South Carolina S 486: A JOINT RESOLUTION TO APPROVE REGULATIONS OF THE COMMISSION ON HIGHER EDUCATION, RELATING TO FREE TUITION FOR RESIDENTS SIXTY YEARS OF AGE, DESIGNATED AS REGULATION DOCUMENT NUMBER 4728, PURSUANT TO THE PROVISIONS OF ARTICLE 1, CHAPTER 23, TITLE 1 OF THE 1976 CODE. - ratified title

Bill Text

2025-2026 Bill 486 Text of Previous Version (Mar. 25, 2025) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 486

Indicates Matter Stricken
Indicates New Matter

(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

A bill

TO AMEND THE SOUTH 
CAROLINA CODE OF LAWS BY ADDING SECTION 44-6-230 SO AS TO ESTABLISH MINIMUM 
COMPENSATION REQUIREMENTS FOR DIRECT CARE WORKERS PROVIDING PERSONAL CARE 
SERVICES THROUGH MEDICAID HOME AND COMMUNITY-BASED SERVICE PROVIDERS AND TO 
PROVIDE FOR PHASED IN UPWARD ADJUSTMENTS TO THE COMPENSATION PAID; TO REQUIRE 
CERTAIN REPORTING BY PROVIDER AGENCIES TO THE SOUTH CAROLINA DEPARTMENT OF 
HEALTH AND HUMAN SERVICES; AND TO AUTHORIZE THE DEPARTMENT TO TAKE CERTAIN 
ENFORCEMENT ACTIONS TO ADDRESS POSSIBLE INACCURACIES OR FRAUD.

Be it enacted by the 
General Assembly of the State of South Carolina:

SECTION 1. Article 1, Chapter 6, Title 44 of the S.C. Code is 
amended by adding:

 Section 44-6-230. (A) For purposes of this section:

 (1) 
"Compensation" means all payments and benefits provided to direct care workers, 
including:

 (a) 
salary, wages, overtime pay, and other remunerations;

 (b) 
health, dental, life, and disability insurance;

 (c) 
paid leave, retirement benefits, and tuition reimbursement; and

 (d) 
the employer share of payroll taxes.

 (2) 
"Department" means the South Carolina Department of Health and Human Services.

 (3) 
"Direct care worker" means a worker who spends the majority of working time 
providing personal care services to individual beneficiaries of Medicaid Home 
and Community-Based Services. The direct care worker may be:

 (a) 
employed by a Medicaid provider, state agency, or third party;

 (b) 
contracted with a Medicaid provider, state agency, or third party; or

 (c) 
delivering services under a consumer-directed services delivery model.

 (4) 
"HCBS" means Medicaid Home and Community-Based Services whether through the State 
plan, 1915(c) waiver, managed care, or demonstration programs.

 (5) 
"Personal care services" means personal care services provided through the home 
and community-based service waiver programs administered by the South Carolina 
Department of Health and Human Services including, but not limited to: intellectual 
disability/related disabilities, head and spinal cord injury, community supports, 
community choices, HIV/AIDS, medically complex children, and mechanical ventilator 
waivers authorized pursuant to Section 1915(c) of the Social Security Act and 
administered by the department.

 (6) 
"HCBS provider agency" means an entity that:

 (a) 
has entered into a Medicaid provider participation agreement with the South 
Carolina Department of Health and Human Services;

 (b) 
is eligible to be reimbursed for personal care services provided to eligible 
members; and

 (c) 
employs or engages direct care workers to provide personal care services for 
HCBS beneficiaries.

 (B)(1)(a) By January 1, 2026, an HCBS 
provider agency that receives Medicaid reimbursement for providing personal 
care services must use at least seventy percent of the Medicaid reimbursement 
as compensation to direct care workers for furnishing their services, which 
shall be deemed the "wage pass-through percentage."

 (b) 
By January 1, 2028, the wage pass-through percentage must be raised to seventy-five 
percent.

 (c) 
By January 1, 2030, the wage pass-through percentage must be raised to eighty 
percent, and the South Carolina Department of Health and Human Services must 
comply with 42 C.F.R. Section 441.302(k)(3).

 (2) 
Before calculating the minimum amount of Medicaid reimbursement that a personal 
care services provider agency is required to use to compensate direct care 
workers, the costs of providing training, travel, and personal protective 
equipment to direct care workers must be deducted from the total amount of Medicaid 
reimbursement that the personal care services provider agency receives.

 (3) 
All HCBS provider agencies shall provide notice to each direct care worker 
employed by that provider agency of the effective date of the wage pass-through 
and the specific wage and benefits to be paid to that employee as of that 
effective date.

 (C)(1) HCBS provider agencies must submit 
a cost report to the South Carolina Department of Health and Human Services to 
document the compliance of payment of the mandated compensation to its direct 
care workers from the reimbursement rates provided by the department.

 (2) 
The cost report must be submitted within one hundred eighty calendar days after 
the effective date of this section. The cost report must be submitted 
thereafter on an annual basis and must adhere to the following requirements:

 (a) 
the accuracy of the cost report must be attested under penalty of perjury by an 
authorized representative of the provider agency; and

 (b) 
the cost report must provide information o