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Public Notice of Proposed Action for Amending the Medically Complex Children Waiver

The South Carolina Department of Health and Human Services (SCDHHS) gives notice that it intends to submit a 1915 (c) home and community-based waiver amendment to the Centers for Medicare and Medicaid Services (CMS) to add attendant care as a self-directed service to the Medically Complex Children (MCC) (SC.0675) waiver program. The addition of the service to the waiver would allow qualifying family members, including parents of minor children, of participants enrolled in the MCC waiver to be the attendant/paid caregiver of the service. Attendants will be subject to the guidelines outlined in the waiver policy. The target date for submission of this waiver action to CMS is on or after Oct. 1, 2024. Implementation of this new service is subject to approval by CMS.

The MCC waiver program is administered and operated by SCDHHS. Current waiver participants will not be adversely impacted.

Attendant Care for MCC Waiver Program Participants 

Attendant care is defined as extensive hands-on assistance for at least two of the seven key activities of daily living (ADLs). The seven ADLs are bathing, dressing, eating, toileting, hygiene, mobility and transferring. The attendant care service is intended for waiver participants who are unable to perform these tasks independently due to a medical condition identified and documented on a validated assessment. The service must be directly related to the physical and functional condition of the waiver participant. The service, when medically necessary, is provided in the waiver participant's home.

ADL care for children under the age of three-years-old is considered age appropriate and the responsibility of the parent or responsible representative. MCC attendant care is intended to provide "extraordinary" direct care services to children aged birth through 20-years-old who need hands-on assistance with ADLs that does not fit the current age-appropriate definition. An evaluation by a licensed professional determines when a child who has not reached the ADL developmental milestones for his or her chronological age is considered to require assistance with ADLs.

Extraordinary care exceeds the range of activities that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to assure the health and welfare of the participant and avoid institutionalization.


The intent to amend the MCC waiver with the proposed service array addition was discussed on April 24, 2024, during the monthly Indian Health Services conference call. The proposed change was also presented to the SCDHHS' Medical Care Advisory Committee (MCAC) meeting May 14, 2024, at 10 a.m., 1801 Main Street, Columbia, South Carolina 29201.

Information regarding the proposed waiver amendment including requirements, service limits and components of the service will be shared during the following webinars:


Medically Complex Children Waiver Amendment - Webinar #1

Friday, June 14, 2024, 9:00 a.m.

Medically Complex Children Waiver Amendment - Webinar #2

Tuesday, June 18, 2024, 7:30 p.m.

Copies of this notice and the Medically Complex Children waiver application are available for review at the following locations:

  1. Electronic (under "Communications" and "Waivers" sections)
  2. Family Connection of South Carolina website:
  3. Hard Copies:
    1. SCDHHS Central Office Lobby: 1801 Main Street, Columbia, SC, 29201
    2. SCDHHS community long term care (CLTC) Regional Offices:

Greenville Florence

620 North Main Street, Suite 300 2701 Alex Lee Boulevard, Suite 200

Greenville, South Carolina 29601 Florence, South Carolina 29506

Spartanburg Conway

101 North Pine Street, Suite 405 1201 Creel Street

Spartanburg, South Carolina 29302 Conway, South Carolina 29527

Greenwood Charleston

617 South Main Street 4130 Faber Place Drive, Suite 303

Greenwood, South Carolina 29646 North Charleston, South Carolina 29405

Rock Hill Anderson

454 South Anderson Road, Suite 11 3215 Martin Luther King Jr. Blvd, Suite H

Rock Hill, South Carolina 29730 Anderson, South Carolina 29625

Columbia Ridgeland

300 Arbor Lake Drive, Suite 900 10175 South Jacob Smart Boulevard

Columbia, South Carolina 29223 Ridgeland, South Carolina 29936

Orangeburg Aiken

191 Regional Parkway, Building A 2361 S. Centennial Ave, Building 2, Ste. B

Orangeburg, South Carolina 29118 Aiken, South Carolina 29803


30 Wesmark Court

Sumter, South Carolina 29150

Comments and Responses:

If you have a question or comment regarding the proposed amendment, please send it to the following mail or email address prior to June 24, 2024.



SC Department of Health and Human Services

Attention: Janice Bailiff

Office of Waivers and Facility Services

Post Office Box 8206

Columbia, SC 29202-8206

Any written comments submitted may be reviewed by the public at SCDHHS, Bureau of Policy, 1801 Main Street, Columbia, SC 29201 from 8:30 a.m. to 5 p.m. Monday thru Friday.

Please direct questions regarding this Medicaid bulletin to

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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