separate state fee.

Fingerprinting

High-risk providers must submit fingerprints and/or have a physical site visit. If fingerprinting runs past the 30-day revalidation deadline, sending a copy of the fingerprint appointment confirmation with the other documents prevents termination. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

SCDHHS screening includes site visits where applicable, and high-risk providers may get a physical site visit at revalidation. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

Since June 1, 2026, high-risk providers (federal or state-designated) revalidate every year and all others every three years, more often than the federal minimum. Under a CMS-approved two-year strategy, everyone first enrolled before June 1, 2025 will be revalidated. A rapid cohort covers opioid treatment programs, DME, home health, hospice, nursing facilities, private RBHS, independent licensed behavioral health practitioners, BCBAs/BCaBAs and HCBS providers. Wait for a notification letter with a revalidation number, then submit online within 30 days. Missing the deadline counts as voluntary termination.

Full South Carolina Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need (State Certification of Need and Health Facility Licensure Act)

Agency

South Carolina Department of Public Health, Certificate of Need Program

Services covered

• nursing homes: new facilities, bed additions or licensure reclassification, and capital expenditures above the regulatory threshold
• hospitals: construction or establishment of a new hospital, and bed additions or reclassification (only until January 1, 2027)

South Carolina certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

258 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

958,052 (as of Jun 1, 2026)

All South Carolina Home care Medicaid rates, ranked →

• SC Community Choices Waiver (1915(c))
• SC Community Supports (CS) Waiver (1915(c))
• SC Head and Spinal Cord Injury (HASCI) Waiver (1915(c))
• SC HIV/AIDS Waiver (1915(c))
• SC Intellectual Disability and Related Disabilities (ID/RD) Waiver (1915(c))
• SC Mechanical Ventilator Dependent Waiver (1915(c))
• SC Medically Complex Children Waiver (1915(c))

South Carolina waivers and waiting lists →