Rate Updates for State Plan Services and Home and Community-based Services
Effective for dates of service on or after Dec. 1, 2026, the South Carolina Department of Health and Human Services is increasing reimbursement rates for state plan services and the home and community-based services (HCBS) provided through the state’s 1915(c) waiver programs that are listed in this bulletin.
Rate Increases for State Plan Services
Updated reimbursement rates for services rendered to Healthy Connections Medicaid members covered by the State Plan are listed in the table below.
| Service Description | Code | Current Rate | New Rate |
|---|---|---|---|
| Children’s personal care | T1019 | $25/hour | $26/hour |
| Enhanced nursing services | T1002 | $50/hour | $51/hour |
| Nursing services | S9123 | $47/hour | $48/hour |
Rate Increases for HCBS Waiver Services
Updated reimbursement rates for services rendered to Healthy Connections Medicaid members enrolled in the 1915(c) HCBS waivers are listed in the table below.
| Service Description | Affected Waivers* | Code | Modifier | Current Rate | New Rate |
|---|---|---|---|---|---|
| Residential Habilitation | ID/RD, HASCI | T2016 | U8 | $536.86 | $552.09 |
| Residential Habilitation | ID/RD, HASCI | T2016 | U7 | $536.86 | $552.09 |
| Residential Habilitation | ID/RD, HASCI | T2016 | U6 | $386.55 | $397.46 |
| Residential Habilitation | ID/RD, HASCI | T2016 | U5 | $329.61 | $338.88 |
| Residential Habilitation | ID/RD, HASCI | T2016 | U4 | $278.77 | $286.58 |
| Residential Habilitation | ID/RD, HASCI | T2016 | U3 | $108.78 | $111.69 |
| Residential Habilitation | ID/RD, HASCI | T2016 | U2 | $125.62 | $127.82 |
| Residential Habilitation | ID/RD, HASCI | T2016 | U1 | $91.76 | $93.28 |
| Residential Habilitation | ID/RD, HASCI | T2017 | $21.49/15 minutes | $22.06/15 minutes | |
| Personal care services | CC, CS, HIV/AIDS, ID/RD, VENT | T1019 | $25/hour | $26/hour | |
| Nursing services | HASCI, HIV/AIDS, ID/RD, VENT | S9123 | $47/hour | $48/hour |
*Waiver acronyms: Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS); Community Choices (CC); Community Supports (CS); Head and Spinal Cord Injury (HASCI); Intellectual Disability/Related Disabilities (ID/RD); Mechanical Ventilator Dependent (VENT)
The new state plan services and home and community-based services rates will be reflected in all related billing systems and the Home and Community-based Services Waiver Fee Schedule by Dec. 1, 2026. All claims billed for dates of service prior to Dec. 1, 2026, will be processed according to the rate effective for those dates of service.
Please direct any questions or concerns regarding this bulletin to MedicaidWaiver@scdhhs.gov.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.