How to start a home health agency in South Carolina

South Carolina requires a Home health agency license from South Carolina Department of Public Health to operate a home health agency. Fee: License fee $100 plus $50 per county served, due annually (new and renewal). Governmental home health agencies are exempt.

License required

Yes

License

Home health agency license

Issuing agency

South Carolina Department of Public Health

Fee

License fee $100 plus $50 per county served, due annually (new and renewal). Governmental home health agencies are exempt.

Renewal

Every year · $100 + $50 per county served each year; routine inspection fee $250 biennial + $25 per county; follow-up inspection $125 + $25 per county.

Survey and inspection

By statute each licensed agency must be inspected at least once a year (§ 44-69-70); DPH's fee table bills routine inspections biennially.

Certificate of need

Required

Medicare certification

Separately, CMS put a 6-month nationwide moratorium on new Medicare enrollment of home health agencies (including new branches and practice locations) into effect on May 13, 2026; it can be extended in 6-month increments, and CMS left any Medicaid/CHIP moratorium to each state.

Regulation

S.C. Code Title 44, ch. 69; S.C. Code Regs. 61-77

1. Obtain a Certificate of Need before licensure (S.C. Code § 44-69-75)
2. Apply to DPH for the license and pay the county-based fee
3. Initial inspection

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 →

For this business

Required (licensing source)

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 →

Model

state-sponsored

State vendor

Care Call (state EVV system; vendor not named)

Services in scope

• personal care
• attendant care
• in-home nursing
• HCBS waiver in-home services

Program

https://www.scdhhs.gov/communications/updates-hcbs-waiver-and-state-plan-home-care-services

South Carolina EVV requirements →

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.

Home health agencies — active organization NPIs (NPPES)

1,204 (as of Sep 13, 2026)

Medicare-certified home health agencies (CMS Care Compare)

68 (as of May 27, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

958,052 (as of Jun 1, 2026)