Instead, a limited number of slots effectively caps enrollment in each waiver, he explained.

Up until last November, everyone who applied and met the eligibility requirements was enrolled in the waiver program. As of Dec. 31, some 22,800 people were enrolled in the Community Choices waiver, according to data provided by the state health department.

Advocates said that because other wait lists are so long, many in need of care often relied on the Community Choices waiver as a stopgap until a slot on another waiver opened.

But late last year, an amendment limited waiver access to those at risk of “serious and imminent harm.”

That change, advocates say, created the need for a wait list for the Community Choices waiver for the first time. Within months, that list has already grown into the thousands.

Last fiscal year, state and federal taxpayers reimbursed providers $467 million for services covered by the Community Choices waiver.

In South Carolina, the state picks up about 30 percent of the Medicaid tab — in this case, that’s roughly $140 million — while the federal government pays the remaining 70 percent, or about $607 million.

Community Choices waiver

The table shows how much the South Carolina Department of Health and Human Services has reimbursed providers each fiscal for health care services covered by the Community Choices Waiver, and the number of people were enrolled each year, according to figures the department provided.

Year

Reimbursement

Enrollment

2020

$188 million

18,435

2021

$219 million

20,570

2022

$243 million

21,098

2023

$434 million

21,212

2024

$412 million

22,140

2025

$467 million

22,854

That reimbursement total has more than doubled over the past five years, likely the result of rising health care costs. Meanwhile, available Community Choices waiver slots increased 24 percent over the same period since 2020, state data shows.

According to Gov. Henry McMaster’s budget proposal for the upcoming fiscal year, another $47.3 million is needed just to maintain “adequate access to care and delivering the care in the most appropriate and cost-effective setting possible through the home and community-based services (HCBS) waiver.”

The rising need for care in SC

From mid-2024 to mid-2025, the Palmetto State gained 79,958 more residents, a one-year increase of 1.5 percent that raised the population to 5,570,274, according to the latest Census Bureau estimates. Meanwhile, the nation’s population grew by just half a percent during the same period.